Dorte Melgaard Kristiansen

Rehospitalisation and mortality after hospitalisation for orapharyngeal dysphagia and community-acquired pneumonia: A 1-year follow-up study

Abstract Research has documented a high prevalence of oropharyngeal dysphagia (OD) in older patients with community-acquired pneumonia (CAP). This study investigated OD as a risk factor for long-term re-hospitalization and mortality in patients hospitalized with CAP. A total of 36 patients (72.2% male, mean age 80.9 years) who were alive 30 days after discharge were included in the follow-up study. Demographic data, CURB65, Charlson Comorbidity Index, Modified Rankin Scale and Barthel-20 score were recorded and OD was assessed with Volume Viscosity Swallow Test. 69.5% of the patients were moderately to severely disabled, and the mean Barthel-20 score was 13.2 and 27.8% lived in nursing homes. In the period from 31 to 180 days 50% of the patients were re-hospitalized and from 181 to 360 days 60.7% were re-hospitalized. Re-hospitalized patients had a significantly higher Barthel-20 score and longer length of stay (LOS) in the hospital. During 31–180 days after discharge 22.2% of the patients died. From 181 to 360 days after discharge 46.4% of the patients died, they had a significantly higher Charlson Comorbidity Index and a significantly weaker handgrip. The one-year mortality was 71.7%. Despite the small sample size, this study confirms a high re-hospitalisation frequency and high mortality. The 1-year mortality is 71.7% for patients hospitalised with CAP and OD.

Revisiting the psychometric properties of a revised Danish version of the McGill ingestive skills assessment

Abstract Background: During a longstanding validation process of the Danish version of the McGill Ingestive Skills Assessment (MISA2-DK) for measuring mealtime performance in dysphagic clients, extensive revisions have been undertaken. Therefore, this study aimed to determine the psychometric properties of this revised version. Methods: In a cross-sectional study, 328 adults referred to occupational therapy for swallowing evaluation were included. MISA2-DK with 36 items distributed into four subscales (positioning for meals, self-feeding skills, liquid ingestion, and solid ingestion) was administered as observation during a meal. Statistical analysis included item analysis by the Rasch model and exploratory factor analysis (EFA). Results: The initial analysis of MISA2-DK presented misfit to the Rasch model, which was resolved by grouping items within subscales into testlets to adjust for local item dependency. However, when testing the items within each subscale, the subscale structure was not supported. The EFA and further item analysis by the Rasch model suggested a different distribution of items—namely, anticipation, bolus preparation, bolus propulsion, and airway protection. Conclusion: The total MISA2-DK score might provide a unidimensional measure of mealtime performance. However, for detailed information of qualitative aspects of dysphagic clients’ mealtime performance, the four EFA-derived subscale domains are recommended.