Study On Factors Influencing Dysphagia In Elderly Patients With Chronic Obstructive Pulmonary Disease Based On Structural Equation Modeling

Objective To understand the incidence of swallowing disorders in elderly patients with Chronic Obstructive Pulmonary Disease(COPD),to explore the influencing factors through structural equation modeling,and to analyze the pathways and effects of each influencing factor to provide a basis for the development of interventions for swallowing disorders in elderly COPD patients.Methods Using the convenience sampling method,1182 elderly COPD patients in the respiratory medicine departments of 13 general hospitals in Ningxia region from April 2019 to August 2020 were selected as the study population,using the general information questionnaire,the Water swallowing test,the Barthel Index,the COPD Assessment Test,the FRAIL debilitation assessment scale,Short Form Mini Nutritional Assessment,and the Geriatric Depression Scale to investigate patients.Exploratory factor analysis was used to construct measurement models,and structural models were constructed by combining literature and professional knowledge to form initial structural equation models.The absolute fitness index,value-added fitness index and parsimony fitness index were used to assess the degree of fit of the model to the data.The modification index,critical ratios,path coefficients and standardized residuals are taken into account,and the model is revised according to the modification index and the actual situation to obtain a model that meets the fitness requirements.Results1.There were 941(79.61%)non-swallowing cases and 241(20.39%)swallowing disorders in 1182 elderly COPD patients.2.The results of the univariate analysis of general information on swallowing disorders and non-swallowing disorders in elderly COPD patients showed that there was no statistically significant difference between different occupations,education level,marital status,residence mode and number of co-morbidities(P>0.05);there was a statistically significant difference between different genders,ages and BMI(Body Mass Index)(P<0.05).3.An exploratory factor analysis was conducted to determine the factors that may affect swallowing disorders in elderly COPD patients,and seven latent variables were constructed based on the exploratory factor analysis: overall condition(frailty,depression,nutritional status,CAT score,ability to perform activities of daily living),disease condition(sputum,cough and breathing),eating condition(eating position,eating time and ability to concentrate on eating),bronchodilators(anticholinergics,theophyllines and beta agonists),chronic diseases(coronary heart disease,diabetes and hypertension),age factors(number of missing teeth and age),smoking condition(gender and smoking history).4.The initial structural equation model was tested for goodness of fit with absolute fitness index GFI=0.946,AGFI=0.930,RMSEA=0.047;value-added fitness index NFI=0.894,IFI=0.921,RFI=0.875,TLI=0.906,CFI=0.920;parsimony fitness index PGFI=0.733,PNFI=0.759,PCFI=0.781,χ~2 degrees of freedom ratios=3.640.The GFI,AGFI,RMSEA,IFI,TLI,CFI,PGFI,PNFI,and PCFI values met the model fitness criteria,but the NFI,RFI,and χ~2 degrees of freedom ratios did not meet the acceptable criteria.5.The modified structural equation model with absolute fitness index GFI=0.958,AGFI=0.944,RMSEA=0.040;value-added fitness index NFI=0.919,IFI=0.946,RFI=0.902,TLI=0.934,CFI=0.945;parsimony fitness index PGFI=0.723,PNFI=0.760,PCFI=0.782,χ~2degrees of freedom ratios=2.856.The model fits well,and all indices meet the fitness criteria.6.The effect relationships for the influence of factors on swallowing disorders in elderly COPD patients were that the overall condition of the surveyed subjects had a direct effect on swallowing disorders(effect value of 0.159);disease condition,eating condition,and chronic disease not only had a direct effect on swallowing disorders,but also had an indirect effect through overall condition(direct effect values respectively were 0.189,-0.126,0.111;indirect effect values respectively were 0.048,-0.019,0.019;total effect values respectively were 0.237,-0.145,0.130),and bronchodilator and smoking condition had not only direct effects on swallowing disorders,but also indirect effects through disease condition(direct effect values respectively were-0.311,0.188;indirect effect values respectively were-0.045,0.041;total effect values respectively were-0.356,0.229);age factor had not only a direct effect on swallowing disorders,but also an indirect effect through overall condition and disease status(direct effect values was 0.318;indirect effect values was 0.109,total effect values was 0.427).Conclusion1.The incidence of swallowing disorders in elderly COPD patients was 20.39%.2.The structural equation model fits well,and the overall condition,disease condition,eating condition,chronic disease,age factor,bronchodilators and smoking condition of the study subjects affect the swallowing disorders of elderly COPD patients.The factors of influence were: overall condition had a direct effect on swallowing disorders;disease condition,eating condition and chronic disease not only had a direct effect on swallowing disorders,but also through overall condition influence them;bronchodilators and smoking condition not only had a direct impact on swallowing disorders,but also through disease condition influence them.Age factors not only have a direct impact on swallowing disorders,but also can be influenced by the overall condition and disease condition.