The importance of integrated care in the management of dysphagia among homebound older patients with heart failure: a narrative review

Introduction: Older homebound patients frequently present with dysphagia and heart failure, two interrelated geriatric syndromes that create a negative cycle resulting in aspiration pneumonia, malnutrition, hospital readmissions, poor prognosis, and diminished quality of life (QOL). In this review, we highlight the importance of integrated care and propose practical approaches to managing these conditions in home care settings. Methods: We conducted a narrative review of the literature addressing the association between dysphagia and heart failure in older adults, with a focus on studies and guidelines relevant to home care. Key themes regarding pathophysiology, clinical challenges, and multidisciplinary strategies for comprehensive management were identified. Results: Heart failure can impair swallowing function through circulatory insufficiency, sarcopenia, and overall frailty. Conversely, dysphagia can worsen heart failure through repeated aspiration events and poor nutritional intake. Compared with hospital environments, home care is resource-limited, leading to delays in assessment and intervention. Evidence suggests that integrating dysphagia management into heart failure care, even in such settings, may help mitigate the negative cycle. Involving multidisciplinary teams-including physicians, nurses, dentists, dietitians, and speech-language-hearing therapists-can optimize circulatory dynamics, nutritional status, oral function, and safe oral intake based on individual risk assessment. Discussion: Integrated and multidisciplinary care is essential for managing older homebound patients with comorbid heart failure and dysphagia. Tailored approaches that consider disease stage and patient and caregiver preferences can enhance safety, reduce readmissions, and maintain dignity and QOL. This review underscores the urgent need for comprehensive care models addressing both conditions simultaneously in resource-limited home care environments.