Dysphagia: In Search of a Unified Definition for the Aging Population

Abstract. Dysphagia is a significant health problem associated with aging, contributing to hospitalization for malnutrition, dehydration, frailty, falls, and pneumonia. By 2030, the US elderly population is anticipated to exceed 72 million with over 12 million of these individuals considered to be experiencing swallowing difficulties. Despite the high incidence and prevalence of dysphagia, particularly in the adult aging population, there is no uniform definition of adult dysphagia. Instead, heterogenous definitions in the extant literature pave the way for ambiguity and philosophical differences among dysphagia experts and other key stakeholders. Establishing an accepted and cogent definition for dysphagia is a critical step in quantifying the exact magnitude of disease in a specific population, and assuring accuracy and consistency across healthcare settings, researchers, third party payers, and other key stakeholders. The goal of this proposal is to convene two multidisciplinary conferences to develop and derive a cohesive definition for dysphagia in the aged population. This application is to request support for the Dysphagia: In Search of a Unified Definition for the Aging Population conference. This unique, multidisciplinary endeavor will leverage experts from numerous specialty areas, including gerontology, critical care, otolaryngology, gastroenterology, pulmonology, bioengineering, nursing, nutrition, and speech-language pathology, to converge and through evidence-based synthesis and discussion agree upon an accepted definition for dysphagia across the domains of screening, diagnosis, treatment, management and ongoing care. The specific aims of this conference are to engage experts and key stakeholders who work with older adults with dysphagia and to collaborate and develop a consensus validation for a unified definition of dysphagia and guidelines that can be applied for use in clinical patient populations, public health, and policy. This work is imperative and long overdue given the continued “greying of America”, and that the majority of the literature in swallowing and swallowing disorders is <40 years old. The culmination of this project will result in data driven consensus statement for evaluation, replication, and/or endorsement by international institutions. The resulting definition and guideline will also be employed to develop a multi-site clinical study (R01) incorporating this new definition to promote best care, and test adherence and coding accuracy within the medical record. This work will provide uniformity in the literature and throughout the healthcare landscape, driving informed decision making, diagnostic accuracy, targeted treatment, and early prevention of dysphagia in aged persons to reduce the burden of complications and in turn health care cost.