Developing clinical observation items for nursing assessment of dysphagia in dementia: An exploratory multicentre pilot study

Introduction: Dysphagia is common in dementia and can lead to 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 assess initial diagnostic signals of nurse-observed clinical items for identifying dysphagia in this population.
Methods: 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 exploratory decision tree modelling to explore 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 = .003), while “Clears throat” did not reach statistical significance (p = .056) but may warrant further investigation in larger samples. In an exploratory decision tree analysis, “Cough while eating” and “Voice sounds throaty – wet voice” emerged as potentially informative items in this pilot sample, achieving 60% sensitivity, with a 13.5% overall misclassification rate.
Conclusions: Two nurse-observed clinical items, “Cough while eating” and “Wet voice”, may represent promising indicators of increased dysphagia risk in people with dementia. These preliminary findings provide a rationale for developing and testing a brief observation-based screening approach. Further research is required to validate these indicators in larger and more diverse samples.