Association between Dysphagia and Frailty in Older Adults: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Searches
2.2. Study Selection and Data Extraction
2.3. Risk-of Bias Assessment
2.4. Data Synthesis and Analysis
3. Results
3.1. Study Selection and Baseline Characteristics
3.2. Studies with Cross-Sectional Data
3.3. Dysphagia and Incident Frailty in One Longitudinal Study
3.4. Meta-Analysis of Dysphagia and Frailty
3.5. Subgroup Meta-Analysis
3.6. Assessment of Methodological Quality and Publication Bias
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Source | Country | Participants No. and Dwelling | Study Design | Age, Mean Range, y | Female, N (%) | Dysphagia Ascertainment | Frailty Ascertainment | Baseline Prevalence of Frailty and Pre-Frailty N (%) | Adjustment for Original Investigation |
---|---|---|---|---|---|---|---|---|---|
Chang et al. [37], 2011 | Taiwan | 275 Community-Dwelling | Cross-sectional | 71.1 65–79 | 148 (53.8) | Self-reported | FFI | Pre-frailty 161 (58.5) Frailty 31 (11.3) | Age, education status, history of falls in 1 year, pain history, depression, polypharmacy, timed up and go, number of comorbidities, MMSE score, and Barthel Index score |
Gonzalez-Fernandez et al. [38], 2014 | United States | 47 Community-Dwelling | Cross-sectional | 86.3 85–94 | 47 (100) | Self-reported and 3-Ounce water swallowing test | FFI | Pre-frailty 28 (59.6) Frailty 6 (12.7) | NA |
Tanaka et al. [39], 2018 (Kashiwa Study) | Japan | 2011 Community-Dwelling | Longitudinal | 73.0 ≥65 | 1017 (50.6) | Self-reported | FFI | Frailty 1151 (57.2) | Age, sex, BMI, chronic conditions, cognitive function, depressive symptoms, living arrangements, yearly income, and current smoking status |
Bahat et al. [5], 2019 | Turkey | 1138 Community-Dwelling | Cross-sectional | 74.1 ≥60 | 790 (69.4) | EAT-10 | FRAIL scale | Pre-frailty 514 (45.3) Frailty 325 (28.6) | Age, sex, presence of neurodegenerative diseases, number of chronic diseases and drugs, HGS (handgrip strength), UGS (usual gait speed), and nutritional status |
Watanabe et al. [22], 2019 (ONEHOME) | Japan | 178 Community-Dwelling | Cross-sectional | 80.2 66–90 | 76 (42.7) | DSS | Frailty Index | Frailty 91 (51.1) | Age and sex |
Ambagtsheer et al. [32], 2020 | Australia | 592 Facility-Dwelling | Cross-sectional | 88.0 (median) ≥75 | 394 (66.6) | Self-reported | Modified 36-Item eFI | Pre-frailty 274 (46.3) Frailty 258 (43.6) | Model 1: age, sex, and facility characteristics (size, rurality) Model 2: Model 1 + 12 ACFI domains Model 3: Model 2 + five most prevalent conditions (arthritis, diabetes, hypertension, osteoporosis, and vision problems) |
Cohen et al. [33], 2020 (NIS-HCUP-AHRQ) | United States | 6,230,114 Hospitalized | Cross-sectional | 70.1 ≥50 | 3,264,580 (52.4) | ICD-9-CM codes | ACG and FRS | Pre-frailty 1,295,864 (20.8) Frailty 43,611 (0.7) | Age, sex, race, hospital characteristics, geographic region, insurance, smoking status, household income, and admission type |
Nishida et al. [34], 2020 | Japan | 3475 Community-Dwelling | Cross-sectional | 75.8 ≥65 | 1920 (55.3) | Self-reported | 25-Item Kihon Checklist | Frailty 419 (12.1) | Age, sex, domains of oral function, nutrition, physical function, homebound status, cognitive function, and depressive mood |
Shimazaki et al. [31], 2020 | Japan | 978 Community-Dwelling | Cross-sectional | M: 73.2 F: 72.9 (median) 65–85 | 510 (52.1) | EAT-10 | 25-Item Kihon Checklist | Pre-frailty 295 (30.3) Frailty 81 (8.3) | Age, sex, BMI, hypertension, and stroke |
Wang et al. [35], 2020 | China | 386 Hospitalized | Cross-sectional | 74.8 65–93 | 190 (49.2) | 30-mL water swallow test | FFI | Pre-frailty 182 (47.2) Frailty 94 (24.4) | Sex, number of chronic diseases, and history of choking/coughing while drinking |
Nishida et al. [24], 2021 | Japan | 320 Community-Dwelling | Cross-sectional | 77.3 ≥65 | 268 (83.8) | EAT-10 | FFI | Pre-frailty 154 (48.1) Frailty 45 (14.1) | Age, sex, family structure, and self-rated health |
Albani et al. [36], 2021 (Newcastle 85+ Study) | England | 853 Community-Dwelling | Cross-sectional | 85.0 >85 | 530 (62.1) | Self-reported | FFI | Pre-frailty 433 (53.9) Frailty 226 (28.1) | Age, sex, BMI, alcohol intake, smoking status, social class, cardiovascular disease, diabetes, hypertension, neuropsychiatric disease, and other health conditions |
Albani et al. [36], 2021 (TOOTH Study) | Japan | 542 Community-Dwelling | Cross-sectional | 87.0 >85 | 306 (56.5) | Self-reported | FFI | Pre-frailty 339 (62.5) Frailty 120 (22.1) | Age, sex, BMI, alcohol intake, smoking status, social class, cardiovascular disease, diabetes, hypertension, neuropsychiatric disease, and other health conditions |
Characteristic | Odds of Frailty | Odds of Frailty and Pre-Frailty | ||||
---|---|---|---|---|---|---|
Studies, No. | Pooled Odds Ratio [95% CI] | I 2, % | p Value for Subgroup Differences | Studies, No. | Pooled Odds Ratio [95% CI] | |
Main estimate | 7 | 5.22 [3.96, 6.89] | 22% | 7 | 4.77 [3.97, 5.74] | |
Study population | 0.44 | |||||
Community-dwelling | 5 | 5.79 [3.91, 8.58] | 38% | 5 | 5.08 [4.04, 6.39] | |
Hospitalized | 1 | 5.11 [2.58, 10.13] | - | 1 | 3.89 [2.14, 7.06] | |
Facility-dwelling | 1 | 3.16 [1.36, 7.34] | - | 1 | 3.16 [1.36, 7.34] | |
Geographic location | 0.22 | |||||
US/Australia | 1 | 3.16 [1.36, 7.34] | - | 1 | 3.16 [1.36, 7.34] | |
Asia | 6 | 5.50 [4.10, 7.38] | 23% | 6 | 4.87 [4.04, 5.89] | |
Sample size | 0.94 | |||||
N < 500 | 4 | 5.22 [3.29, 8.29] | 0% | 4 | 4.29 [2.79, 6.59] | |
N ≥ 500 | 3 | 5.36 [3.07, 9.38] | 69% | 3 | 5.01 [3.50, 7.18] | |
Mean age | 0.75 | |||||
70 ≤ age < 80 | 5 | 4.69 [2.06, 10.69] | 32% | 5 | 4.80 [3.92, 5.87] | |
Age ≥ 80 | 2 | 5.22 [3.96, 6.89] | 42% | 2 | 4.69 [2.06, 10.69] | |
Assessment tools for frailty in all study populations | 0.61 | |||||
FFI | 3 | 5.63 [3.56, 8.89] | 0% | 3 | 3.71 [2.29, 6.03] | |
Non-FFI | 4 | 5.22 [3.96, 6.89] | 57% | 4 | 5.20 [3.82, 7.07] | |
Assessment tools for dysphagia in all study populations | 0.44 | |||||
Self-reported | 3 | 4.53 [3.62, 5.66] | 0% | 3 | 4.46 [3.57, 5.58] | |
EAT-10 or DSS | 3 | 6.86 [3.74, 12.60] | 41% | 3 | 6.36 [4.32, 9.36] | |
Water swallow test | 1 | 5.11 [2.58, 10.13] | - | 1 | 3.89 [2.14, 7.06] | |
Community-dwelling study populations | 5 | 5.79 [3.91, 8.58] | 38% | 5 | 5.08 [4.04, 6.39] | |
Sample size | ||||||
N < 500 | 3 | 5.32 [2.85, 9.94] | 0% | 0.70 | 3 | 4.77 [2.56, 8.88] |
N ≥ 500 | 2 | 6.42 [3.05, 13.51] | 81% | 2 | 5.46 [3.59, 8.32] | |
Mean age | ||||||
70 ≤ age < 80 | 4 | 5.66 [3.51, 9.12] | 49% | 0.63 | 4 | 5.01 [3.80, 6.59] |
Age ≥ 80 | 1 | 7.32 [2.88, 18.64] | - | 1 | 7.32 [2.88, 18.64] | |
Assessment tools for frailty in Community-dwelling study populations | 0.37 | |||||
FFI | 2 | 4.11 [1.77, 9.52] | 0% | 2 | 3.39 [1.47, 7.80] | |
Non-FFI | 3 | 6.47 [3.74, 11.19] | 65% | 3 | 5.57 [3.97, 7.81] | |
Assessment tools for dysphagia in Community-dwelling study populations | 0.21 | |||||
Self-reported | 2 | 4.53 [3.62, 5.66] | 0% | 2 | 4.58 [3.63, 5.78] | |
EAT-10 or DSS | 3 | 6.86 [3.74, 12.60] | 41% | 3 | 6.36 [4.32, 9.36] |
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Yang, R.-Y.; Yang, A.-Y.; Chen, Y.-C.; Lee, S.-D.; Lee, S.-H.; Chen, J.-W. Association between Dysphagia and Frailty in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2022, 14, 1812. https://doi.org/10.3390/nu14091812
Yang R-Y, Yang A-Y, Chen Y-C, Lee S-D, Lee S-H, Chen J-W. Association between Dysphagia and Frailty in Older Adults: A Systematic Review and Meta-Analysis. Nutrients. 2022; 14(9):1812. https://doi.org/10.3390/nu14091812
Chicago/Turabian StyleYang, Ru-Yung, An-Yun Yang, Yong-Chen Chen, Shyh-Dye Lee, Shao-Huai Lee, and Jeng-Wen Chen. 2022. "Association between Dysphagia and Frailty in Older Adults: A Systematic Review and Meta-Analysis" Nutrients 14, no. 9: 1812. https://doi.org/10.3390/nu14091812