Association between dysphagia diet intake at acute-care discharge and activities of daily living at discharge from a convalescent rehabilitation ward: a single-center retrospective cohort study in Japan

Abstract

Purpose: This study examined whether intake of a dysphagia diet at acute-care discharge was associated with activities of daily living (ADL) at discharge from a convalescent rehabilitation ward among older orthopedic patients.Methods: This retrospective study included patients aged ≥65 years admitted to a convalescent rehabilitation ward between January 2019 and April 2024. Patients with pharyngeal or esophageal dysphagia were excluded. The exposure was dysphagia diet intake at acute-care discharge. Motor Functional Independence Measure (FIM) score at rehabilitation discharge was analyzed using multivariable linear regression adjusted for age, admission motor FIM score, and cognitive function. Nutritional indicators at rehabilitation admission were compared between groups, and reasons for diet modification during acute care were summarized.Results: Among 300 patients, 74 (24.7%) received a dysphagia diet at acute-care discharge. At rehabilitation admission, the dysphagia diet group had poorer nutritional and muscle-related status than the regular diet group. After adjustment, dysphagia diet intake was associated with a 3.41-point lower motor FIM score at discharge. Ill-fitting dentures were the most common reason for diet modification (33.8%); however, the reason was unclear in 27.0% of cases.Conclusion: Among older orthopedic patients without pharyngeal or esophageal dysphagia, intake of a dysphagia diet at acute-care discharge was associated with lower ADL at discharge from a convalescent rehabilitation ward after adjustment for selected covariates. This finding should be interpreted as a clinical risk marker rather than evidence that clinically indicated dysphagia diets should be avoided. Early reassessment of diet modifications and correction of reversible oral conditions may help improve rehabilitation care.