Deglutição em pessoas idosas e o processo de fragilização: uma análise na perspectiva do modelo biopsicossocial

Abstract

Introduction: dysphagia and frailty share common characteristics in older individuals. The severity of dysphagia is associated with the level of functional dependence in this population, as the overall functional impairment increases, so does the functional impairment of swallowing. However, not all older individuals with modifications in the anatomy and physiology of swallowing can be characterized as dysphagic, as the natural aging process itself can lead to presbyphagia. The literature suggests that the assessment of swallowing function should align with the biopsychosocial model proposed by the International Classification of Functioning, Disability, and Health (ICF). Objective: to analyze the association between swallowing in older individuals and the process of frailty from the perspective of the biopsychosocial model. Methods: analytical cross-sectional observational study with a non-probabilistic sample consisting of 100 elderly individuals followed by the Jenny de Andrade Faria Institute (IJAF) of the Hospital das Clínicas of the Federal University of Minas Gerais (HC-UFMG), which is a healthcare service for the elderly integrated into the Unified Health System (SUS) network in Belo Horizonte. The research was approved by the Research Ethics Committee under approval number: 6,059,301. The instruments for data collection were: Clinical-Functional Vulnerability Index-20 (IVCF-20), Charlson Comorbidity Index, Functional Independence Measure (FIM), Self-reported Oropharyngeal Dysphagia Screening for Older Adults (RaDI), Screening for Masticatory Disorders in Older Adults (SMDOA), Orofacial Myofunctional Evaluation Protocol for Older People (OMES-Elders), and Functional Oral Intake Scale (FOIS). After selecting the set of categories related to chewing and swallowing, the respective disability qualifiers were coded to the ICF categories. Descriptive and bivariate analyses were performed, as well as multivariate analysis for variables with a p-value less than 0.2. Results: the median age of participants was 84 years, with the majority (62%) being female. Of the total participants, 73% were classified as frail, while 63% showed functional independence. It was found that the OMES-Elders protocol is not able to indicate the initial diagnosis of dysphagia in older individuals when compared to RaDI. From the perspective of the biopsychosocial model, the chewing category showed no association with the studied variables. There was an association between the swallowing category and frailty in older individuals according to IVCF-20, between the swallowing category and functional dependence according to FIM, as well as with the motor and cognitive domains of this scale. Additionally, there was an association between the swallowing category and the presence of comorbidities according to the Charlson Comorbidity Index. In the final model, there was an association between swallowing impairment and frailty and functional dependence. Furthermore, there was an association between dysphagia using the OMES-Elders and RaDI protocols and frailty according to IVCF-20, between swallowing and overall functionality according to FIM, as well as between dysphagia and the motor domain of FIM. Conclusion: there is an association between swallowing and dysphagia with functionality and frailty in elderly people. The analysis from the perspective of the biopsychosocial model contributed to a broader approach to the concept of health in Speech Therapy, enabling greater implementation of this approach among healthcare professionals in the management of older individuals.