Screening for dysphagia in older people: A validation study of the psychometric properties of the Danish 4 Question Test (4QT-DK)

AIM: The four-item questionnaire test (4QT) is a simple screening measure of dysphagia for older people. A positive answer to any item indicates the need for further assessment. The 4QT is fast, simple to apply and requires no training beforehand. However, it is not translated to Danish, and the psychometric properties in an older Danish population are unknown. The aim was to translate the 4QT to Danish, determine criterion validity according to the existing measures, the Minimal Eating Observation Form-II (MEOF-II) and Volume-Viscosity Swallow Test (V-VST), and determine construct and structural validity and reliability by exploring whether 4QT fits the assumptions of the Rasch model.

METHODS: The 4QT was translated and back-translated. A total of 73 participants aged ≥65 years were included and screened with the 4QT-DK, and assessed using the V-VST and MEOF-II. Criterion validity was assessed compared with the V-VST and MEOF-II according to sensitivity, specificity and predictive values. Construct and structural validity were examined using confirmatory factor analysis and Rasch model analysis investigating item and person fit, differential item functioning for sex, age, primary disease and local dependency. Reliability was assessed using Cronbach's coefficient alpha.

RESULTS: For criterion validity, the 4QT-DK showed high sensitivity (84% and 90% with the V-VST and MEOF-II, respectively). As expected, specificity was lower (36%, and 42%). Analyses confirmed the psychometric validity of the 4QT-DK. Reliability was low (Cronbach's alpha = 0.58) due to the number of items.

CONCLUSION: The 4QT-DK is a valid and sensitive measure for screening older people for dysphagia. Further studies are required to assess the psychometric properties and confirm findings in a larger Danish sample. Geriatr Gerontol Int 2025; 25: 294-299.