Swallowing impairment in older persons following burn injury: Validation of incidence and predictive factors for dysphagia

Nicola Clayton^1,2,3,4, Caroline Nicholls^2,5, Cheryl Brownlow^2,5, Justine O’Hara², Andrea Issler-Fisher², Oliver Fisher⁶, Peter Maitz^2,4,
¹Speech Pathology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
²Burns Unit, Concord Repatriation General Hospital , Sydney, NSW, Australia
³School of Health & Rehabilitation Sciences, University of Queensland , Brisbane, QLD, Australia
⁴Faculty of Medical and Health Sciences, University of Sydney , Sydney, NSW, Australia
⁵Nutrition & Dietetics Department, Concord Repatriation General Hospital , Sydney, NSW, Australia
⁶UNSW Department of Surgery, St George Hospital, Sydney, NSW, Australia

Abstract

Background: Management of burns in older persons is complex with evidence indicating advanced age is associated with elevated risk for morbidity and mortality. Morbidity can include dysphagia, with early retrospective data identifying prevalence rates of 47% in older burn patients and associations with medical, burn and nutritional outcomes. Furthermore, %TBSA burn and nutritional status were independently predictive for dysphagia. A prospective study is now required to confirm the incidence, nature and predictive factors for dysphagia in this population.

Aims: To prospectively (1) confirm the incidence, (2) describe the nature, and (3) validate a set of risk factors, for dysphagia in patients ≥75 years admitted with severe burn injury.

Methods: All patients >75years admitted to Concord Repatriation General Hospital with severe burn injury over a 4-year period (2019-2023) were assessed for dysphagia on presentation and continually monitored throughout their admission. Burn injury, demographic and nutritional data were prospectively captured and analysed for association with and predictive value for dysphagia.

Results: Sixty-two patients (33-male) aged 75-95 years (median=83 years) were recruited. Dysphagia was identified in 50% during their hospital admission. Dysphagia was significantly associated with burn size (p=0.002), pre-existing cognitive impairment (p=0.004), hospital length-of-stay (p=0.002), in-hospital complications including delirium (p=0.000), feeding dependence (p=0.004), nutritional assessment (p=0.004) and enteral feeding duration (p=0.011). Presence of pre-existing cognitive impairment and development of secondary co-morbidities during admission were independently predictive for dysphagia.

Conclusions: Dysphagia incidence is high in older persons with burns and associated with increased morbidity, regardless of burn mechanism, surgery or bed rest.

Biography

Dr Nicola Clayton is a Clinical Specialist Speech Pathologist in the Intensive Care and Severe Burn Injury Units at Concord Hospital in Sydney. She holds honorary appointments with the University of Sydney and University of Queensland. Dr Clayton is internationally recognised for her expertise, research and education in the field of complex dysphagia, critical care and severe burn injury.