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Original Article

The Risk of Dysphagia and Dysphagia-specific Quality of Life among Community Dwelling Older Adults in Senior Center

Min-Su Kim1, Yeon-Hwan Park2
Korean Journal of Adult Nursing 2014;26(4):393-402.
Published online: August 31, 2014

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Corresponding author: Park, Yeon-Hwan College of Nursing, Seoul National University, 28 Yeongeon-dong, Jongro-gu, Seoul 110-744, Korea. Tel: +82-2-740-8846, Fax: +82-2-745-8017, E-mail: hanipyh@snu.ac.kr
• Received: February 25, 2014   • Accepted: July 6, 2014

Copyright © 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The aim of this study was to describe the risk of dysphagia among older adults in senior centers and to find therelationshipsbetween the risk of dysphagia and dysphagia-specific qualityof life.
  • Methods
    Theparti-cipantswere 260 community-dwellingolder adults, aged 65 years in two senior centers. Data werecollected by self-report questionnaires or face to face interviews. The instruments were the modified dysphagia risk assessment scale for elderly and dysphagia-specific quality of life questionnaire. The data were analyzed using t-test, x2-test, logistic regression, andpearson's correlation.
  • Results
    162olderadults (62.3%) wereclassifiedashaving the risk of dysphagia. Severe dry mouth (OR=15.677, CI=2.986~82.297), neurologic disease (OR=10.125, CI= 1.092~93.899), gastritis (OR=5.731,CI=1.482~22.173), denture discomfort (OR=2.969, CI=1.016~8.677), teeth discomfort (OR=2.61, CI=1.311~5.196) were the significant factors predicting the risk of dysphagia. There is a significant correlationbetweenthe riskof dysphagia and dysphagia-specificquality of life.
  • Conclusion
    Dysphagia could be a major health problem among community dwelling older adults. It can affect the dysphagia-specific quality of life. Older adults having severe dry mouth, neurologic disease, or gastritis should receive dysphagia risk assessment and proper management on a regular basis. An effective nursing intervention needs to be developed for the older adults with risk factors of dysphagia.
  • Key Words: Aged; Dysphagia; Quality of life
Table 1.
Differences to Dysphagia Risk by Process of Swallowing
Variables Non-risk (n=98) Risk (n=162) t p
M±SD(Range) M±SD(Range)
Pharyngeal dysfunction 0.19±0.59 (0~3) 2.37±2.98 (0~17) -9.006 .001 ＜
Deglutition dysfunction 0.49±0.93 (0~5) 2.85±2.48 (0~13) -10.911 .001 ＜
Oral dysfunction 0.90±1.34 (0~5) 8.05±4.86 (0~20) -17.646 .001 ＜
Esophageal dysfunction 0.27±0.71 (0~4) 2.08±2.38 (0~9) -9.051 .001 ＜
Table 2.
Differences to Dysphagia Risk by Socio-demographic Characteristics of the Subjects
Characteristics Categories Non-risk(n=98) Risk (n=162) x2 or t p
n (%) or M±SD (Range) n (%) or M±SD (Range)
Age (year)   75.21±6.10 (65~90) 76.12±6.31 (65~93) -1.142 .255
Gender Female 62 (63.3) 113 (69.8) 1.168 .172
Male 36 (36.7) 49 (30.2)
Level of education Elementary school ≤ 38 (38.8) 87 (53.7) 7.928 .160
Middle-High school 57 (48.0) 63 (38.9)
College ≥ 13 (13.2) 12 (7.4)
Living arrangement Alone 33 (33.7) 86 (53.1) 14.913 .005
Couple 26 (26.5) 44 (27.2)
2 generations ≥ 39 (39.8) 32 (19.7)
Number of family   2.42±1.58 (1~8) 1.77±1.12 (1~6) 3.582 .001 ＜
Monthly expense (10,000 won)   56.43±58.76 (0~300) 42.70±36.80 (0~200) 2.080 .390
Table 3.
Differences to Dysphagia Risk by General Health and Oral Health Related Characteristics
Variables Characteristics Categories Non-risk (n=98) Risk (n=162) x2 or t p
n (%) or M±SD (Range) n (%) or M±SD (Range)
Health related characteristics Number of chronic disease   1.40±1.13 1.78±1.25 -2.524 .012
Type of chronic disease Neurology disease 1 (1.0) 14 (8.6) 6.524 .007
Heart disease 53 (54.1) 92 (56.8) 0.182 .383
Diabetes mellitus 18 (18.4) 40 (24.7) 1.409 .151
Gastritis 6 (6.1) 25 (15.4) 5.039 .018
Depression or insomnia 3 (3.1) 15 (9.3) 3.640 .044
Number of medication (a day)   2.27±2.23 3.08±3.42 -2.326 .021
Body weight (kg) 58.82±9.53 56.26±9.09 2.141 .033
  (40~90) (30~83)    
Perceived dysphagia Yes 5 (5.1) 33 (20.4) 11.407 .001 ＜
Attitude toward dysphagia No 93 (94.9) 129 (79.6) 0.448 .295
Yes 57 (58.2) 101 (62.3)    
Oral health related characteristics Number of teeth No 41 (41.8) 61 (37.7)    
Number of tooth brushing (a day)   2.27±1.20 2.04±1.21 1.484 .001 ＜
Teeth discomfort Yes 35 (35.7) 86 (53.1) 7.407 .005
No 63 (64.3) 76 (46.9)    
Denture user Yes 37 (37.8) 84 (51.9) 4.877 .019
No 61 (62.2) 78 (48.1)    
Duration of denture usage (hour/a day)   6.41±9.31 9.51±10.04 -2.530 .012
  (0~24) (0~24)    
Denture discomfort Yes 11 (29.7) 46 (54.8) 11.303 .004
No 26 (70.3) 38 (45.2)    
Dry mouth during the day None 66 (67.3) 45 (27.8) 44.308 .001 ＜
A little 28 (28.6) 73 (45.1)    
Severe 2 (2.0) 25 (15.4)    
Very severe 2 (2.0) 19 (11.7)    
Table 4.
Logistic Regression Analysis of Factors which Influence Dysphagia Risk
Classification Factor   OR 95% CI p
Risk Dry mouth during the day Severe 15.677 2.986~82.297 .001
Very severe 9.047 1.680~48.726 .010
A little 4.147 2.075~8.286 .001 ＜
None 1    
Neurology disease   10.125 1.092~93.899 .042
Gastritis   5.731 1.482~22.173 .011
Denture discomfort   2.969 1.016~8.677 .047
Teeth discomfort   2.610 1.311~5.196 .006
Protective Number of teeth   0.947 0.903~0.993 .024
    Predicted Percentage correct (%)
Yes No Total
Observed (dysphagia risk) - Yes 61 37 98  
No 30 132 162 74.2
Total 91 169 260  
2LL=268.009, x2=76.511 (df=6, p .001), Nagelkerke R2=0.347.
Table 5.
Correlation Dysphagia risk with Dysphagia Specific Quality of Life for the Subjects
Variables Dysphagia risk
r p
Global dysphagia specific quality of life -0.560 ＜.001
Emotional dysphagia specific quality of life -0.582 ＜.001
Functional dysphagia specific quality of life -0.575 ＜.001
Physical dysphagia specific quality of life -0.686 ＜.001
Total sum -0.687 ＜.001
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    The Risk of Dysphagia and Dysphagia-specific Quality of Life among Community Dwelling Older Adults in Senior Center
    Korean J Adult Nurs. 2014;26(4):393-402.   Published online August 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.4.393
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    The Risk of Dysphagia and Dysphagia-specific Quality of Life among Community Dwelling Older Adults in Senior Center
    Korean J Adult Nurs. 2014;26(4):393-402.   Published online August 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.4.393
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    The Risk of Dysphagia and Dysphagia-specific Quality of Life among Community Dwelling Older Adults in Senior Center
    The Risk of Dysphagia and Dysphagia-specific Quality of Life among Community Dwelling Older Adults in Senior Center

    Differences to Dysphagia Risk by Process of Swallowing

    Variables Non-risk (n=98) Risk (n=162) t p
    M±SD(Range) M±SD(Range)
    Pharyngeal dysfunction 0.19±0.59 (0~3) 2.37±2.98 (0~17) -9.006 .001 ＜
    Deglutition dysfunction 0.49±0.93 (0~5) 2.85±2.48 (0~13) -10.911 .001 ＜
    Oral dysfunction 0.90±1.34 (0~5) 8.05±4.86 (0~20) -17.646 .001 ＜
    Esophageal dysfunction 0.27±0.71 (0~4) 2.08±2.38 (0~9) -9.051 .001 ＜

    Differences to Dysphagia Risk by Socio-demographic Characteristics of the Subjects

    Characteristics Categories Non-risk(n=98) Risk (n=162) x2 or t p
    n (%) or M±SD (Range) n (%) or M±SD (Range)
    Age (year)   75.21±6.10 (65~90) 76.12±6.31 (65~93) -1.142 .255
    Gender Female 62 (63.3) 113 (69.8) 1.168 .172
    Male 36 (36.7) 49 (30.2)
    Level of education Elementary school ≤ 38 (38.8) 87 (53.7) 7.928 .160
    Middle-High school 57 (48.0) 63 (38.9)
    College ≥ 13 (13.2) 12 (7.4)
    Living arrangement Alone 33 (33.7) 86 (53.1) 14.913 .005
    Couple 26 (26.5) 44 (27.2)
    2 generations ≥ 39 (39.8) 32 (19.7)
    Number of family   2.42±1.58 (1~8) 1.77±1.12 (1~6) 3.582 .001 ＜
    Monthly expense (10,000 won)   56.43±58.76 (0~300) 42.70±36.80 (0~200) 2.080 .390

    Differences to Dysphagia Risk by General Health and Oral Health Related Characteristics

    Variables Characteristics Categories Non-risk (n=98) Risk (n=162) x2 or t p
    n (%) or M±SD (Range) n (%) or M±SD (Range)
    Health related characteristics Number of chronic disease   1.40±1.13 1.78±1.25 -2.524 .012
    Type of chronic disease Neurology disease 1 (1.0) 14 (8.6) 6.524 .007
    Heart disease 53 (54.1) 92 (56.8) 0.182 .383
    Diabetes mellitus 18 (18.4) 40 (24.7) 1.409 .151
    Gastritis 6 (6.1) 25 (15.4) 5.039 .018
    Depression or insomnia 3 (3.1) 15 (9.3) 3.640 .044
    Number of medication (a day)   2.27±2.23 3.08±3.42 -2.326 .021
    Body weight (kg) 58.82±9.53 56.26±9.09 2.141 .033
      (40~90) (30~83)    
    Perceived dysphagia Yes 5 (5.1) 33 (20.4) 11.407 .001 ＜
    Attitude toward dysphagia No 93 (94.9) 129 (79.6) 0.448 .295
    Yes 57 (58.2) 101 (62.3)    
    Oral health related characteristics Number of teeth No 41 (41.8) 61 (37.7)    
    Number of tooth brushing (a day)   2.27±1.20 2.04±1.21 1.484 .001 ＜
    Teeth discomfort Yes 35 (35.7) 86 (53.1) 7.407 .005
    No 63 (64.3) 76 (46.9)    
    Denture user Yes 37 (37.8) 84 (51.9) 4.877 .019
    No 61 (62.2) 78 (48.1)    
    Duration of denture usage (hour/a day)   6.41±9.31 9.51±10.04 -2.530 .012
      (0~24) (0~24)    
    Denture discomfort Yes 11 (29.7) 46 (54.8) 11.303 .004
    No 26 (70.3) 38 (45.2)    
    Dry mouth during the day None 66 (67.3) 45 (27.8) 44.308 .001 ＜
    A little 28 (28.6) 73 (45.1)    
    Severe 2 (2.0) 25 (15.4)    
    Very severe 2 (2.0) 19 (11.7)    

    Logistic Regression Analysis of Factors which Influence Dysphagia Risk

    Classification Factor   OR 95% CI p
    Risk Dry mouth during the day Severe 15.677 2.986~82.297 .001
    Very severe 9.047 1.680~48.726 .010
    A little 4.147 2.075~8.286 .001 ＜
    None 1    
    Neurology disease   10.125 1.092~93.899 .042
    Gastritis   5.731 1.482~22.173 .011
    Denture discomfort   2.969 1.016~8.677 .047
    Teeth discomfort   2.610 1.311~5.196 .006
    Protective Number of teeth   0.947 0.903~0.993 .024
        Predicted Percentage correct (%)
    Yes No Total
    Observed (dysphagia risk) - Yes 61 37 98  
    No 30 132 162 74.2
    Total 91 169 260  
    2LL=268.009, x2=76.511 (df=6, p .001), Nagelkerke R2=0.347.

    Correlation Dysphagia risk with Dysphagia Specific Quality of Life for the Subjects

    Variables Dysphagia risk
    r p
    Global dysphagia specific quality of life -0.560 ＜.001
    Emotional dysphagia specific quality of life -0.582 ＜.001
    Functional dysphagia specific quality of life -0.575 ＜.001
    Physical dysphagia specific quality of life -0.686 ＜.001
    Total sum -0.687 ＜.001
    Table 1. Differences to Dysphagia Risk by Process of Swallowing

    Table 2. Differences to Dysphagia Risk by Socio-demographic Characteristics of the Subjects

    Table 3. Differences to Dysphagia Risk by General Health and Oral Health Related Characteristics

    Table 4. Logistic Regression Analysis of Factors which Influence Dysphagia Risk

    Table 5. Correlation Dysphagia risk with Dysphagia Specific Quality of Life for the Subjects

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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