Oropharyngeal dysphagia (OD) can be considered a ‘‘geriatric syndrome’’ given its high prevalence, increased morbidity, common risk factors, and interaction with other geriatric syndromes[1].Current estimates of dysphagia prevalence in community-dwelling older adults (age ≥ 65; self-reported) range from 11 to 16% [2, 3]. From a screening tool, Yang et al. estimated the prevalence of dysphagia to be 33.7% in adults 65and older [4]. Physiologic changes in swallowing may occur as a component of natural aging. Ekberg et al. reported that 84% of elderly patients had radiologic findings consistent with physiologic impairment despite functional swallowing[5]. Temporal measures of swallowing may be longer in healthy older adults compared to younger adults [6–8]. In a study of healthy older adults, upper esophageal sphincter opening was reduced, residue was heightened, and pharyngeal manometric measures were reduced [9]. In terms of central control, healthy older adults evidenced significantly greater brain volume activation when swallowing water than when swallowing saliva [10]. Despite these age-related changes, swallowing may remain functional for most older adults, in that the effect of physiologic changes on oral intake, overall health, and quality of life is minimal to none.
The Dysphagia Handicap Index (DHI)was designed as a clinically efficient, easy to complete HRQOL scale for individuals with OD deriving from a variety of medical diagnoses. With 25 items, the DHI investigates the physical, functional, and emotional impacts that OD may have on the patient’s life and provides a self-evaluation of OD severity. To date, the DHI has been used to distinguish between different levels of HRQOL in adult OD patients of etiological heterogeneity in cross-sectionally designed studies [11–16]. Moreover, the DHI was used to assess changes in swallowing self-perception as an outcome measure of treatment efficacy in patients with Parkinson’s disease [17, 18], cricopharyngeal spasm and pharyngeal pouch [19], post-thyroidectomy dysphagia[20], and Head and Neck Cancer [21]. The DHI has attracted growing attention in the international literature, presenting overall satisfactory psychometric properties [22]. Besides its original English version, it has been cross culturally validated into Arabic [23], Persian [24, 25], Japanese [26], Hebrew[27], Kannada [28], and Korean [29].
In order to determine the self-reported frequency of swallowing function in older community-dwelling adults with no diagnosis of dysphagia, participants in the older age group completed the DHI [30].The DHI is a validated measure of patient-reported quality of life that queries the effect of dysphagia on emotional, functional, and physical aspects of a person’s life. The incidence of dysphagia in older adults is high, but it has not attracted widespread attention. At present, there is no simple and easy autonomous reporting tool for dysphagia in China. Therefore, the research provides a theoretical basis for the application and promotion of the DHI scale by evaluating its reliability and validity, and analyzing the dysphagia and its influencing factors of older adults in China.
The following characteristics hold for current domestic and foreign studies: The measuring tools were mostly constructed based on the researcher’s own experience, and an evaluation tool for the DHI of older adults has not yet developed in China. Accordingly, this study evaluates the psychometric properties of a DHI instrument designed for older Chinese adults. The construction of a DHI instrument for older people is imperative to help the government achieve evaluation standardization and scientifically improve the management level.
Purpose of the study
The purpose of this study was to evaluate the psychometric properties of the dysphagia handicap index scale. Using this scale, we will be able to assess the perceptions of the oropharyngeal dysphagia status for older adults in China.