Nursing home residents suffering from dysphagia, a common problem with swallowing among the elderly, are at greater risk of death, according to a new study.

Those experiencing weight loss and dysphagia face an even higher mortality, and require special attention from nursing homes, researchers advised. Those are a few of the findings published in the September issue of the Journal of Post-Acute and Long-Term Care Medicine, the organization said Wednesday.

Pouring over data from 191 nursing homes in 14 countries, German researchers estimated that about 15% of residents displayed obvious cases of dysphagia. Of the more than 10,000 residents included, the six-month mortality rate was significantly higher (24.7%) compared to those without the condition (11.9%). Death rates climbed even higher, to 38.9%, for those who had experienced weight loss.

The study authors note that this may be the “tip of the iceberg,” as reported rates of dysphagia vary greatly,with a wide range of definitions and diagnostic methods across the globe.