Sensitivity and Specificity of the Geriatric Bedside Swallowing Screen (GEBS): A Diagnostic Accuracy Pilot Study / Sensitivität und Spezifität des Geriatric Bedside Swallowing Screen (GEBS): Eine Diagnostische Pilotstudie

Javorszky, Susanne Maria; Reiter, Raphael; Frank, Wilhelm; Iglseder, Bernhard

doi:10.2478/ijhp-2025-0009

Abstract

Purpose

The projected increase in older adults in the EU to 28.5% by 2050 highlights the need for improved geriatric care. Oropharyngeal dysphagia is common in older adults; it is linked to frailty and neurodegenerative diseases, and can cause malnutrition, dehydration, and aspiration pneumonia. Though screening reduces pneumonia cases in stroke patients, it also risks overdiagnosis in geriatric patients due to age-related swallowing changes that are often misinterpreted by existing tools.

Objectives

To address this gap, the Geriatric Bedside Swallowing Screen (GEBS) was developed. The goal was to validate the GEBS against an objective instrumental assessment, the Flexible Endoscopic Evaluation of Swallowing (FEES).

Methods

Between November 2022 and June 2024, a total of 30 participants aged 75 years or more (mean age 79.13 SD ± 5.7) from an acute geriatric ward in Salzburg, Austria, were recruited for this prospective observational cohort study. Participants completed both GEBS and FEES within seven consecutive days, with the FEES investigators being blinded for the results of the GEBS.

Results

The GEBS demonstrated a sensitivity of 67% and a specificity of 83%, as well as positive and negative predictive values of 73% and 80%, respectively. There were no adverse effects.

Conclusions

The results indicate the GEBS’s potential as a promising dysphagia screening tool specifically for geriatric patients. Swallowing function should be assessed as part of geriatric assessments, as recommended by the guidelines of several societies.

References

Baijens, L. W. J., Clavé, P., Cras, P., Ekberg, O., Forster, A., Kolb, G., Leners, J. C., Masiero, S., Del Mateos Nozal, J., Ortega, O., Smithard, D. G., Speyer, R. & Walshe, M. (2016). European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clinical Interventions in Aging, 11, 1403–1428. https://doi.org/10.2147/CIA.S107750
Search in Google Scholar Back to article
Belafsky, P. C., Mouadeb, D. A., Rees, C. J., Pryor, J. C., Postma, G. N., Allen, J. & Leonard, R. J. (2008). Validity and reliability of the Eating Assessment Tool (EAT-10). The Annals of Otology, Rhinology, and Laryngology, 117(12), 919–924. https://doi.org/10.1177/000348940811701210
Search in Google Scholar Back to article
Bossuyt, P. M., Reitsma, J. B., Bruns, D. E., Gatsonis, C. A., Glasziou, P. P., Irwig, L., Lijmer, J. G., Moher, D., Rennie, D., Vet, H. C. W. de, Kressel, H. Y., Rifai, N., Golub, R. M., Altman, D. G., Hooft, L., Korevaar, D. A. & Cohen, J. F. (2015). STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies. BMJ 2015 (Clinical research ed.), 351, h5527. https://doi.org/10.1136/bmj.h5527
Search in Google Scholar Back to article
British Geriatrics Society. (2019). Comprehensive geriatric assessment toolkit for primary care practitioners. British Geriatrics Society. https://www.bgs.org.uk/cgatoolkit
Search in Google Scholar Back to article
Brott, T., Adams, H. P., Olinger, C. P., Marler, J. R., Barsan, W. G., Biller, J., Spilker, J., Holleran, R., Eberle, R. & Hertzberg, V. (1989). Measurements of acute cerebral infarction: a clinical examination scale. Stroke, 20(7), 864–870. https://doi.org/10.1161/01.str.20.7.864
Search in Google Scholar Back to article
Butler, S. G., Stuart, A., Case, L. D., Rees, C., Vitolins, M. & Kritchevsky, S. B. (2011). Effects of liquid type, delivery method, and bolus volume on penetration-aspiration scores in healthy older adults during flexible endoscopic evaluation of swallowing. The Annals of Otology, Rhinology, and Laryngology, 120(5), 288–295. https://doi.org/10.1177/000348941112000502
Search in Google Scholar Back to article
Cichero, J. A. Y., Lam, P., Steele, C. M., Hanson, B., Chen, J., Dantas, R. O., Duivestein, J., Kayashita, J., Lecko, C., Murray, J., Pillay, M., Riquelme, L. & Stanschus, S. (2017). Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework. Dysphagia, 32(2), 293–314. https://doi.org/10.1007/s00455-016-9758-y
Search in Google Scholar Back to article
Clavé, P., Arreola, V., Romea, M., Medina, L., Palomera, E. & Serra-Prat, M. (2008). Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clinical Nutrition (Edinburgh, Scotland), 27(6), 806–815. https://doi.org/10.1016/j.clnu.2008.06.011
Search in Google Scholar Back to article
Daggett, A., Logemann, J., Rademaker, A. & Pauloski, B. (2006). Laryngeal penetration during deglutition in normal subjects of various ages. Dysphagia, 21(4), 270–274. https://doi.org/10.1007/s00455-006-9051-6
Search in Google Scholar Back to article
Daniels, S. K., Anderson, J. A. & Petersen, N. J. (2013). Implementation of stroke dysphagia screening in the emergency department. Nursing Research and Practice, 2013, 1–7. https://doi.org/10.1155/2013/304190
Search in Google Scholar Back to article
Daniels, S. K., McAdam, C. P., Brailey, K. & Foundas, A. L. (1997). Clinical assessment of swallowing and prediction of dysphagia severity. American Journal of Speech-Language Pathology, 6(4), 17–24. https://doi.org/10.1044/1058-0360.0604.17
Search in Google Scholar Back to article
Deutsche Gesellschaft für Geriatrie. (2024). S1-Leitlinie Geriatrisches Assessment der Stufe 2: Living Guideline [S1 Guideline Level 2 Geriatric Assessment]. AWMF-Register-Nr. 084-002LG (Nr. 5). AWMF. https://register.awmf.org/de/leitlinien/detail/084-002LG
Search in Google Scholar Back to article
Flynn, E., Smith, C. H., Walsh, C. D. & Walshe, M. (2018). Modifying the consistency of food and fluids for swallowing difficulties in dementia. The Cochrane Database of Systematic Reviews, 9(9), CD011077. https://doi.org/10.1002/14651858.CD011077.pub2
Search in Google Scholar Back to article
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6
Search in Google Scholar Back to article
Hansen, T., Beck, A. M., Kjaersgaard, A. & Poulsen, I. (2022). Second update of a systematic review and evidence-based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia. Clinical Nutrition ESPEN, 49, 551–555. https://doi.org/10.1016/j.clnesp.2022.03.039
Search in Google Scholar Back to article
Heidler, M.-D. (2019). Dysphagie bei tracheotomierten patienten nach langzeitbeatmung [Dysphagia in tracheostomized patients after long-term ventilation]. Pneumologie, 73(09), 533–537. https://doi.org/10.1055/a-0977-5276
Search in Google Scholar Back to article
Jardine, M., Miles, A. & Allen, J. (2021). Self-reported Swallowing and nutrition status in community-living older adults. Dysphagia, 36(2), 198–206. https://doi.org/10.1007/s00455-020-10125-y
Search in Google Scholar Back to article
Javorszky, S. M. (2022). Schluckstörungen in der geriatrie: Vom screening zur behandlung: Eine Übersichtsarbeit [Swallowing disorders in geriatrics: From screening to treatment: A review]. Praxis Sprache, 67(2), 85–97.
Search in Google Scholar Back to article
Javorszky, S. M., Reiter, R. & Iglseder, B. (2023). Validation of a geriatric bedside swallowing screen (GEBS): Protocol of a prospective cohort study. JMIR Research Protocols, 12, e46252. https://doi.org/10.2196/46252
Search in Google Scholar Back to article
Labeit, B., Muhle, P., Itter, J. von, Slavik, J., Wollbrink, A., Sporns, P., Rusche, T., Ruck, T., Hüsing-Kabar, A., Gellner, R., Gross, J., Wirth, R., Claus, I., Warnecke, T., Dziewas, R. & Suntrup-Krueger, S. (2022). Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults. Frontiers in Aging Neuroscience, 14, 912691. https://doi.org/10.3389/fnagi.2022.912691
Search in Google Scholar Back to article
Martino, R., Silver, F., Teasell, R., Bayley, M., Nicholson, G., Streiner, D. L. & Diamant, N. E. (2009). The Toronto Bedside Swallowing Screening Test (TOR-BSST): Development and validation of a dysphagia screening tool for patients with stroke. Stroke, 40(2), 555–561. https://doi.org/10.1161/STROKEAHA.107.510370
Search in Google Scholar Back to article
Mateos-Nozal, J., Martos, J. & Masiero, S. (2024). Oropharyngeal dysphagia as a geriatric syndrome. In P. Clavé & O. Ortega (Eds.), A multidisciplinary approach to managing swallowing dysfunction in older people (pp. 7–23). Elsevier. https://doi.org/10.1016/B978-0-323-91686-8.00019-7
Search in Google Scholar Back to article
Ohira, M., Ishida, R., Maki, Y., Ohkubo, M., Sugiyama, T., Sakayori, T. & Sato, T. (2017). Evaluation of a dysphagia screening system based on the Mann Assessment of Swallowing Ability for use in dependent older adults. Geriatrics & Gerontology International, 17(4), 561–567. https://doi.org/10.1111/ggi.12755
Search in Google Scholar Back to article
Palli, C., Fandler, S., Doppelhofer, K., Niederkorn, K., Enzinger, C., Vetta, C., Trampusch, E., Schmidt, R., Fazekas, F. & Gattringer, T. (2017). Early dysphagia screening by trained nurses reduces pneumonia rate in stroke patients: A clinical intervention study. Stroke, 48(9), 2583–2585. https://doi.org/10.1161/STROKEAHA.117.018157
Search in Google Scholar Back to article
Quan, H., Li, B., Couris, C. M., Fushimi, K., Graham, P., Hider, P., Januel, J.-M. & Sundararajan, V. (2011). Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. American Journal of Epidemiology, 173(6), 676–682. https://doi.org/10.1093/aje/kwq433
Search in Google Scholar Back to article
Rosenbek, J. C., Robbins, J. A., Roecker, E. B., Coyle, J. L. & Wood, J. L. (1996). A penetration-aspiration scale. Dysphagia, 11(2), 93–98. https://doi.org/10.1007/BF00417897
Search in Google Scholar Back to article
Starrost, U., Bartolome, G., Schröter-Morasch, H., Ziegler, W., Fussenegger, C., Marano, C., Krischock, Y. & Schilling, B. (2012). Der Bogenhausener Dysohagiescore - BODS: Inhaltsvalidität und Reliabilität [The Bogenhausen Dysphagia Score - BODS: Content Validity and Reliability]. Dysphagieforum 2.
Search in Google Scholar Back to article
Thiem, U., Jäger, M., Stege, H. & Wirth, R. (2023). Diagnostic accuracy of the ‘Dysphagia Screening Tool for Geriatric Patients’ (DSTG) compared to Flexible Endoscopic Evaluation of Swallowing (FEES) for assessing dysphagia in hospitalized geriatric patients – A diagnostic study. BMC Geriatrics, 23(1), 856. https://doi.org/10.1186/s12877-023-04516-7
Search in Google Scholar Back to article
Tian, L., Hu, Z., Yang, L. & Xiang, Y. (2024). The prevalence of dysphagia at risk among older adults in nursing homes: A meta-analysis. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 24(1), 127–137. https://doi.org/10.1111/psyg.13034
Search in Google Scholar Back to article
Trapl, M., Enderle, P., Nowotny, M., Teuschl, Y., Matz, K., Dachenhausen, A. & Brainin, M. (2007). Dysphagia bedside screening for acute-stroke patients: The Gugging Swallowing Screen. Stroke, 38(11), 2948–2952. https://doi.org/10.1161/STROKEAHA.107.483933
Search in Google Scholar Back to article
Umay, E., Eyigor, S., Bahat, G., Halil, M., Giray, E., Unsal, P., Unlu, Z., Tikiz, C., Vural, M., Cincin, A. T., Bengisu, S., Gurcay, E., Keseroglu, K., Aydeniz, B., Karaca, E. C., Karaca, B., Yalcin, A., Ozsurekci, C., Seyidoglu, D., . . . Ozturk, E. A. (2022). Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H. Annals of Geriatric Medicine and Research, 26(2), 94–124. https://doi.org/10.4235/agmr.21.0145
Search in Google Scholar Back to article
Ward, K. T. & Reuben, D. B. (2024). Comprehensive Geriatric Assessment. Wolters Kluwer. https://www.uptodate.com/contents/comprehensive-geriatric-assessment
Search in Google Scholar Back to article
Warnecke, T., Teismann, I., Oelenberg, S., Hamacher, C., Ringelstein, E. B., Schäbitz, W. R. & Dziewas, R. (2009). The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke, 40(2), 482–486. https://doi.org/10.1161/STROKEAHA.108.520775
Search in Google Scholar Back to article
World Health Organization. (2022). International Classification of Diseases: Eleventh Revision (11th edition, rev). https://icd.who.int/browse/2024-01/mms/en
Search in Google Scholar Back to article
World Health Organization (2024). International Classification of Functioning, Disability and Health (ICF). https://icd.who.int/dev11/l-icf/en#/http://id.who.int/icd/entity/923782542
Search in Google Scholar Back to article
Wirth, R., Dziewas, R., Beck, A. M., Clavé, P., Hamdy, S., Heppner, H. J., Langmore, S., Leischker, A. H., Martino, R., Pluschinski, P., Rösler, A., Shaker, R., Warnecke, T., Sieber, C. C. & Volkert, D. (2016). Oropharyngeal dysphagia in older persons - From pathophysiology to adequate intervention: A review and summary of an international expert meeting. Clinical Interventions in Aging, 11, 189–208. https://doi.org/10.2147/CIA.S97481
Search in Google Scholar Back to article
Wu, X. S., Miles, A. & Braakhuis, A. (2022). An Evaluation of texture-modified diets compliant with the international dysphagia diet standardization initiative in aged-care facilities using the consolidated framework for implementation research. Dysphagia, 37(5), 1314–1325. https://doi.org/10.1007/s00455-021-10393-2
Search in Google Scholar Back to article
Yang, R.-Y., Yang, A.-Y., Chen, Y.-C., Lee, S.-D., Lee, S.-H. & Chen, J.-W. (2022). Association between dysphagia and frailty in older adults: A systematic review and meta-analysis. Nutrients, 14(9), 1812. https://doi.org/10.3390/nu14091812
Search in Google Scholar Back to article