Post-Stroke Dysphagia Linked to Greater Dependency, Inability to Return to Work

New research is shedding light on serious psychosocial consequences associated with post-stroke dysphagia, including increased dependency in daily living and a greater risk of being unable to return to work.1

Findings from the analysis of STROKE-CARD Registry data highlight ways in which dysphagia's impact extends beyond physical recovery to create distinct barriers to social rehabilitation, underscoring the need for awareness as well as comprehensive rehabilitation strategies addressing both the physical and psychosocial impacts of post-stroke dysphagia.1

Dysphagia is a common consequence of stroke, putting affected patients at risk for pneumonia, malnutrition, dehydration, and significantly affecting quality of life. Successful post-stroke recovery depends heavily on psychosocial reintegration, but dysphagia may pose important implications for this recovery process.1,2

“Dysphagia is a frequent complication of acute ischemic stroke that extends beyond its well-documented physical implications of malnutrition, pneumonia and mortality,” Anel Karisik, MD, of the Medical University of Innsbruck, and colleagues wrote.1 “While these immediate medical consequences are well-studied, the impact of post-stroke dysphagia on psychosocial recovery remains under-investigated.”

To examine the relationship between post-stroke dysphagia and early psychosocial outcomes 3 months after acute ischemic stroke, investigators assessed data from the STROKE-CARD Registry, a prospective observational registry aimed at monitoring the long-term outcomes of patients with acute ischemic stroke or high-risk transient ischemic attack. In the present analyis, investigators included all consecutive ischemic stroke patients admitted to the Medical University of Innsbruck between December 2020 and August 2023.1

All patients underwent systematic dysphagia screening within 24 hours of admission using the Gugging Swallowing Screen (GUSS). Patients who failed screening underwent detailed clinical swallowing examination by speech and language therapists.1

Investigators assessed 3 key psychosocial outcomes at baseline and 3-month follow-up through structured clinical interviews and systematic documentation review:

• Dependency, which was defined as new requirement for assistance with daily activities, specifically the need for a 24-hour care or eligibility for a governmental care allowance
• Living status, which was categorized as independent (living alone or with partner and/or children) versus dependent (nursing facility or residing with relatives due to nursing needs), with change defined as transition from pre-stroke independence to post-stroke dependence
• Employment status, which was assessed in participants < 65 years of age, with changes defined as a shift from active pre-stroke employment to inactive status post-stroke, including sick leave or early retirement due to stroke-related disability

Among 1117 patients included in the analysis, 233 (20.9 %) were diagnosed with dysphagia during initial stroke admission (mean 1.7 ± 1.2 days). Among those with dysphagia, the mean age was 70.6 ± 13.4 years and 36.3% were female.1

The proportion of patients with persisting dysphagia until discharge (mean 14.0 ± 8.3 days) was 165 (14.6 %), and the severity of dysphagia was classified as mild in 106 (45.5 %), moderate in 95 (41.2 %), and severe in 31 (13.3 %) cases. Of note, patients with dysphagia presented with more severe strokes (median NIHSS, 7; IQR, 3–14 vs median NIHSS, 2; IQR 1–4; P <.001) at hospital admission.1

Investigators achieved a follow-up rate of 98.3%, with 19 patients lost to follow-up, including 13 due to death within 3 months post-stroke.1

At 3 months post-stroke, investigators noted patients with dysphagia showed significantly greater rates of adverse psychosocial outcomes compared to those without, including dependency in daily activities (23.0% vs 5.1%; adjusted odds ratio [aOR], 2.63; 95% CI, 1.5–4.5) and need for governmental care allowance (34.2% vs 9.0%; aOR, 2.41; 95% CI, 1.6–3.8). Additionally, in working-age patients ≤ 65 years of age, those with dysphagia were more likely not to return to work (69.4 % vs 29.7 %, aOR 2.61; 95% CI, 1.2–5.8).1

“These findings emphasize that dysphagia's impact extends beyond physical recovery to create distinct barriers to social rehabilitation,” investigators concluded.1 “Our results underscore the need for comprehensive rehabilitation strategies that address both the physical and psychosocial challenges faced by stroke survivors with dysphagia.”

References

1. Karisik A, Moelgg K, Buergi L, et al. Impact of dysphagia on early psychosocial consequences after acute ischemic stroke. J Neurol Sci. 2025;476:123624. doi:10.1016/j.jns.2025.123624

2. González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after Stroke: an Overview. Curr Phys Med Rehabil Rep. 2013;1(3):187-196. doi:10.1007/s40141-013-0017-y