Characterizing Oral and Swallowing Function in Older Adults Presenting to the Emergency Department

University of Wisconsin, Madison

Summary

The purpose of this study is to learn about oral and swallowing function in older adults presenting to the emergency department. The hypothesis is that older adults often have problems with oral and swallowing function and these problems relate to other conditions. Study activities are done during the emergency department visit and include providing saliva samples, completing a bedside water swallow test, completing oral function assessments, completing respiratory function tests, and answering survey questions.

Description

Oropharyngeal dysphagia is characterized by changes in swallow event timing, biomechanics, and pressure generation that occur with advancing age resulting in aspiration of bacteria-laden saliva, food, and liquid into the lungs. Currently, oral and swallowing function is not routinely or comprehensively assessed in older adults despite poor oral health and oropharyngeal dysphagia being known risk factors for pneumonia, the leading infectious cause of mortality among adults 65+. This study seeks to extensively characterize oral and swallowing function in older adults presenting to the emergency…

Eligibility

Age range: 60+ years
Sex: All
Healthy volunteers: No

Detailed criteria

Inclusion Criteria: * Age ≥ 60 * Clinically stable and able (not NPO) to safely drink water and eat a saltine cracker per ED provider Exclusion Criteria: * Prisoner * Non-English speaking

Interventions

Diagnostic Test
3-ounce water swallow test
Bedside water swallow dysphagia screen where vocal quality of the participant is assessed before and after swallowing 3 ounces of water
Diagnostic Test
Kayser-Jones Brief Oral Health Status Examination (BOHSE)
Scored assessment of the lymph nodes, lips, tongue, tissue inside of cheek, floor and roof of mouth, gums between teeth and/or under artificial teeth, saliva, condition of natural/artificial teeth, chewing position of teeth, and oral cleanliness
Diagnostic Test
Tongue pressure
Maximum isometric lingual pressure at the front and back of tongue will be measured by placing an air-filled pressure bulb on the surface of the oral tongue and having participants press the bulb "as hard as possible" against the hard palate
Diagnostic Test
Test of Masticating and Swallowing Solids (TOMASS)
Measurement of bites, masticatory cycles, swallows, and time taken to consume a cracker
Diagnostic Test
Respiratory function tests
Participants will take a maximum inhalation and forcefully exhale into a spirometer to measure maximum expiratory pressure (MEP), fully exhale their air and take a maximal inhalation into the spirometer to measure maximum inspiratory pressure (MIP), and produce a single strong cough into to spirometer to measure peak expiratory flow (PEF) and forced expiratory volume (FEV1)

Location

University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin