Swallowing Impairments in ICU Survivors and Community-Dwelling Adults

This study will involve one in-person research visit for community dwelling adults and two research visits for critically ill adults (one in the ICU, one 3-months post-hospital discharge) that will last approximately 1 hour and will consist of a screening, cough testing, swallow function testing, assessments of hand grip and tongue strength, and completion of questionnaires. Caregivers of ICU survivors will complete questionnaires at the 3-month follow up visit.

Primary outcomes

• Swallowing safety and efficiency [During baseline visit at time of enrollment for community dwelling adults. During baseline visit at time of enrollment and 3 months post-hospital discharge for critically ill adults.]: The validated Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale will be used to measure swallowing safety and efficiency.

Secondary outcomes

• Voluntary cough peak expiratory flow [During baseline visit at time of enrollment for community dwelling adults. During baseline visit at time of enrollment and 3 months post-hospital discharge for critically ill adults.]: A measure of cough strength
• Grip strength [During baseline visit at time of enrollment for community dwelling adults. During baseline visit at time of enrollment and 3 months post-hospital discharge for critically ill adults.]: Grip strength be used to quantify clinical frailty using a digital hand dynamometer.
• Tongue strength [During baseline visit at time of enrollment for community dwelling adults. During baseline visit at time of enrollment and 3 months post-hospital discharge for critically ill adults.]: Tongue strength will be assessed using the Iowa Oral Pressure Instrument (IOPI).
• Swallowing and Eating Related Fatigue Questionnaire (SERF) [During baseline visit at time of enrollment for community dwelling adults. During baseline visit at time of enrollment and 3 months post-hospital discharge for critically ill adults.]: Scores on the SERF range 0-48 with higher scores indicating greater impairment.
• Eating Assessment Tool 10 (EAT-10) [During baseline visit at time of enrollment for community dwelling adults. During baseline visit at time of enrollment and 3 months post-hospital discharge for critically ill adults.]: The EAT-10 contains 10 questions (score range: 0-40), higher scores indicate greater impairment.
• 3 oz water swallow test [During baseline visit at time of enrollment for community dwelling adults. During baseline visit at time of enrollment and 3 months post-hospital discharge for critically ill adults.]: Participants will be given a cup of three ounces of water and instructed to drink the water continuously. Fail criteria includes interrupted drinking and/or coughing/throat clearing during or immediately following the drinking task.
• Reflex cough [During baseline visit at time of enrollment for community dwelling adults. During baseline visit at time of enrollment and 3 months post-hospital discharge for critically ill adults.]: Participants will undergo reflex cough testing.
• Screening for Oral Frailty Tool (SOFT) [During baseline visit at time of enrollment for community dwelling adults. During baseline visit at time of enrollment and 3 months post-hospital discharge for critically ill adults.]: Oral frailty will be assessed as present/absent using the Screening for Oral Frailty Tool.
• Swallowing Related Quality of Life Questionnaire (SWAL-QOL) [During baseline visit at time of enrollment for community dwelling adults. 3 months post-hospital discharge for critically ill adults.]: Scores on the SWAL-QOL range from 0-100 with lower scores indicating greater impairment.
• Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) Questionnaire [3 months post-hospital discharge for care partners of critically ill adults.]: Scores on the CARES range from 0-26 with higher scores indicating greater caregiver burden.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion criteria community-dwelling adults:

1. adult ≥18 years old
2. no prior history of neurological diseases or respiratory diseases
3. no prior history of head and neck surgery/head and neck cancer/radiation to head and neck region
4. no prior history of dysphagia.

Exclusion criteria community-dwelling adults:

1. <18 years old
2. neurological disease or respiratory disease diagnosis
3. history of head and neck cancer/surgery to the head and neck region
4. history of dysphagia.

Inclusion criteria critically-ill adults:

1. adult ≥ 18 years old
2. ICU patients requiring monitoring or treatment for respiratory failure and/or shock (e.g., hypovolemic, septic, and/or cardiogenic)
3. cognitive capacity and willingness to provide informed consent
4. medically stable for testing (e.g., can sit upright, respiratory status is stable \[Sp02 > 90%, off mechanical ventilation or CPAP/BiPAP for > 30 minutes, respiratory rate < 30 bpm\], and Richmond Agitation-Sedation Scale score is 0 (awake and alert).

Exclusion criteria critically ill adults:

1. neurological disease diagnosis
2. history of head and neck cancer/surgery to the head and neck region
3. history of dysphagia prior to ICU admission.

Inclusion criteria caregivers:

1. caregiver of critically ill adult who meets inclusion criteria for study
2. willing to complete questionnaire.

Exclusion criteria caregivers:

1. not a caregiver of critically ill adult
2. unwilling to complete questionnaire.