Orophary ryngeal Dysphaga And Frail ility: Can It It Be Rela - - PowerPoint PPT Presentation

Orophary ryngeal Dysphagıa And Frail ility: Can It It Be Rela lated?

Gülistan BAHAT, Özlem YILMAZ, Şükran DURMAZOĞLU, Cihan KILIÇ, Başar AYKENT, Mehmet Akif KARAN

CONFLICT OF INTEREST DISCLOSURE

I have no potential conflict of interest to report

Objective

• Community dwelling elderly people → Oropharyngeal dysphagia (OD)

frequency ↑

• Etiology Multiple factors
• Usually an ignored clinical problem
• OD  A geriatric syndrome
• ODAssociated with adverse outcomes

↑Mortality

Malnutrition

Infections

(Related aspiration)

Functionality ↓

1.Wirth, Rainer, et al. Clin Interv Aging 2016, 11: 189. 2.Sura L, et al. Clin Interv Aging. 2012;7:287-98.

Objective

• Fraility  Major interest in geriatrics
• Frail older adultMajor issue of geriatrics

Treatment strategies Survivor expectation

Objective

• Fraility ↑↑  In elderly
• OD ↑↑  In elderly
• ↑ more in nursing homes
• ↑ in the presence of neurodegenerative disease

Is there a relationship between them ??

Objective

• Fragility-OD relationship in literature 1,2,3
• A few
• Limited number of cases
• Indirectly link available
• Independent relationship?
• 1. Rofes L, et al. Neurogastroenterol Motil 2010; 22: 851-8.e230
• 2. Wakabayashi, H. Clinical calcium, 2014, 24.10: 1509-1517
• 3. Hathaway, B, et al. Annals of Otology, Rhin & Laryn., 2014, 123.9: 629-635.

Studies available

Material and and method:

• Prospective, Cross-sectional and Consecutively
• Elderly patients evaluated from our outpatient clinic (≥60 y)
• July 2015-September 2016 (15 months)
• Age, sex, total illness and total number of medicines, presence of

neurodegenerative disease, Katz GYA

• Dysphagia scanning with EAT-10 questionnaire (2 thresholds for

EAT-10 3 and ≥ 15) *

*Cheney, et al. Annals of Otology, Rhin. & Laryn., 2015, 124.5: 351-354.

Frailty

FRAIL scale

Measurement

BMI Hand grip strenght Calf circumference Usual walking speed(UWS)

Malnutrition

MNA-SF

Material and and method: : Statistics

• Parameters with OD: univariat analysis (chi-square, ...)
• OD independent factors: Regression (Linear and Logistic regression

analysis)

Results

1138 elderly people EAT-10 questionnaire was applied

• Average age74.1± 7.3 (60-98)
• 348 (30.6 %) male and 790 (69.4%) female

Results

• EAT -10 questionnaire 1138
• ≥ 3 threshold dysphagia
• 63.7 %, (n=413)
• ≥ 15 threshold dysphagia
• 6.7 %, (n=76)

Results

• FRAIL scale was applied to 851 patients.

Fraility Female Male Total Normal 122 ( 21.1 %) 103 (37.9%) 225 (28.4 %) Prefrail 269 ( 46.5 %) 116 (42.6%) 385 (45.2 %) Frail 188 (32.5%) 53 (19.5%) 241 (28.2%) Total 579 272 851

Fraility is around 28% in total (n=851) Female 32 %(n=579) Male 19 % (n=272)

Results

• FRAIL data are available in 851 patients  EAT-10 ≥ 3: 62.0 % (n=527)

EAT-10 ≥15: 4.9 % (n=42) Frail+ EAT-10 ≥ 3  73.1 % (n=176) Frail + EAT-10 ≥ 15  13.6 % (n=33)

Variables EAT ≥ 3 EAT ≥ 15 n p n p Age 1138 0,05 1138 0,02 Total illness number 1130 0,003 1130 0,001 Total drug number 1125 <0,001 1125 < 0,001 Hand grip strength 561 <0,001 561 0,002 UWS 469 0,03 469 0,01 Fraility 851 <0,001 851 <0,001 MNA SF 563 <0,001 563 0,001 Female 790 <0,001 790 0,001 Neurodegenerative disease 184 0,002 184 0,003 BMI 563 0,009 563 0,7 Katz ADL 565 <0,001 565 0,001

Significant findings in univariate analyzes

Variables EAT ≥ 3 EAT ≥ 15 n p n p Age 1138 0,05 1138 0,02 Total illness number 1130 0,003 1130 0,001 Total drug number 1125 <0,001 1125 < 0,001 Hand grip strength 561 <0,001 561 0,002 UWS 469 0,03 469 0,01 Fraility 851 <0,001 851 <0,001 MNA SF 563 <0,001 563 0,001 Female 790 <0,001 790 0,001 Neurodegenerative disease 184 0,002 184 0,003 BMI 563 0,009 563 0,7 Katz ADL 565 <0,001 565 0,001

Significant findings in univariate analyzes

In In regression analysis EAT-10 ≥ 3

Variables Sig. Exp(B) Age 0,649 0,992 Total illness number 0,135 0,883 Total drug number 0,016 1,142 Hand grip strength 0,219 0,977 UWS 0,818 0,884 Fraility 0,012 1,282 MNA SF 0,796 0,984 Female 0,897 0,961 Neurodegenerative disease 0,627 1,174

In In regression analysis EAT-10 ≥ 15 15

Variables Sig. Exp(B) Age 0,449 0,967 Total illness number 0,717 0,935 Total drug number 0,081 1,220 Hand grip strength 0,336 0,941 UWS 0,769 0,658 Fraility 0,042 1,673 MNA SF 0,987 1,002 Female 0,699 1,456 Neurodegenerative disease 0,276 0,438

In In regression analy lysis According to EAT-10 total score

Model

Unstandardized Coefficients Standardized Coefficients

Sig. B Beta Age

• 0,054
• 0,086

0,124 Total illness number

• 0,184
• 0,085

0,252 Total drug number 0,268 0,195 0,010 Hand grip strength

• 0,024
• 0,046

0,519 UWS

• 0,194
• 0,012

0,856 Fraility 0,738 0,203 <0,001 MNA SF

• 0,187
• 0,078

0,113 Female

• 0,351
• 0,036

0,574 Neurodegenerative disease 0,036 0,003 0,957

Discussion

We have found 16 results '' fraility

• ropharyngeal dysphagia '' in

Pubmed

6 study were unconcerned 4 review

Only 6 original paper

2015 15 studies were reviewed 9947 elderly people High quality 6 studies  fraility(r = 0.34) However, there is insufficient evidence to describe independent risk factors at this time

Are the results sim imil ilar to our r study? : : Why hy?

• Studies on the components of the fraility
• Similar to our study because it reflects indirectly fraility

but

• Independent fraility relationship could not be shown in the studies.

Our study is strong because .. ...

• We have too much patients
• We included all the cases (no bias)
• We examined a large number of factors (including

neurodegenerative diseases)

• We examined the patients we met each day (important for our

practice) Missing aspects

• It is not cross-sectional
• Cause-effect relationship can not be established.

Why/how OD OD-Fraility are rela lated?

Fraility Oropharyngeal Dysphagıa

Conclusions

Hand grip strength +FRAIL are evaluated together  Hand grip strength losed its significance UWS+MNA+FRAIL are evaluated together UWS+MNA losed their significance Fraility

Hand grip strength Functionality Malnutrition Usual walk speed

Conclusions

Hand grip strength, UWS, MNA,EGYA +FRAIL are evaluated together Only Fraility is significance

• In the other studies this indirect relationship was shown

(IADL and muscle strength are significant an indirect indicator of fraility)

Thank you for your attention