Application of Orofacial Muscle Strength Measurement to Screen for Penetration/Aspiration Risk in Older Adults With Sarcopenia: A Diagnostic Accuracy Study.

BACKGROUND

Early identification of penetration/aspiration (P/A) risk in older adults with sarcopenia is crucial to prevent complications and maintain quality of life.

PURPOSE: To evaluate the diagnostic utility of orofacial muscle strength measurements for predicting the risk of P/A in older adults with sarcopenia.

METHODS

In this observational and prospective study, we collated consecutive data from community-dwelling older adults diagnosed with sarcopenia at a musculoskeletal disorder clinic. Altogether, 54 participants underwent orofacial muscle strength measurements (the index test) using the Iowa Oral Performance Instrument and a videofluoroscopic swallowing study (VFSS) (the reference test) to evaluate for the presence of P/A. Receiver operating characteristic (ROC) curve analysis was performed to determine orofacial muscle strength based on P/A.

RESULTS

Overall, 34 patients showed penetration in the VFSS, although none of the patients showed signs of aspiration. The cut-off for tongue strength to identify the risk of P/A was ≤ 20.5 kPa, with a sensitivity and specificity of 0.75 and 0.74, respectively; the area under the curve (AUC) was 0.88. The cut-off for buccinator strength was ≤ 19.5 kPa, with a sensitivity and specificity of 0.65 and 0.68, respectively, with an AUC of 0.69. The cut-off for lip muscle strength was ≤ 18.5 kPa, with a sensitivity and specificity of 0.65 and 0.71, respectively, with an AUC of 0.69.

CONCLUSION

The evaluation of buccinator and lip muscle strength did not demonstrate sufficient diagnostic utility for detecting the risk of P/A in older patients with sarcopenia; however, tongue strength showed reliable diagnostic utility for identifying the risk of P/A.