Characterization of Geriatric Dysphagia Diagnoses in Age-Based Cohorts

• Published in: OTO open : the official open access journal of the American Academy of Otolaryngology--Head and Neck Surgery Foundation 2020-07, Vol.4 (3), p.2473974X20939543-n/a
• Main Authors: Applebaum, Jeremy, Lee, Emerson, Harun, Aisha, Davis, Ashley, Hillel, Alexander T., Best, Simon R., Akst, Lee M.
• Format: Article
• Language: English
• Subjects: Age; Dysphagia; EAT‐10; Esophagus; Geriatrics; Medical diagnosis; Original Research; Otolaryngology
• ISSN: 2473-974X; 2473-974X
• DOI: 10.1177/2473974X20939543

Objective An aging population requires increased focus on geriatric otolaryngology. Patients aged ≥65 years are not a homogenous population, and important physiologic differences have been documented among the young-old (65-74 years), middle-old (75-84), and old-old (≥85). We aim to analyze differences in dysphagia diagnoses and swallowing-related quality-of-life among these age subgroups. Study Design Retrospective chart review. Setting Tertiary care laryngology clinic. Subjects and Methods We identified chief complaint, diagnosis, and self-reported swallowing handicap (Eating Assessment Tool [EAT-10] score) of all new patients aged ≥65 years presenting to the Johns Hopkins Voice Center between April 2015 and March 2017. Dysphagia diagnoses were classified by physiologic etiology and anatomic source. Diagnostic categories and EAT-10 score were evaluated as functions of patient age and sex. Results Of 839 new patients aged ≥65 years, 109 (13.0%) reported a chief complaint of dysphagia and were included in this study. The most common dysphagia etiologies were neurologic and esophageal. Most common diagnoses were diverticula (15.6%), reflux (13.8%), and radiation induced (8.3%). Diverticula, cricopharyngeal hypertonicity, and radiation-induced changes were associated with higher EAT-10 score (P < .001). Significant differences by sex were found in anatomic source of dysphagia, as men and women were more likely to present with oropharyngeal and esophageal disease, respectively (P = .023). Dysphagia etiology and EAT-10 score were similar across age subgroups. Conclusion Important differences among dysphagia diagnosis and EAT-10 score exist among patients aged ≥65 years. Knowledge of these differences may inform diagnostic workup, management, and further investigations in geriatric otolaryngology.