Direct-access model for dysphagia management in community-dwelling older adults: retrospective analysis of 120 patients

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Abstract Background Oropharyngeal dysphagia is a significant geriatric syndrome linked to severe clinical complications, yet community-dwelling older adults frequently normalize symptoms, leading to under-reporting and delayed care. While hospital-based management is highly protocolized, routine community screening remains low. This study evaluates a community-integrated service model designed as an alternative to traditional medical gatekeeping through public health literacy outreach and direct patient access. Methods A retrospective observational cohort study was conducted on the 120 unique patients (mean age 81.56 years; 44 males, 76 females) treated between May 2024 and July 2025 at a private teaching hospital in Hong Kong SAR, China. Participants were stratified by entry portal into a proactive, community-driven direct-access pathway ( n = 95) or a traditional, physician-driven referral pathway ( n = 25). Swallowing status and function were classified using the Functional Oral Intake Scale and the Functional Dysphagia Scale. Descriptive and inferential statistics were used to compare clinical profiles and outcomes between the pathways. Results The direct-access cohort demonstrated substantial medical complexity, exhibiting high prevalence rates of stroke (24.2%), dementia (24.2%), and Parkinson’s disease (12.6%), which were statistically indistinguishable from the Clinical-Referral cohort ( p = 0.741) At baseline, only 19.2% of the overall cohort presented with normal swallowing function, while 71.7% required immediate texture modifications. Universal care was provided, with 100% of patient-caregiver dyads receiving specialized education, 94.2% receiving tailored diet specifications, and 56.7% undergoing individualized rehabilitation exercises. Following intervention, 20.8% of the total cohort were successfully discharged, and 12.5% were triaged to external medical specialties. Conclusions A proactive community direct-access model in this study demonstrated that it can be effective in identifying high-risk, clinically significant dysphagia in community-dwelling seniors who are prone to normalizing their symptoms. This approach offers a plausible framework for early risk management, supporting ageing-in-place initiatives and establishing speech-language pathologists as accessible primary care gatekeepers.