Prevalence and Predictors of Self-Reported Swallowing Difficulties in Community-Dwelling Older Adults: A Population-Based Study from the National Health and Aging Trends Study (NHATS)

It is well established that dysphagia is common amongst older adults, yet there is a paucity of evidence from population-based studies confirming prevalence and risk factors. The current study aimed to determine prevalence and predictors of self-reported swallowing difficulty in community-dwelling older adults. The National Health and Aging Trends Study is a nationally representative population study that has followed American Medicare beneficiaries aged 65 and older since 2011. Annual, interviews collect detailed information on biological, medical, psychological, social, lifestyle and economic data. The current study analyzed data from the first 11 rounds of interviews to estimate prevalence and the predictors of self-reported swallowing difficulty. Estimates of prevalence were computed per year based on analytic weights and linearized standard errors. Logistic regression was used to determine the predictors of participant-reported swallowing difficulties for a subgroup of adults in Round 5, as well as 1497 community-dwelling older adults who responded to all 11 rounds of interviews, representing a stable cohort across 11 years. For both models, lifestyle and health factors were considered, such as: smoking; requiring help to eat and prepare meals; life satisfaction; social participation; various medical conditions; cognition; fall status; and respiratory status. Prevalence of self-reported swallowing difficulty ranged from 8.7 to 10.2% over 11 years, with many participants experiencing swallowing difficulties intermittently. Cross-sectional analyses (Round 5 data) revealed that the odds of swallowing difficulties increased with less education, those identifying as Hispanic as compared to white, and those with relatively lower incomes. Longitudinal analyses, controlling for the effect of age, suggested the following independent predictors over time: self-reported poor health, higher BMI, reduced peak airflow, needing help to eat, and limited physical activity. This information should be carefully considered by clinicians, researchers, and policymakers to ensure we are able to address the needs of our dysphagia patients as they continue to age. Social determinants of health must also be considered to ensure equitable care across the population.