Patterns of Decision Making in Dysphagia Rehabilitation for Older Adults in Chronic Care: A Cross-Sectional Study

Objectives

To explore factors associated with decision making regarding training, environmental adjustments, and dental interventions in dysphagia rehabilitation for care-dependent older adults in the chronic care phase.

Design

Exploratory cross-sectional study.

Setting and Participants

Care-dependent older adults receiving dysphagia rehabilitation via dental home care between 2018 and 2023 in the Kanto region of Japan.

Methods

Data were retrospectively collected from clinical records. Key variables included types of intervention received, age, sex, Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale, and Charlson Comorbidity Index. Patients were classified into 3 clusters using k-means clustering based on age, frailty, FOIS score, and residential environment. Group comparisons were performed to evaluate differences in intervention strategies and duration.

Results

A total of 242 patients (mean age: 83.3 years; 38.4% male) were included. Training was implemented in 56.6% of patients, environmental adjustments in 90.1% (eg, posture adjustment: 30.7%, eating and food guidance: 89.4%), and dental interventions in 26.4%. Cluster analysis showed that younger, tube-fed patients, many of whom were living at home, were more likely to receive training (P < .001) and had longer intervention durations (P < .001), whereas older patients more often received compensatory strategies (P = .471).

Conclusions and Implications

In chronic-phase dysphagia rehabilitation, training is not always prioritized. Intervention choices appear to be influenced by patient characteristics, such as age, oral intake status, and other clinical conditions. Environmental adjustments were the most common intervention, highlighting the importance of compensatory strategies in care-dependent older adults.