Developing Clinical Observation Items for Nursing Assessment of Dysphagia in Dementia: An exploratory multicentre pilot study

Abstract

Introduction

Dysphagia is common among people with dementia and is associated with serious complications such as aspiration pneumonia and malnutrition. Early identification is essential; however, established assessments are often impractical in dementia care because they require active patient cooperation and may be limited by care-resistant behaviour. This study aimed to examine the diagnostic potential of nurse-observed clinical items for identifying dysphagia in this population.

Method

An exploratory multicentre pilot study was conducted on two geriatric wards in Austria. Nurses observed participants during mealtime using a 23-item checklist developed through a prior Delphi process. Dysphagia status was subsequently assessed by speech-language pathologists. Statistical analyses included chi-square tests, t-tests, Mann–Whitney U tests, and decision tree modelling to identify predictive indicators.

Results

Thirty-seven participants (mean age 79.1 ± 5.5 years) were included, of whom 27% were diagnosed with dysphagia. Eleven of the 23 observed items showed variation within the sample. “Cough while eating” was significantly associated with dysphagia (p = 0.003), while “Clears throat” demonstrated a statistical trend (p = 0.056). Decision tree analysis identified “Cough while eating” and “Voice sounds throaty – wet voice” as the most informative indicators, correctly classifying 60% of dysphagia cases with an overall misclassification rate of 13.5%.

Conclusion

Two nurse-observed clinical items— “Cough while eating” and “Wet voice”—appear to be useful indicators of increased dysphagia risk in people with dementia. These findings support a brief observation-based screening approach. Further research is required to validate these indicators in larger and more diverse samples.