Swallowing problems increase chance of dying after hip surgery

Older people with swallowing difficulties have worse health outcomes after undergoing hip surgery, new research shows.

In one of the largest studies of its type ever done, speech therapists Dr Anna Miles and Dr Jacqui Allen from the University of Auckland analysed Waitemata DHB hospital and clinical data for 2500 hip fracture patients over a six-year period.

They identified people in the data with a condition known as dysphagia, which is difficulty swallowing food or drink and which mainly affects older people, particularly those over 80. The study then compared health outcomes for those patients with health outcomes for hip fracture patients without dysphagia.

It found health outcomes were significantly poorer for those with swallowing problems including four times the risk of dying within 30 days of hospital discharge, 14 times the risk of developing aspiration pneumonia and hospital stays twice as long as non-dysphagia patients – 14 days compared to 32.

While people with swallowing difficulties were generally older, with an average age of 85 compared to an average age of 78 for the non-dysphagia group, poorer health outcomes remained higher even when age was accounted for.

The study also looked at the economic costs of dysphagia and found it cost New Zealand’s health system twice to four times as much to treat people with the condition because of their longer stays in hospital.

Dr Allen, from the University’s Faculty of Medical and Health Sciences, says while this study used data on people recovering from hip surgery, the complications caused by the disorder potentially affect any older adult undergoing treatment for conditions such as chest infection or injury from a fall.

“We all know of older people admitted to hospital for a fracture or an infection who then go on to develop unrelated problems and as a speech therapist who specialises in dysphagia, I think we need better ways to detect the condition and treat it before problems arise.”

Dr Allen, and Dr Miles from the University’s School of Psychology, say a simple screening process of hospital admissions to detect swallowing problems would result in significant cost savings for the health system and make dysphagia patients' time in hospital much easier.

Speech-language therapists have a number of approaches to treating dysphagia including changing a patient’s diet to include softer foods, adjusting a patient’s positioning or the way they swallow, and by providing exercises to strengthen swallowing muscles.

The study is published in Laryngoscope, a journal of the American Laryngological, Rhinological and Otological Society.

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