Dysphagia after hip fracture based on functional oral intake and its association with prefracture vulnerability

Background Oral intake problems and dysphagia are important clinical issues during rehabilitation in older adults after hip fracture surgery. Objective This study aimed to determine the proportion of patients with dysphagia based on functional oral intake at acute-care and post-acute care discharge in older adults after hip fracture surgery and to examine its association with prefracture functional and cognitive vulnerability. Methods This retrospective observational study used multicenter data from the Kitakyushu Liaison Clinical Pathway for Hip Fractures. Patients aged 60 years or older who were admitted to acute-care hospitals for hip fracture and underwent surgery were included. Functional oral intake was classified using dietary information recorded in the pathway, with FOIS levels 1–5 operationally defined as dysphagia. The acute-care discharge analysis included 1725 patients, and the post-acute care discharge analysis included 853 patients. Multivariable logistic regression analyses were performed using multiple imputation, with complete-case analyses as sensitivity analyses. Results Dysphagia was observed in 608 patients (35.2%) at acute-care discharge and in 219 patients (25.7%) at post-acute care discharge. FOIS levels 1–3 were observed in 24 patients (1.4%) and 41 patients (4.8%), respectively. Among the 458 patients with dietary information available at both discharge points, the proportion classified as FOIS-derived levels 1–5 was 36.2% at acute-care discharge and 24.7% at post-acute care discharge, whereas the corresponding proportions for FOIS-derived levels 1–3 were 2.4% and 4.2%, respectively. Older age, dementia, long-term care insurance certification, and lower prefracture Barthel Index (BI) were significantly associated with dysphagia at both acute-care and post-acute care discharge in the main and sensitivity analyses. Conclusions Dysphagia based on functional oral intake was frequently observed at both acute-care and post-acute care discharge in older adults after hip fracture surgery. Older age, dementia, long-term care insurance certification, and lower prefracture BI, which may reflect prefracture functional and cognitive vulnerability, were consistently associated with dysphagia.