Swallow screening of older adults at hospital admission

Abstract

Objectives

The risk of swallowing difficulties increases in older adults due to a combination of factors such as multiple comorbidities and polypharmacy. Swallowing may be further destabilised by the onset of acute illness. At hospital admission, these factors can be identified and combined with a simple screening tool to select patients for additional assessment and intervention. This prospective observational cross-sectional cohort study aimed to screen hospitalised adults age 75 years or older (older than 65 years for Māori and Pasifika) for swallowing risks, regardless of the reason for admission.

Methods

A total of 644 participants were screened with the Eating Assessment Tool (EAT-10) self-report questionnaire from August 2021 to December 2023. Clinical teams were instructed to use the EAT-10 to guide management. Clinical outcomes were monitored for 30 days postdischarge, and the relationship between EAT-10 scores and subsequent clinical management was explored.

Results

Age and ethnicity were not correlated with increased EAT-10 (p > .05), but the number of comorbidities (p < .001) and regular medications on admission were correlated with a higher EAT-10 score (p < .001). Despite the screening process, there were associations between elevated EAT-10 scores and readmission (p < .001), pneumonia (p < .001) and mortality (p < .01).

Conclusions

These results suggest that screening for swallowing difficulties in at-risk older patients is valuable and allows teams to take action to prevent adverse clinical outcomes. Further investigation is required to clarify the timing for screening and to explore optimal clinical pathways for those identified at risk.