Application of Orofacial Muscle Strength Measurement to Screen for Penetration/Aspiration Risk in Older Adults With Sarcopenia: A Diagnostic Accuracy Study

Background: Early identification of penetration/aspiration (P/A) risk in older adults with sarcopenia is crucial to prevent complications and maintain quality of life.

Purpose: To evaluate the diagnostic utility of orofacial muscle strength measurements for predicting the risk of P/A in older adults with sarcopenia.

Methods: In this observational and prospective study, we collated consecutive data from community-dwelling older adults diagnosed with sarcopenia at a musculoskeletal disorder clinic. Altogether, 54 participants underwent orofacial muscle strength measurements (the index test) using the Iowa Oral Performance Instrument and a videofluoroscopic swallowing study (VFSS) (the reference test) to evaluate for the presence of P/A. Receiver operating characteristic (ROC) curve analysis was performed to determine orofacial muscle strength based on P/A.

Results: Overall, 34 patients showed penetration in the VFSS, although none of the patients showed signs of aspiration. The cut-off for tongue strength to identify the risk of P/A was ≤ 20.5 kPa, with a sensitivity and specificity of 0.75 and 0.74, respectively; the area under the curve (AUC) was 0.88. The cut-off for buccinator strength was ≤ 19.5 kPa, with a sensitivity and specificity of 0.65 and 0.68, respectively, with an AUC of 0.69. The cut-off for lip muscle strength was ≤ 18.5 kPa, with a sensitivity and specificity of 0.65 and 0.71, respectively, with an AUC of 0.69.

Conclusion: The evaluation of buccinator and lip muscle strength did not demonstrate sufficient diagnostic utility for detecting the risk of P/A in older patients with sarcopenia; however, tongue strength showed reliable diagnostic utility for identifying the risk of P/A.