Dysphagia and nutritional risk in old adults in nursing homes and rehabilitation units

Rationale: Dysphagia in older residents in nursing homes and rehabilitation units is common and associated with malnutrition. The aim of this narrative review was to identify intervention studies on dysphagia, and to see whether interventions had effect on nutritional status. Methods: We performed a systematic literature search in the databases EMBASE, MEDLINE and CINAHL from 2012 - Feb17th 2022. Inclusion criteria were residents ≥65 years in nursing homes or rehabilitation units with dysphagia and nutritional status reported. Only papers in English or Scandinavian language and original articles with a control group or a pre-post test design were included. Exclusion criteria were palliative care, bariatric surgery and cancer. The data extraction was carried out by two independent reviewers (KIF, EH) using the software Covidence and a pre-prepared form. Disagreement in the selection were resolved by discussion. Results: A total of 452 records was identified. Duplicates (n=139) were removed and 8 records were excluded due to language. We screened 305 titles, and excluded 139 articles. The remaining 166 abstracts were assessed and five full text articles were included for analysis; one cluster randomized controlled trial and four pre-post test studies. The five studies identified suggest that texture modification (n=2), training of muscles involved in swallowing (n=2) and feeding
strategies (n=1) are beneficial for nutritional status; e.g. improved swallowing function, increased food intake, increased body weight. Conclusion: Five intervention studies in older adults with dysphagia were identified. Evidence for the effect of interventions is scarce, but indicates beneficial effects on nutritional status. However, pre-post designs, limited sample size and few studies hinder firm conclusions regarding the effectiveness of the interventions.