住院老年人的吞咽困难：多中心NUTRIFAG队列中的患病率、发病率及预测因素：实证定量研究。

文献信息

中文摘要

目的： 确定65岁及以上住院成人中疑似和临床诊断吞咽困难的患病率、发病率、相关因素及进展。
设计： 在九家公立医院开展的多中心前瞻性观察性队列研究。
方法： 连续招募住院时间≥48小时的老年人（≥65岁）。在入院和出院时收集社会人口学、功能、认知、营养和临床数据。使用进食评估工具-10筛查吞咽困难，并通过容积-黏度吞咽试验进行临床诊断。描述性、双变量和多变量分析包括逻辑回归和Cox回归模型。该研究获得参与伦理委员会的批准。
结果： 研究纳入3139名患者，其中2817名有出院数据。疑似吞咽困难在入院时影响16.01%，出院时为12.96%；在临床评估的患者中，诊断性吞咽困难分别影响69.66%和76.57%。住院期间出现新发病例（疑似2.50%；诊断8.33%）。小腿围较低、功能依赖和轻度认知障碍与疑似和确诊吞咽困难均独立相关。吞咽困难的存在与住院时间延长相关。
结论： 吞咽困难在老年人中常见，且在住院期间常持续存在或加重。其与功能、认知和营养脆弱性的关联强化了系统筛查和随访的必要性。
对专业和/或患者护理的意义： 护士可以将吞咽困难筛查和再评估整合到老年护理中，优先考虑存在功能、认知或营养脆弱性的老年住院患者。
影响： 吞咽困难在住院期间持续存在或出现；研究结果支持护士主导的筛查和再评估在住院老年人中的潜在价值。
报告方法： 按照加强观察性流行病学研究报告声明进行队列研究报告。
患者或公众贡献： 一名患者代表参与了研究设计和变量选择。NUTRIFAG公众咨询小组支持对研究结果和临床相关性的解释。

英文摘要

AIMS: To determine the prevalence, incidence, associated factors and progression of suspected and clinically diagnosed dysphagia in hospitalised adults aged 65 years and over.
DESIGN: A multicentre prospective observational cohort study in nine public hospitals.
METHODS: Older adults (≥ 65 years) staying ≥ 48 h were consecutively recruited. Sociodemographic, functional, cognitive, nutritional and clinical data were collected at admission and discharge. Dysphagia was screened using the Eating Assessment Tool-10 and clinically diagnosed with the Volume-Viscosity Swallow Test. Descriptive, bivariate and multivariate analyses included logistic and Cox regression models. The study was approved by participating ethics committees.
RESULTS: The study included 3139 patients with discharge data available for 2817. Suspected dysphagia affected 16.01% at admission and 12.96% at discharge; among clinically assessed patients, diagnosed dysphagia affected 69.66% and 76.57%, respectively. New cases appeared during hospitalisation (2.50% suspected; 8.33% diagnosed). Lower calf circumference, functional dependence and mild cognitive impairment were independently associated with both suspected and confirmed dysphagia. The presence of dysphagia was linked to longer hospital stays.
CONCLUSION: Dysphagia was common and often persisted or worsened during hospitalisation in older adults. Its association with functional, cognitive and nutritional vulnerability reinforces the need for systematic screening and follow-up.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses can integrate dysphagia screening and reassessment into geriatric care, prioritising older inpatients with functional, cognitive or nutritional vulnerability.
IMPACT: Dysphagia persisted or emerged during hospitalisation; findings support the potential value of nurse-led screening and reassessment in hospitalised older adults.
REPORTING METHOD: Reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement for cohort studies.
PATIENT OR PUBLIC CONTRIBUTION: A patient representative contributed to study design and variable selection. The NUTRIFAG Public Advisory Group supported the interpretation of findings and clinical relevance.