Post-stroke dysphagia rehabilitation in the old and oldest old: outcome and relevance for discharge home

摘要

We assessed the outcome of dysphagia rehabilitation in all the 139 patients with post-stroke dysphagia admitted to our Neurorehabilitation Unit during 2 years (2017 and 2018), divided into two groups: old (aged 65–84 years) and oldest-old (aged 85 or above). We studied which factors predicted dysphagia improvement in the two groups. The potential association of improvement with type of discharge was also evaluated. On admission, ‘old’ patients had more frequently aphasia ( P = 0.02) and less frequently dysarthria ( P = 0.03); ‘oldest old’ had more severe pressure ulcers ( P = 0.008), higher levels of c reacting protein ( P = 0.01) and more heart problems ( P = 0.004). None of these factors was associated with the outcome of dysphagia. We found no difference between the two groups in the severity of dysphagia, as measured with Dysphagia Outcome and Severity Scale on admission and discharge, but due to minor differences, the degree of improvement was higher in the ‘old’ group ( P = 0.02). The number of patients discharged with improved swallowing was also comparable. Cognitive impairment had a negative predicting role in the ‘old’ group (odds ratio 0.270, 95% confidence interval 0.101–0.725, P = 0.007). Norton Scale score predicted dysphagia improvement in the ‘oldest old’ group (odds ratio 1.611, 95% confidence interval 1.102–2.355, P = 0.007). Dysphagia improvement was associated with discharge home in general ( P = 0.011) and in the ‘old’ group ( P = 0.04). Our data, though preliminary, could give a contribution to implement patient-specific rehabilitation strategies; these could increase swallowing improvement in post-stroke dysphagia.