Frailty Status and Dysphagia Trajectory Among Hospitalized Nursing Home Residents With Advanced Dementia.

OBJECTIVE

The objective of this analysis was to describe the association of dysphagia and frailty in persons living with dementia (PLWD) residing in skilled nursing facilities (SNFs) who experienced hospitalization.

DESIGN

Retrospective cohort.

SETTING AND

PARTICIPANTS

Long-stay US nursing home residents from 2012-2018 with advanced dementia who experienced a hospitalization.

METHODS

Among the cohort, we captured Minimum Data Set (MDS) assessments of dysphagia before and after hospitalization. MDS items were also used to measure FRAIL-NH (fatigue, resistance, ambulation, incontinence, weight loss, nutritional approach, help with dressing) scale components before hospitalization. Adjusted analyses identified the risk for dysphagia in the pre-hospital cohort and new dysphagia in the post-hospital cohort according to pre-hospital frailty status.

RESULTS

Among the pre-hospital cohort (n = 1,207,345), 85% (n = 1,026,736) were classified as frail. Almost half of the cohort (n = 562,574, 46.6%) was on a mechanically altered diet. Dysphagia frequency was higher among frail residents (6.2% vs 2.4% prefrail vs 1.1% nonfrail). After adjustment for demographics and comorbidities, frailty was associated with greater risk of dysphagia [adjusted incidence rate ratio (IRR), 3.97; 95% CI, 3.49-4.49]. Among those who survived hospitalization (n = 1,078,321), frailty was also associated with new dysphagia (adjusted IRR, 1.7; 95% CI, 1.6-1.7).

CONCLUSIONS AND IMPLICATIONS: Frailty is associated with increased risk of dysphagia among PLWD residing in SNFs. Additionally, frail PLWD who experience hospitalization are at increased risk of new dysphagia. These results have important implications for designing interventions to decrease dysphagia among frail PLWD. Given the wide disparity between the rates of mechanically altered diets and dysphagia as determined by MDS items, additional validation studies on the use of the MDS in dysphagia are warranted.