Experience in the Application of GUSS Swallowing Function

Assessment Scale and Self-Rating Masticatory Ability Assessment

Scale for the Elderly People Health Care

Minchuan Huang

1,*

, I Ping Chen

2,*

and Shuying Chung

School of Computer Science, Guangdong University of Petrochemical Technology, Maoming 525000, China

Institute of Nursing College, Central Taiwan University of Science and Technology, Taichung, 406053, Taiwan, China

Keywords:

Gugging Swallowing Screen (GUSS), Swallowing Function, Masticatory Ability, Geriatric Medicine,

Empirical Nursing Care.

Abstract: Elderly people have progressive problems with swallowing function degradation as they get older. The

degradation of swallowing function has a great impact on many living diets in the elderly, which easily causes

body dehydration, nutrition imbalance, with and without susceptibility to aspiration pneumonia, problems

with physiological function, and psychological problems. Common problems, elderly people fear of eating

and drinking due to choking, self-social isolation, pulmonary trachea phlegm and other problems. The elderly

will also have a decreased swallowing function, a reduced oral intake capacity, and a significantly lower

ability to perform activities of daily living. To cite GUSS (gugging swallowing screen) swallowing function

assessment scale and self-rated masticatory ability assessment scale, five elderly people with different age

intervals were selected to implement clinical real-life observation and interview record, according to the

research subjects' self-conscious health and no swallowing function present status, the suggestions and

precautions for planning self-improvement methods.

1 INTRODUCTION

According to Article 2 of the legal database of

Taiwan's elderly welfare law, the age standard of the

elderly is that those over 65 are called old persons

(Balou, 2019; Krishnan, 2020). Many medical studies

have shown that effective and safe swallowing ability

is an important factor in maintaining health and

quality of life. Swallowing function involves a

complex coordination process of psychology, feeling

and motor behavior (Nuchit, 2020; Carnaby, 2020;

Shimizu, 2021; Sasegbon, 2017).

Dysphagia definition: there are problems involving

the mouth, pharynx, esophagus or gastroesophageal

junction in the process of food entering the stomach

from the mouth through chewing. Dysphagia is the

inability to chew food effectively. One or more foods

cannot be safely Swallow into the esophagus.

Uncoordinated breathing and swallowing.

Swallowing activities are divided into oral

preparation stage, oral stage, pharyngeal stage and

esophageal stage according to the location of food. If

there is a problem in any stage that affects eating, it

is also an abnormal phenomenon of swallowing

(Kuramoto, 2020).

Dysphagia in the elderly is the most common and

life-threatening serious problem, such as aspiration

pneumonia, malnutrition, dehydration and so on. In

view of the increasing popularity of chewing and

swallowing difficulties, especially in the elderly of

different ages (e.g. 65, 70, 80 and 90 years old),

chewing and swallowing problems have varying

degrees (Jardine, 2021).

To explore the incidence of dysphagia in the elderly,

research in Taiwan shows that dysphagia affects the

elderly in the community: 15% at the age of 65, 23%

at the age of 70, 16.6% at the age of 70 to 79 and 33%

over the age of 80. Foreign studies have shown that

dysphagia affects elderly patients: 56% to 78% of

hospitalized elderly patients, 47.5% of hospitalized

elderly patients in acute geriatric ward, 30% of stroke

patients, 52% to 82% of patients with Parkinson's

disease, 60% of patients with lateral amyotrophic

sclerosis, 40% of patients with multiple sclerosis and

84% of patients with Alzheimer's disease (Wirth,

2016). The prevalence of pharyngeal disorders in the

Huang, M., Chen, I. and Chung, S.

Experience in the Application of GUSS Swallowing Function Assessment Scale and Self-Rating Masticatory Ability Assessment Scale for the Elderly People Health Care.

DOI: 10.5220/0012018100003633

In Proceedings of the 4th International Conference on Biotechnology and Biomedicine (ICBB 2022), pages 187-191

ISBN: 978-989-758-637-8

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

187

elderly population is high, but it is underestimated

and underdiagnosed. It may increase related

complications, affecting morbidity, length of hospital

stay and medical costs (Khan, 2014).

2 SYMPTOMS AND

EVALUATION OF DYSPHAGIA

Dysphagia symptoms are common in the elderly

(Kahrilas, 1994; Vose, 2018; Ashiga, 2019).

Assessment tools include GUSS (pigging swallowing

screen), SSA (standardized swallowig assessment),

EAT-10 (eating assessment tool), SWAL-QOL

(swallowing quality of life), SPDQ (self-competent

dysphagia questionnaire), self-assessed screening

test for masticatory ability.

2.1

Symptoms of Dysphagia

Symptom observation of clinical nursing: excessive

oral action is required for chewing or swallowing.

Coughing or choking often occurs during or after

eating. Each bite needs to be swallowed two or three

times. There is still a lot of food left on the tongue

after dinner. The food is piled on one side of the

mouth but not consciously. Food falls out during

chewing. Easy to drool, especially during meals.

There is often a large amount of secretion (saliva)

around the mouth. When entering, there will be a

grunt (similar to phlegm sound).

2.2 Key Factors Affecting Swallowing

Function in the Elderly

The physiological changes of aging include muscle

atrophy, decreased tissue elasticity, structural

changes of the cervical spine, decreased saliva and

decreased brain response. The insufficient strength of

the tongue leads to the obstacle of chewing and the

inability to trigger the swallowing reflex in time

(Khan, 2014). Aging causes the decline of oral

sensory function, the decrease of the number of taste

buds and the atrophy of oral mucosa, which affects

the passivation of tongue and lip to spatial touch, the

decrease of oral sense to viscous substances, the

deterioration of body feeling and the dullness of taste

(Youmans, 2006). The slow process of reflection

leads to obvious delay in the transmission and

pushing of food mass, which is easy to cause the

inhalation of foreign bodies and lead to aspiration

pneumonia. The lack of hyoid bone displacement and

the reduction of hyoid bone, epiglottis ligament,

muscle fibres will affect the protective mechanism of

the respiratory tract: aging will affect the as chewing

difficulty or swallowing.

3 CLINICAL SWALLOWING

EVALUATION AND TEST

RESULTS

Using GUSS, EAT-10 and Self-assessed screening

test for masticatory ability, five elderly people in the

community were healthy and had no swallowing

problems (Vose, 2018; Molfenter, 2018). Chart of

clinical evaluation and testing is shown in Figure 1.

Figure 1: Chart of clinical evaluation and testing.

ICBB 2022 - International Conference on Biotechnology and Biomedicine

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3.1 Clinical Trial

Conditions and methods of clinical swallowing test:

the subjects should be awake and can cooperate with

the instructions. Subject SaO2 > 90%, no obvious

respiratory urgency or insufficient vocal cord / throat

function, and no oxygen mask or respirator is

required. The subject had no suspected symptoms of

aspiration pneumonia in the past 3 days. Before the

test, clean the mouth, according to the standard

procedure to avoid choking food / secretions during

the test. First give the subject 3ml of water to drink,

observe whether there is any problem, and repeat the

same step 3 times. If there is no abnormal

swallowing, increase the amount of water tested to 10

ml, 30 ml and 50m in sequence. If the subject will

choke in any process, stop the test and record the

reaction during swallowing. Participants: five elderly

people in the community who felt healthy and had no

swallowing function problems.

3.2 Gugging Swallowing Screen

(GUSS)

Table 1: Indirect swallowing test and direct swallowing

test.

GUSS

(Guggi

Swallo

wing

Screen)

♂96 ♀91 ♂74 ♀84 ♀71

Total

score

20 18 20 17 20

1. ※Sample: add thickeners with one third to half

spoon water (thick as pudding) Ask the patient has

3-5 spoon if without any symptoms, assess after 5

spoons.

2. ※Following 3,5,10,20ml water ， continue

with50ml water if without any symptoms, assess

until presence of listed results.

3. ※Clinic: Fibrotic Nasopharyngoscope

swallowing function test: dry bread soaked in color

liquid.

4. ※Use functional examination, such as

swallowing X-ray television fluoroscopy, fiber

Nasopharyngoscope swallowing function

examination.

3.3 Eating Assessment Tool (EAT-10)

Early detection of patients at high risk of swallowing

disorders in order to receive further swallowing

evaluation and swallowing treatment as soon as

possible. A score of 3 or more is dysphagia. The

reliability and validity of eating assessment tool

EAT-10: The Cronbach alpha was 0.960. The

correlation coefficient within the test retest project

ranges from 0.72 to 0.91 (Belafsky, 2008).

Table 2: Assessment of swallowing ability (EAT-10):

within 3 months, 10 questions will be assessed (score

means: 0 is no problem, 4 is serious).

EAT-10

(Eating

Assessment

Tool

)

♂9

♀9

♂7

♀8

♀7

Total score 1 11 10 5 5

5. ※judgment result ≥ 3 points: abnormal.

Represents a possible risk of dysphagia.

3.4 Self-Assessed Screening Test for

Masticatory Ability

Table 3: self-assessed screening test for masticatory ability.

self-

assessed

screening

test for

masticatory

abilit

♂96 ♀91 ♂74 ♀84 ♀71

Total score 3 10 6 10 6

6. ※Within 6 months, evaluate the following 14

questions. Judgment result: some laborious and

unable to eat ≥ 4 kinds.

4 MEDICAL AND NURSING

PROGRAMS

The case receiving process of the empirical study on

oral care for the elderly is divided into seven steps, as

shown in Figure 2. The flow chart of evaluation

empirical research.

Experience in the Application of GUSS Swallowing Function Assessment Scale and Self-Rating Masticatory Ability Assessment Scale for

the Elderly People Health Care

189

Figure 2: The flow chart of evaluation empirical research.

4.1

Consultation Program for Finding

Dysphagia

Visit a qualified medical institution: evaluation and

referral of rehabilitation department or

Otorhinolaryngology department. Speech therapist

assesses swallowing function. Provide swallowing

training. Swallowing related health education

courses. Radiation therapist if swallowing

photography is required, the radiologist shall assist in

it after being referred by the doctor. Nutritionist a

balanced and complete diet is recommended. Suitable

nutritious food or nutritious fortified food is

recommended.

4.2

Video-Fluoroscopic Swallowing

Study (VFSS)

The golden (best) standard for evaluating patients'

swallowing ability. To confirm the structural and

physiological abnormalities causing the patient's

symptoms. Identify and evaluate the ability and

treatment plans for patients to eat safely and / or

effectively. It needs to be evaluated by the dynamic

image the television fluorescence photography

(VFSS).

4.3

Oral and Pharyngeal Mobility

Exercise

Oral movement control exercise, tongue activity,

exercise, impedance movement, food, ball control

movement, improve the rough movement of getting

objects, the movement of holding close food ball, the

movement of promoting food ball, the activity of

pharyngeal structure, respiratory tract entrance, vocal

cord closure movement, tongue root movement,

laryngeal lifting movement (false voice exercise),

neuromuscular electric stimulation.

Head and neck relaxation exercise: Tilt your head

to the left and right, lower your head and raise your

head. Mouthwash saliva swallowing movement: hold

your left hand flat to rotate next to your left cheek,

and your left cheek is in the shape of mouthwash. Lip,

tongue and tooth movement: extend the tongue to

move left and right. Oral rotation: make a snapping

sound and a lip shape that makes a snapping sound.

5 CONCLUSION

With the deterioration of tongue muscle strength and

the aging of teeth, the diet of the elderly may indeed

bring many difficulties and inconvenience in

chewing and swallowing.

However, with proper maintenance and treatment

of teeth, effective training of tongue muscle strength,

adjustment of food types and selection of suitable

food materials, the elderly can still eat nutritionally

balanced and delicious.

ACKNOWLEDGMENTS

We would like to thank the School of Nursing,

Central Taiwan University of Science and

Technology, the Taichung Blood Donation Center of

the Taiwan Blood Foundation, and Guangdong

University of Petrochemical Technology (Project

Number: 2019rc076 (702-519186, 702-

72100003102)).

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