Shared determinants of dysphagia and voice symptoms in institutionalized older adults: the role of functional decline, xerostomia, and frailty

Dysphagia and voice disorders are common among older adults and may share anatomical, physiological, and clinical determinants. However, these conditions are usually investigated separately, particularly in long-term care settings. To investigate the coexistence of dysphagia symptoms and voice-related complaints and identify shared determinants among institutionalized older adults. A multicenter cross-sectional study was conducted among 279 older adults residing in 16 long-term care facilities in Brazil. Dysphagia symptoms were assessed using the Eating Assessment Tool (EAT-10), and voice-related complaints were evaluated using the Screening Index for Voice Disorder (SIVD). Sociodemographic characteristics, sarcopenia, frailty, functional dependence, nutritional status, polypharmacy, and xerostomia were assessed using validated instruments. Spearman correlation and multivariable negative binomial regression models were used to examine associations. Dysphagia symptoms and voice-related complaints were identified in 34.1% and 14.7% of participants, respectively. EAT-10 and SIVD scores were positively correlated (ρ = 0.339; p < 0.001). Polypharmacy, functional dependence, and xerostomia emerged as common determinants of both swallowing and voice symptom burden. Higher dysphagia symptom severity was additionally associated with longer institutionalization time, frailty, malnutrition, and sarcopenia. Xerostomia showed the strongest association with both dysphagia and voice symptom burden. Dysphagia symptoms and voice-related complaints were significantly correlated and shared important clinical determinants. These findings support integrated screening and management strategies targeting swallowing, vocal function, oral health, and functional status in institutionalized older adults. Swallowing and voice symptoms represent interconnected manifestations of functional decline in institutionalized older adults. Functional dependence, polypharmacy, and xerostomia were common determinants of both outcomes. Xerostomia showed the strongest association with swallowing and voice symptom burden. Frailty, sarcopenia, and malnutrition were independently associated with greater dysphagia symptom severity. Integrated geriatric assessment may support the early identification of older adults at risk of swallowing and voice impairments.