Age and Ageing Advance Access originally published online on December 15, 2006
Age and Ageing 2007 36(1):90-94; doi:10.1093/ageing/afl149
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Long-term outcome after stroke: does dysphagia matter?
1 Richard Stevens Ward, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK
2 Division of Health and Social Care Research, GKT, London SE1 3QD, UK
Address correspondence to: D. G. Smithard. Tel: (+44) 1233 616214 Fax: (+44) 1233 616662. Email: david.smithard{at}ekht.nhs.uk
Background: swallowing problems (dysphagia) are common following acute stroke and are independent predictors of short-term outcome. It is uncertain as to whether these swallowing problems are associated with outcome in the longer-term.
Aim: insert to determine whether dysphagia present in the first week of acute stroke associated with long-term outcome.
Methods: a population-based long-term follow-up of people with first in a life-time stroke. Dysphagia was assessed within 1 week of stroke and patients were followed up at 3 months and yearly for 5 years by face-to-face interview. Outcome was defined by survival and place of residence, using multinomial logistic regression. Barthel Scores were divided into the two groups 15-20 and 0-14, and modelled using multiple logistic regression.
Results: there were 567 patients with dysphagia (mean age 74.3 years) and 621 with a safe swallow (mean age 69.6 years). Following multinomial logistic regression, residence in a nursing home was more likely to occur in those who failed the swallow test during the first week of their stroke; however, this only reached statistical significance at 3 months (relative risk ratio (RRR) = 1.73; 95% confidence interval (CI) 1.02 to 2.95), and years 4 (RRR 3.35, 1.37–8.19) and 5 (RRR 3.06, 1.06-8.83). There was also a significant association with increased mortality only during the first three months (RRR 2.03, 1.12 to 3.67).
Conclusion: this study confirms that the presence of dysphagia during the acute phase of stroke is associated with poor outcome during the subsequent year, particularly at 3 months, and is associated with increased institutionalisation rate in the long term.
Keywords: stroke, community, dysphagia, outcome, elderly
Received 10 January 2006; accepted in revised form 24 October 2006.
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