Functional health literacy in adults and elderly with dysphagia

Ribeiro, Urssula Aparecida Santos Leal; Vicente, Laélia Cristina Caseiro; Lemos, Stela Maris Aguiar

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Brasil

Audiology - Communication Research

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Brasil

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Sumário

Original Article • Audiol., Commun. Res. 26 • 2021 • https://doi.org/10.1590/2317-6431-2020-2351 copy

Functional health literacy in adults and elderly with dysphagia

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To verify the association between Functional Health Literacy in adults and elderly with dysphagia and socioeconomic, clinical, and swallowing ability data according to cognitive screening.

Methods

Observational analytical cross-sectional study with 49 participants in a rehabilitation clinic. We analyzed medical records, Brazil Economic Classification Criteria, Mini Mental State Examination, Short Assessment of Health Literacy for Portuguese-speaking Adults, Speech Therapy Protocol for Dysphagia Risk Assessment, Functional Oral Intake Scale, and Dysphagia Handicap Index. Descriptive, bivariate, and multiple logistic regression analyzes were performed.

Results

Most participants presented functional literacy in inadequate health, neurological disease, higher score on cognitive performance, mild and moderate dysphagia, and were fed orally with restrictions. There was an association in the multiple logistic regression of functional health literacy with schooling and underlying disease for the group with a higher score on cognitive performance, participants with higher education were 11.9 more likely to have adequate health literacy, neurological participants demonstrated 93.0 times more likely to have inadequate health literacy.

Conclusion

Individuals with a higher level of education and those who did not have underlying neurological disease sowed less chance of having inadequate Functional Health Literacy.

Keywords:
Health literacy; Deglutition disorders; Adult; Elderly; Ambulatory care

		n	%
Life cycle	Adult	24	49
Life cycle	Elderly person	25	51
Gender	Male	16	32.6
Gender	Female	33	67.3
Education level	Minor (incomplete elementary school to incomplete high school)	25	51
Education level	Major (secondary and higher education)	24	49
Residence	Belo Horizonte	31	63.2
	Metropolitan region	7	14.2
	Interior	11	22.4
BECC	A1	0	0
	A2	0	0
	B1	1	2
	B2	9	18.4
	C1	17	34.7
	C2	14	28.6
	D and E	8	16.3
Functional Health Literacy	Adequate	23	46.9
Functional Health Literacy	Inadequate	26	53.1
Baseline disease	Neurological	36	73.5
Baseline disease	Non-neurological	13	26.5
Mini Mental State Examination	Higher score	28	57.1
Mini Mental State Examination	Lower score	21	42.9
DRAP	Mild change	25	51.1
	Moderate change	22	44.9
	Severe change	2	4
FOIS	Use of alternative route	1	2
	Orally a consistency	3	6.1
	Oral use with restriction	37	75.5
	Unrestricted oral use	8	16.4
Self-assessment of swallowing according to activity limitation and restriction of dysphagia participation - (SHI)	Normal	1	2
	Mild problem	10	20.4
	Moderate problem	23	46.9
	Severe problem	15	30.7

		Lower score on cognitive screening				p-value*	Higher score on cognitive screening				p-value^* * Fisher’s exact test;
		Adequate functional health literacy		Inadequate functional health literacy			Adequate functional health literacy		Inadequate functional health literacy
		n	%	n	%		n	%	n	%
Gender	Male	2	28.5	4	28.5	0.99	6	37.5	4	33.3	0.57
Gender	Female	5	71.5	10	71.5	0.99	10	62.5	8	66.7	0.57
Education level	Minor	1	14.3	7	50.0	0.17	8	50.0	9	75.0	0.25
Education level	Major	6	85.7	7	50.0	0.17	8	50.0	3	25.0	0.25
Baseline disease	Neurological	6	85.7	10	71.5	0.62	9	56.3	11	91.7	0.08
Baseline disease	Non-neurological	1	14.3	4	28.5	0.62	7	43.7	1	8.3	0.08
BECC	B1 and B2	2	28.5	4	28.5	0.81	3	18.7	1	8.3	0.53
	C1 and C2	5	71.5	8	57.2		11	68.8	7	58.4
	D and E	0	0.0	2	14.3		2	12.5	4	33.3
DRAP	Slight change	3	42.8	9	64.3	0.57	8	50.0	5	41.6	0.83
	Moderate change	4	57.2	4	28.6		7	43.7	7	58.4
	Serious change	0	0.0	1	7.2		1	6.3	0	0.0
FOIS	Alternative use	0	0.0	1	7.2	0.62	1	6.1	1	8.2	0.99
	Orally a consistency	1	14.3	0	0.0		12	75.0	8	66.6
	Oral use with restriction	6	85.7	11	78.5		3	18.7	3	25.0
	Unrestricted oral use	0	0.0	2	14.3		1	6.2	1	8.2
		Median	Mean (±SD)	Median	Mean (±SD)	p-value**	Median	Mean (±SD)	Median	Mean (±SD)	p-value^ Simple logistic regression
Age		63.0	55.1 (SD± 19.1)	65.5	62.8 (SD± 18.4)	0.33	55.0	57.6 (SD± 16.3)	55.0	55.8 (SD± 15.0)	0.71
Activity limitation and restriction to dysphagia participation - total SHI		44.0	45.1 (SD± 20.75)	40.0	41.4 (SD± 17.1)	0.55	40.00	38.2 (SD± 22.9)	34.0	32.6 (SD± 16.7)	0.43

		Functional health literacy				p-value^* * Fisher's exact test or Pearson's chi-square test;
		Adequate		Inadequate
		n	%	n	%
Gender	Male	8	34.78	8	30.77	0.999
Gender	Female	15	65.22	18	69.23	0.999
Education level	Minor school	9	39.13	16	61.54	0.156
Education level	Major school	14	60.87	10	38.46	0.156
Baseline disease	Neurological	15	65.22	21	80.77	0.332
Baseline disease	Non-neurological	8	34.78	5	19.23	0.332
BECC	B1 and B2	5	21.74	5	19.23	0.459
	C1 and C2	16	69.57	15	57.69
	D and E	2	8.70	6	23.08
DRAP	Mild alteration (functional swallowing + mild dysphagia)	11	47.83	14	53.85	0.885
	Moderate change (mild/moderate dysphagia + moderate dysphagia)	11	47.83	11	42.31
	Severe change (moderate/severe dysphagia + severe dysphagia)	1	4.35	1	3.85
FOIS	Restriction of food orally using alternative route	0	0.00	1	3.85	0.822
	Orally one consistency	2	8.70	1	3.85
	Oral use more than one consistency, but with special preparation	18	78.26	19	73.08
	Unrestricted oral use	3	13.04	5	19.23
		Median	Mean (±SD)	Median	Mean (±SD)	p-value^ Simple logistic regression
Age		60.0	56.9 (SD± 16.8)	59.0	59.7 (SD± 17.0)	0.542
Activity limitation and restriction of participation in dysphagia according to the total SHI		44.00	40.35 (SD± 22.10)	39.00	37.38 (SD± 17.17)	0.583

Cognitive screening	Lower score					Higher score				Regardless of the score
FHL		OR	95% confidence interval for OR		p-value^* * Multiple logistic regression with Backward selection method; Variables included in the initial model: age, gender, education level, underlying disease, Brazil Economic Classification Criterion; Dysphagia Risk Assessment Protocol; Functional Oral Intake Scale (Functional Oral Intake Scale); and Restriction to participation in swallowing	OR	95% confidence interval for OR		p-value*	OR	95% confidence interval for OR		p-value*
FHL		OR	Inferior limit	Upper limit		OR	Inferior limit	Upper limit	p-value*	OR	Inferior limit	Upper limit	p-value*
Education level	Minor	-	1	-	-	1	-	-	-	1	-	-	-
Education level	Major	0.12	0.01	1.45	0.09	0.11	0.01	0.91	0.04	0.33	0.10	1.13	0.07
Baseline disease	Neurological	-	1	-	-	1	-	-	-	1	-	-	-
Baseline disease	Non-neurological	4.01	0.31	52.12	0.28	0.07	0.00	0.82	0.03	0.31	0.07	1.36	0.12

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[1] Conflict of interests: No.