Oropharyngeal Dysphagia
Conditions
Brief summary
The purpose of this study is to learn about oral and swallowing function in older adults presenting to the emergency department. The hypothesis is that older adults often have problems with oral and swallowing function and these problems relate to other conditions. Study activities are done during the emergency department visit and include providing saliva samples, completing a bedside water swallow test, completing oral function assessments, completing respiratory function tests, and answering survey questions.
Detailed description
Oropharyngeal dysphagia is characterized by changes in swallow event timing, biomechanics, and pressure generation that occur with advancing age resulting in aspiration of bacteria-laden saliva, food, and liquid into the lungs. Currently, oral and swallowing function is not routinely or comprehensively assessed in older adults despite poor oral health and oropharyngeal dysphagia being known risk factors for pneumonia, the leading infectious cause of mortality among adults 65+. This study seeks to extensively characterize oral and swallowing function in older adults presenting to the emergency department to clarify the relationship of oral hypofunction, dysphagia, and the upper airway microbiome. To achieve this aim, study procedures include a bedside dysphagia screen, oral health assessment, tongue pressure measurement, masticatory function assessment, respiratory function tests, salivary compositional analysis, oral microbiome analysis, and microphysiological system analysis which applies saliva samples to a bronchiolar lumen model to mimic aspiration and quantify cellular and tissue responses to the saliva microbiome and secreted mediators. Per amendment approved 10/29/2025: Saliva samples for microbiota analysis will not be collected from participants enrolled after 10/22/2025.
Interventions
DIAGNOSTIC_TEST3-ounce water swallow test
Bedside water swallow dysphagia screen where vocal quality of the participant is assessed before and after swallowing 3 ounces of water
DIAGNOSTIC_TESTKayser-Jones Brief Oral Health Status Examination (BOHSE)
Scored assessment of the lymph nodes, lips, tongue, tissue inside of cheek, floor and roof of mouth, gums between teeth and/or under artificial teeth, saliva, condition of natural/artificial teeth, chewing position of teeth, and oral cleanliness
DIAGNOSTIC_TESTTongue pressure
Maximum isometric lingual pressure at the front and back of tongue will be measured by placing an air-filled pressure bulb on the surface of the oral tongue and having participants press the bulb "as hard as possible" against the hard palate
DIAGNOSTIC_TESTTest of Masticating and Swallowing Solids (TOMASS)
Measurement of bites, masticatory cycles, swallows, and time taken to consume a cracker
DIAGNOSTIC_TESTRespiratory function tests
Participants will take a maximum inhalation and forcefully exhale into a spirometer to measure maximum expiratory pressure (MEP), fully exhale their air and take a maximal inhalation into the spirometer to measure maximum inspiratory pressure (MIP), and produce a single strong cough into to spirometer to measure peak expiratory flow (PEF) and forced expiratory volume (FEV1)
Sponsors
University of Wisconsin, Madison
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 60 * Clinically stable and able (not NPO) to safely drink water and eat a saltine cracker per ED provider
Exclusion criteria
* Prisoner * Non-English speaking
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Positive oropharyngeal dysphagia screen prevalence | During emergency department visit, approximately 2-5 minutes for bedside dysphagia screen and 5-10 minutes for patient reported swallowing function | Number of participants with positive oropharyngeal dysphagia screen identified through bedside dysphagia screen and patient reported swallowing function |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean brief oral health status examination (BOHSE) score | During emergency department visit, approximately 2-5 minutes | Score 0 - 20 with 20 indicating the worst oral health |
| Oral dryness prevalence | During emergency department visit, up to 10 minutes for saliva collection | Number of participants with stimulated salivary flow rate (volume saliva/collection time) less than two standard deviations below published norms |
| Decreased tongue pressure prevalence | During emergency department visit, approximately 2-5 minutes | Number of participants with maximum isometric lingual pressures at front or back tongue location less than fifth percentile for published age-matched norms |
| Decreased masticatory function prevalence | During emergency department visit, approximately 2-5 minutes | Number of participants with test of masticating and swallowing solids (TOMASS) greater than two standard deviations above published age- and sex-matched norms for any of four components: number of bites, number of masticatory cycles, number of swallows, total time |
| pH of saliva sample | During emergency department visit, up to 10 minutes for saliva collection | pH 0-14 of saliva as measured by digital pH meter |
| Extensional viscosity of saliva sample | During emergency department visit, up to 10 minutes for saliva collection | Extensional viscosity of saliva as measured by an extensional rheometer |
| Salivary Substance P Concentration | During emergency department visit, up to 10 minutes for saliva collection | Protein concentration (ng/mL) of Substance P in saliva |
| Oral microbiome | During emergency department visit, up to 10 minutes for saliva collection | Comparison of microbial community composition in buccal mucosa, tongue dorsum, and saliva based on oral and swallowing function |
| Cell barrier function | During emergency department visit, up to 10 minutes for saliva collection | Diffusion assays to quantify cell barrier function in bronchiole and blood vessel model after application of saliva to bronchiolar lumen |
| Protein composition | During emergency department visit, up to 10 minutes for saliva collection | Multiplex bead-based ELISA to identify concentration (ng/mL) of proteins in bronchiole and blood vessel model after application of saliva to bronchiolar lumen |
| Gene expression | During emergency department visit, up to 10 minutes for saliva collection | Quantification of gene expression in bronchiole and blood vessel model after application of saliva to bronchiolar lumen |
| Immunofluorescent staining | During emergency department visit, up to 10 minutes for saliva collection | Quantification of immunofluorescent staining in bronchiole and blood vessel model after application of saliva to bronchiolar lumen |
| Immune cell trafficking | During emergency department visit, up to 10 minutes for saliva collection | Quantification of immune cell trafficking in bronchiole and blood vessel model after application of saliva to bronchiolar lumen |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORMichael S Pulia, MD, PhD
University of Wisconsin, Madison
Outcome results
None listed