Risk factors for aspiration pneumonia in frail older people: a systematic literature review

Risk factors of pneumonia after thoracic aortic surgery

OBJECTIVE

Pneumonia is a common complication and a significant cause of mortality following cardiovascular surgery. This study aimed to investigate the incidence and risk factors for pneumonia after thoracic aortic surgery.

METHODS

A retrospective review was conducted on the medical records of 380 patients who underwent thoracic aortic surgery between January 2016 and December 2019. Patients were classified into pneumonia and non-pneumonia groups based on postoperative outcomes. Pneumonia was further categorized as aspiration pneumonia, ventilation-associated pneumonia (VAP), or other types. Risk factors were identified through univariate and multivariate analyses.

RESULTS

Postoperative pneumonia during hospitalization occurred in 30 patients (7.9 %), including 18 cases of aspiration pneumonia (4.7 %) and 9 cases of VAP (2.4 %). Risk factors identified included hoarseness before surgery, aortic arch replacement, longer anesthesia time, longer intubation duration, necessity for tracheostomy, cerebrovascular disease after surgery, and postoperative recurrent laryngeal nerve paralysis. Multivariate analysis suggested that hoarseness before surgery and the necessity for tracheostomy were independent risk factors for pneumonia during hospitalization.

CONCLUSION

This study identified key risk factors for postoperative pneumonia after thoracic aortic surgery. These findings may aid in identifying high-risk patients and implementing preventive strategies to reduce postoperative pneumonia.

Predictors of Pneumonia in Patients With Penetration-Aspirations Detected on Fiberoptic Endoscopic Evaluation of Swallowing

Aspiration pneumonia is a serious condition resulting from swallowing dysfunction. However, predicting high risk patients remains challenging. This study aimed to assess the incidence and risk factors for pneumonia in oropharyngeal dysphagia patients exhibiting episodes of penetration or aspiration during fiberoptic endoscopic swallowing evaluation (FEES). A retrospective analysis was performed on patients who visited a dysphagia clinic between 2016 and 2022, and demonstrated at least one episode of penetration or aspiration during the FEES (Penetration Aspiration Scale [PAS] score ≥ 3). Data collected included demographics, comorbidities and FEES findings. Outcomes included mortality, hospital admissions to treat pneumonia events, and incidents of pneumonia managed by primary care providers or outpatient medical facilities. Statistical analyses included descriptive statistics, chi-squared tests, t-tests, logistic regression and Kaplan-Meier survival analysis. Among 73 patients (mean follow-up: 3.87 ± 1.5 years), 33 (45.2%) exhibited penetration, and 40 (54.8%) aspiration. Pneumonia developed in 41 patients (56%), with 33 (45%) hospitalized. A total of 28 patients (38.4%) died during follow-up. A history of prior pneumonia (OR: 1.374, p = 0.02) and Murray Secretion Scale score (OR: 1.121, p = 0.022) were associated with subsequent pneumonia events. Reduced laryngeal sensation showed a near-significant trend toward association with pneumonia-related hospitalizations in the penetration group (58.3% vs. 19%, P = 0.052). No significant association was found between PAS and pneumonia or mortality. Prior pneumonia and secretions accumulation during FEES significantly predict pneumonia in patients presenting with penetration-aspiration during FEES. Reduced laryngeal sensation showed a nearly-significant trend toward pneumonia-related hospitalizations.

Exploring the role of respiratory virus infections in aspiration pneumonia: a comprehensive analysis of cases with lower respiratory tract infections

BACKGROUND

While respiratory virus infection has been implicated in the onset of bacterial pneumonia, no research has investigated the association of respiratory viruses with the onset of aspiration pneumonia (AP). This study aimed to investigate the role of respiratory virus infections in AP.

METHODS

Patients presenting with acute respiratory symptoms and undergoing influenza antigen testing at the emergency department of Okinawa Chubu Hospital from February 2020 to January 2021, and diagnosed with lower respiratory tract infections, were included. Cases were categorized into AP, pneumonia other than AP (non-AP), and acute bronchitis (AB) based on physician diagnoses recorded in medical records. The residual nasal swab specimens were further tested with multiplex PCR tests for respiratory viruses.

RESULTS

A total of 209 subjects were included in the study: 59 in the AP group, 118 in the non-AP group, and 32 in the AB group. The AP group was characterized by older age, higher rates of nursing home residency, a greater prevalence of comorbidities such as cerebrovascular disease and dementia, a lower sputum culture positivity rate, and a different spectrum of causative pathogens compared to the other groups. The virus positivity rate in the AP group was 47%, compared to 50% in the non-AP group and 53% in the AB group, with no significant difference observed. The AP group exhibited the highest rate of only respiratory viruses detected and the lowest rate of both respiratory viruses and bacteria detected among the groups. There was no significant difference in the types of viruses detected between the AP group and the other groups, with rhinovirus being the most frequently detected virus across all groups. In the AP group, virus-negative cases were significantly older on average. No other significant differences in background, symptoms, or clinical data were observed between virus-positive and virus-negative cases within the AP group.

CONCLUSION

In the AP group, the rate of respiratory virus detections was comparable to that of the non-AP and AB groups. This suggests a potential link between respiratory virus infections and the development of AP, emphasizing the need for novel preventive strategies. While distinguishing between AP patients with and without respiratory virus detections based on clinical findings was challenging, recognizing the frequent involvement of respiratory virus infections in AP highlights the importance of enhanced infection control and awareness in its management.

Fiberoptic Endoscopy Evaluation of Swallowing (FEES) Findings Associated with High Pneumonia Risk in a Cohort of Patients at Risk of Dysphagia

Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia.

[Pneumonia due to silent aspiration: a diagnostic and therapeutic challenge]

Aspiration pneumonia (AP) may present as gross aspiration of large gastric contents or as a consequence of silent aspiration of contaminated oropharyngeal secretions.AP due to silent aspiration is caused by dysphagia and, in some instances, impaired cough reflex. Factors favouring the development of pneumonia include advanced age as well as severe comorbidity and impaired functional status.Therefore, silent aspiration is a frequent etiology of community-acquired pneumonia in aged patients but also of nosocomial pneumonia. Recurrent pneumonia should always prompt the consideration of AP.Treatment of acute AP should include not only the use of antimicrobial agents but also chest physiotherapy and airway clearance techniques. In addition, all patients with silent aspiration and AP should be subject to an investigation of swallowing function and, in the presence of dysphagia, also receive treatment for this condition. This includes methods of restitution, compensation and adaptation of impaired swallowing function.

Predictors and inpatient outcomes of aspiration pneumonia in patients with percutaneous endoscopic gastrostomy tube: An analysis of national inpatient sample

BACKGROUND

Percutaneous endoscopic gastrostomy (PEG) tubes are commonly inserted to provide a route for enteral feeding in patients who are unlikely to have adequate oral intake for prolonged periods of time. This study aims to determine the incidence of aspiration pneumonia among PEG tube patients.

METHODS

We conducted a retrospective analysis of NIS database records (October 2015 to December 2020) for patients with PEG. Primary and secondary outcomes were assessed using ICD-10-CM/PCS codes.

RESULTS

We identified a total of 2,053,560 weighted hospitalizations involving patients with PEG tube. Those with aspiration pneumonia were older (mean age 67.01 vs. 63.85, p < 0.01) and were predominantly male. At baseline, the aspiration pneumonia group had higher rates of dementia (AOR 1.22, 95 % CI: 1.19-1.24), malnutrition (AOR 1.13, 95 % CI: 1.11-1.15), cerebrovascular disease (AOR 1.29, 95 % CI 1.25-1.33), cardiac arrhythmias (AOR 1.05, 95 % CI 1.03-1.08), congestive heart failure (AOR 1.20, 95 % CI 1.17-1.24), COPD (AOR 1.18, 95 % CI 1.15-1.20), paralysis (AOR 1.06, 95 % CI 1.03-1.09), alcohol abuse (AOR 1.12, 95 % CI 1.07-1.17), and psychoses (AOR 1.07, 95 % CI 1.02-1.13). Those with aspiration pneumonia exhibited increased mortality (p < 0.01, AOR 1.59, 95 % CI 1.54-1.65), higher incidence of severe sepsis (AOR 2.03, 95 % CI 1.98-2.07) and longer hospital stays, and accrued greater hospital charges (p < 0.01). Notably, while GERD is typically considered a risk factor for AP, our findings indicated that GERD was associated with a decreased risk of AP in this patient population.

CONCLUSION

Patients with a PEG tube who develop aspiration pneumonia experience increased mortality rates, extended hospitalizations, a higher frequency of septic shock, and augmented healthcare consumption. Notably, old male, congestive heart failure, cerebrovascular disease, dementia, and COPD play a pivotal role in predicting these outcomes.

Association between removable prosthesis-wearing and pneumonia: a systematic review and meta-analysis

BACKGROUND

A high burden of respiratory pathogens colonizing removable prosthesis surfaces suggests the potential of association between removable prosthesis-wearing and respiratory infections. Therefore, this systematic review and meta-analysis aimed to evaluate the evidence from clinical studies concerning the association between removable prosthesis-wearing and respiratory infections.

METHODS

Clinical studies that reported respiratory infections associated with adult patients wearing removable prostheses in any centers (hospitals and nursing homes) or communities were included. Literature was searched across five electronic databases (MEDLINE, Cochrane Library, EMBASE, Web of Science, and Scopus) to 28 May 2024. An additional search was performed for unpublished trials and references cited in related studies. The Newcastle-Ottawa Scale was employed for the quality assessment. The certainty assessment was established using GRADE. The results were pooled using a frequentist random-effects meta-analysis and the odds ratios generated.

RESULTS

A total of 1143 articles were identified. Thirteen articles had full-text articles screening and an additional two articles were added through reference linkage. Ultimately, six non-randomized clinical studies reporting various types of pneumonia contributed to this review. Overall odds of having pneumonia among prosthesis wearers were 1.43 (95% CI: 0.76 to 2.69) and 1.27 (95% CI: 1.11 to 1.46) using the random- and fixed-effects models, respectively. The heterogeneity in the meta-analysis was substantial. In subgroup analysis according to the study design, the heterogeneity within prospective studies was much reduced, I2 = 0% (p = 0.355). The certainty of the evidence evaluated using the GRADE approach was low to very low evidence for prosthesis wearers developing pneumonia based on studies.

CONCLUSIONS

There was no conclusive evidence from the non-randomized clinical studies supporting whether prosthesis-wearing is a risk factor for pneumonia based on outcomes from this review.

Mapping Dysphagia Research Trends in Community Dwelling Older Adults: A Bibliometric Analysis

BACKGROUND

In recent years, research on dysphagia has gained significant traction as one of the key topics of oral health research pertaining to the aged. Numerous academics have studied dysphagia in great detail and have produced numerous excellent scientific research findings.

OBJECTIVE

To review the literature regarding dysphagia in community-dwelling older adults and identify the knowledge and trends using bibliometric methods.

METHODS

The literature on dysphagia in older adults in the community was gathered from the Web of Science Core Collection (WoSCC), with inclusion criteria specifying English-language publications. The retrieval deadline was November 28, 2022. We extracted the following data: title, year, abstract, author, keywords, institution, and cited literature, and used CiteSpace (version 6.1.R3) to visualize the data through the knowledge map, burst keyword analysis, cluster analysis, and collaborative network analysis.

RESULTS

A total of 979 articles and reviews were retrieved. Regarding productivity, the top 2 countries were the United States (n =239) and Japan (n =236). Hidetaka Wakabayashi (n =26) was one of the most prolific writers. The first paper in the frequency ranking of references cited was a white paper: European Society for Swallowing Disorders and European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome (n =53). "Prevalence" (n =173), "risk factor" (n =119), and "aspiration pneumonia" (n =108) were the most frequently occurring keywords (excluding defining nouns). The study identified reliability, tongue pressure, home discharge, and swallowing function as research hotspots from 2020 to 2022.

CONCLUSION

Prevalence, risk factors, and pneumonia are significant areas of study. Tongue pressure and sarcopenia are research hotspots and potential targets. In the future, research on dysphagia needs to refine strategies for prevention and control, as well as provide tertiary preventative services.

Is polypharmacy a risk factor for aspiration pneumonia in older adults? A case-control study

INTRODUCTION

The incidence of aspiration pneumonia and the number of medicines prescribed increase with older age. Many medicines pose a risk for aspiration pneumonia, especially those that decrease swallowing function. Older adults with polypharmacy often receive a combination of these medicines. This study aimed to clarify whether polypharmacy is a risk factor for aspiration pneumonia.

METHODS

Older adults aged ≥ 65 years receiving oral medicines were included in this case-control study. Patients hospitalized for pneumonia served as the case group, and other age-matched hospitalized patients served as the control group. Patient data were collected retrospectively, and logistic regression analysis was performed using items that showed significant differences in the univariate analysis as explanatory variables.

RESULTS

Logistic regression analysis revealed that the number of medicines was not a risk factor for aspiration pneumonia; however, it was associated with the Functional Oral Intake Scale score, male sex, body mass index, and number of comorbidities.

CONCLUSION

Although polypharmacy is often defined only by the number of medicines, it is not a risk factor for aspiration pneumonia. A detailed comparison of prescription medicines between the pneumonia and non-pneumonia groups is necessary.

Supporting safe swallowing of care home residents with dysphagia: How does the care delivered compare with guidance from speech and language therapists?

INTRODUCTION

Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered.

METHODS

Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents' care plans and speech and language therapist recommendations.

RESULTS

Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision.

CONCLUSION

Care homes need to be supported to establish a safe swallowing culture to improve residents' safety and care experience.

WHAT THIS PAPER ADDS

What is already known on this subject? Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents. There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia. Care for nursing home residents at mealtimes is often task-centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia. What this study adds? Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification. Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas. Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported. What are the clinical implications of this work? Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission. Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia. The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines. Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely. Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety.

Recommendations of good practice to prevent aspiration pneumonia in older adults at risk of oropharyngeal dysphagia living in nursing homes: A modified e-Delphi study protocol

BACKGROUND

Aspiration pneumonia (AP) is a subset of pneumonia caused by the aspiration of food and fluids to the lungs and is highly prevalent in the older population. Oropharyngeal dysphagia (OD) is one of the risk factors for AP and it is also associated with malnutrition, dehydration and poor functional outcomes. As pneumonia is the second most common infection in nursing homes (NHs) and OD represents a major concern to NH staff, good practices for the prevention of AP in older adults at risk of OD are needed.

PURPOSE

The aim of this modified e-Delphi study is to build consensus among a panel of experts regarding a set of recommendations for NH staff on good practices to prevent AP in older adults at risk of OD living in NHs. The objective of this paper is to establish the methodology inherent to the Delphi study.

METHODS

An online modified Delphi study will be developed in three rounds. Criteria for the Delphi panel participants include holding a master's or doctoral degree in OD or speech and language therapy; or having 10 or more years of experience in OD; or having at least one scientific publication related to OD. A previously described modified Delphi methodology will be used to achieve consensus (75% agreement). An additional round will be performed to collect the experts' perspectives regarding the priority for application of each recommendation previously validated.

DISCUSSION

This protocol aimed to describe the methodology of a future Delphi study on the prevention of AP, seeking to fulfil the gap in the literature regarding this topic. The modified Delphi technique is a widely used method for collecting experts' opinion in health sciences, but the absence of standardised guidelines allows some heterogeneity between studies with the same aim.

WHAT THIS PAPER ADDS

What is already known on the subject Aspiration pneumonia (AP) is related to three main risk factors: impaired safety of swallow, impaired nutritional status and poor oral health. It is known that being dependent for feeding is one of the main risk factors for AP and around 50% of nursing home (NH) residents need feeding assistance. Thus, it is important to promote specialised intervention and care by the NH staff for preventing AP. What this paper adds to existing knowledge It is hypothesised that increasing the knowledge of NH staff regarding the best practices for preventing AP in older adults at risk of oropharyngeal dysphagia (OD) will improve outcomes such as quality of life, incidence of AP and mortality. What are the potential or actual clinical implications of this work? The recommendations resulting from this study will address a current gap in healthcare practice of NH staff regarding older adults at increased risk for OD and, consequently, for AP.

Dysphagia in Ischaemic Stroke Patients: One Centre Retrospective Study

The aim of this study was to examine the frequency of dysphagia in patients with ischaemic stroke. It was crucial to evaluate the relationship between swallowing disorders and selected demographic and clinical indicators. Additionally, the association between various patient feeding methods and selected demographic and clinical factors was assessed. Based on the analysis of medical documentation, we identified the most important clinical parameters, including demographic data, the frequency of stroke risk factors, the location of the ischaemic lesion, cortical involvement, stroke severity as measured by the NIHSS (Nationale Institutes of Health Stroke Scale), and the methods of feeding post-stroke patients. Dysphagia was observed in 65.9% of the patients in the study group. Hypertension was the most common chronic illness in the studied population of ischemic stroke patients (91.8% of patients). Diet modification (35.7%) and PEG (25%) were the frequent methods of feeding in patients with confirmed dysphagia. Age played a significant role in determining the feeding methods in patients with dysphagia. Patients with a PEG (Percutaneous Endoscopic Gastrostomy) tube were the oldest (79.37 ± 10.80) and 75% of them had pneumonia. Early identification of swallowing difficulties in stroke patients is critical in determining an appropriate and safe feeding plan, as well as initiating logopedics therapy to improve swallowing efficacy and minimize pulmonary complications.

Predictors and impact of aspiration pneumonia in patients undergoing esophagogastroduodenoscopy: national inpatient sample 2016-2020

OBJECTIVES

Aspiration pneumonia is a rare but feared complication among patients undergoing esophagogastroduodenoscopy (EGD). Our study aims to assess the incidence as well as risk factors for aspiration pneumonia in patients undergoing EGD.

METHODS

National Inpatient Sample 2016-2020 was used to identify adult patients undergoing EGD. Patients were stratified into two groups based on the presence of aspiration pneumonia. Multivariate logistic regression analysis was performed to identify the risk factors associated with aspiration pneumonia. We adjusted for patient demographics, Elixhauser comorbidities and hospital characteristics.

RESULTS

Of the 1.8 million patients undergoing EGD, 1.9% of the patients developed aspiration pneumonia. Patients with aspiration pneumonia were mostly males (59.54%), aged >65 years old (66.19%), White (72.2%), had Medicare insurance (70.5%) and were in the lowest income quartile (28.7%). On multivariate analysis, the age >65 group, White race, congestive heart failure (CHF), neurological disorders and chronic obstructive pulmonary disease were associated with higher odds of aspiration pneumonia. This complication was associated with higher in-hospital mortality (9% vs. 0.8%; P  < 0.001) and longer length of stay (10.54 days vs. 4.85 days; P  < 0.001).

CONCLUSION

Our study found that rates of post-EGD aspiration pneumonia are increasing. We found a significant association between various comorbidities and aspiration pneumonia. Our data suggests that we need to optimize these patients before EGD, as the development of aspiration is associated with worsened outcomes. Further prospective studies are needed to clarify these associations.

Identifying patients at increased risk of non-ventilator-associated pneumonia on admission to hospital: a pragmatic prognostic screening tool to trigger preventative action

BACKGROUND

Non-ventilator healthcare-associated pneumonia (NV-HAP) is an important healthcare-associated infection. This study tested the feasibility of using routine admission data to identify those patients at high risk of NV-HAP who could benefit from targeted, preventive interventions.

METHODS

Patients aged ≥64 years who developed NV-HAP five days or more after admission to elderly-care wards, were identified by retrospective case note review together with matched controls. Data on potential predictors of NV-HAP were captured from admission records. Multi-variate analysis was used to build a prognostic screening tool (PRHAPs); acceptability and feasibility of the tool was evaluated.

RESULTS

A total of 382 cases/381 control patients were included in the analysis. Ten predictors were included in the final model; nine increased the risk of NV-HAP (OR between 1.68 and 2.42) and one (independent mobility) was protective (OR 0.48; 95% CI 0.30-0.75). The model correctly predicted 68% of the patients with and without NV-HAP; sensitivity 77%; specificity 61%. The PRHAPs tool risk score was 60% or more if two predictors were present and over 70% if three were present. An expert consensus group supported incorporating the PRHAPs tool into electronic logic systems as an efficient mechanism to identify patients at risk of NV-HAP and target preventative strategies.

CONCLUSIONS

This prognostic screening (PRHAPs) tool, applied to data routinely collected when a patient is admitted to hospital, could enable staff to identify patients at greatest risk of NV-HAP, target scarce resources in implementing a prevention care bundle, and reduce the use of antimicrobial agents.

A Long-Term Study of Adverse Outcomes Associated With Oral Corticosteroid Use in COPD

Background

Oral corticosteroids (OCS) are often prescribed for chronic obstructive pulmonary disease (COPD) exacerbations.

Methods

This observational, individually matched historical cohort study used electronic medical records (1987-2019) from the UK Clinical Practice Research Datalink linked to English Hospital Episode Statistics (HES) to evaluate adverse outcomes in patients with COPD who used OCS (OCS cohort) and those not exposed to OCS (non-OCS cohort). Risk of 17 adverse outcomes was estimated using proportional hazard regression.

Results

Of 323,722 patients, 106,775 (33.0%) had COPD-related OCS prescriptions. Of the 106,775 patients in the overall cohort, 58,955 had HES linkage and were eligible for inclusion in the OCS cohort. The individual matching process identified 53,299 pairs of patients to form the OCS and non-OCS cohorts. Median follow-up post-index was 6.9 years (OCS cohort) and 5.4 years (non-OCS cohort). Adjusted risk of multiple adverse outcomes was higher for the OCS cohort versus the non-OCS cohort, including osteoporosis with/without fractures (adjusted hazard ratio [aHR] 1.80; 95% confidence interval [CI] 1.70-1.92), type 2 diabetes mellitus (aHR 1.44; 95% CI 1.37-1.51), cardiovascular/cerebrovascular disease (aHR 1.26; 95% CI 1.21-1.30), and all-cause mortality (aHR 1.04; 95% CI 1.02-1.07). In the OCS cohort, risk of most adverse outcomes increased with increasing categorized cumulative OCS dose. For example, risk of cardiovascular/cerebrovascular disease was 34% higher in the 1.0-<2.5 g group versus the <0.5 g group (HR 1.34; 95% CI 1.26-1.42).

Conclusion

Any OCS use was associated with higher risk of adverse outcomes in patients with COPD, with risk generally increasing with greater cumulative OCS dose.

Construction and evaluation of a nomogram prediction model for aspiration pneumonia in patients with acute ischemic stroke

Background

Aspiration Pneumonia (AP) is a leading cause of death in patients with Acute Ischemic Stroke (AIS). Early detection, diagnosis and effective prevention measures are crucial for improving patient prognosis. However, there is a lack of research predicting AP occurrence after AIS. This study aimed to identify risk factors and develop a nomogram model to determine the probability of developing AP after AIS.

Method

A total of 3258 AIS patients admitted to Jinshan Hospital of Fudan University between January 1, 2016, and August 20, 2022, were included. Among them, 307 patients were diagnosed with AP (AP group), while 2951 patients formed the control group (NAP group). Univariate and multivariate logistic regression analyses were conducted to identify relevant risk factors for AP after AIS. These factors were used to establish a scoring system and develop a nomogram model using R software.

Results

Univariate analysis revealed 20 factors significantly associated (P < 0.05) with the development of AP after AIS. These factors underwent multivariate logistic regression analysis, which identified age (elderly), National Institute of Health Stroke Scale (NIHSS) score, dysphagia, atrial fibrillation, cardiac insufficiency, renal insufficiency, hepatic insufficiency, elevated Fasting Blood Glucose (FBG), elevated C-Reactive Protein (CRP), elevated Neutrophil percentage (NEUT%), and decreased prealbumin as independent risk factors. A nomogram model incorporating these 11 risk factors was constructed, with a C-index of 0.872 (95 % CI: 0.845-0.899), indicating high accuracy. Calibration and clinical decision analyses demonstrated the model's reliability and clinical value.

Conclusion

A nomogram model incorporating age, NIHSS score, dysphagia, atrial fibrillation, cardiac insufficiency, renal insufficiency, hepatic insufficiency, FBG, CRP, NEUT%, and prealbumin effectively predicts AP risk in AIS patients. This model provides guidance for early intervention strategies, enabling the identification of high-risk individuals for timely preventive measures.

Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists

INTRODUCTION

The contributing factors of aspiration pneumonia have been well documented. However, there are gaps in the literature regarding identifying the weight associated with each factor and the relationship between factors.

METHOD

In this study, 20 potential predictors of aspiration pneumonia (with four additional variables) have been applied to historic Speech and Language Therapy records to greater understand the significance of each contributor of aspiration pneumonia. 152 cases with an oropharyngeal dysphagia, and a Speech and Language Therapy recommendation of eating and drinking with known aspiration and the associated potential risk of developing an aspiration pneumonia, were included in the data. These were inpatients and outpatients, and had various diagnoses but all had had a videofluoroscopy.

RESULTS

Logistic regression analysis found seven factors that were individually significant in predicting the development of aspiration pneumonia with 84.93% sensitivity and 91.03% specificity DISCUSSION: Logistic regression and random forest analyses led to the proposal of a new matrix of predictors of aspiration pneumonia with respective scoring weights for individual and cumulative contributors (a direction for future research).

Pneumonia Risk Increased by Dementia-Related Daily Living Difficulties: Poor Oral Hygiene and Dysphagia as Contributing Factors

OBJECTIVE

Although pneumonia is the leading cause of death among patients with dementia, the specific underlying causes remain unclear. In particular, the potential connection between pneumonia risk and dementia-related daily living difficulties, such as oral hygiene practice and mobility impairment, and the use of physical restraint as a management practice, has not been extensively studied.

METHODS

In our retrospective study, we included 454 admissions corresponding to 336 individual patients with dementia who were admitted to a neuropsychiatric unit due to behavioral and psychological symptoms. The admissions were divided into two groups: those who developed pneumonia while hospitalized (n=62) and those who did not (n=392). We investigated differences between the two groups in terms of dementia etiology, dementia severity, physical conditions, medical complications, medication, dementia-related difficulties in daily living, and physical restraint. To control potential confounding variables, we used mixed effects logistic regression analysis to identify risk factors for pneumonia in this cohort.

RESULTS

Our study found that the development of pneumonia in patients with dementia was associated with poor oral hygiene, dysphagia, and loss of consciousness. Physical restraint and mobility impairment showed a weaker, nonsignificant association with the development of pneumonia.

CONCLUSIONS

Our findings suggest that pneumonia in this population may be caused by two primary factors: increased pathogenic microorganisms in the oral cavity due to poor hygiene, and an inability to clear aspirated contents due to dysphagia and loss of consciousness. Further investigation is needed to clarify the relationship between physical restraint, mobility impairment, and pneumonia in this population.

Dementia, stroke, age, use of medical devices and antipsychotic drugs may increase the risk of nosocomial infections among elderly patients hospitalized at Neurology Clinics

Healthcare-acquired infections (HCAI) represent a major health problem worldwide. Stroke and dementia are considered risk factors for HCAI. Preliminary data suggest that use of antipsychotic drugs also increase the risk for HCAI. Here, we performed a retrospective study aimed at investigating the major risk and protective factors for HCAI in a cohort of elderly subjects hospitalized at an Italian tertiary Neurology Clinics. We included all patients with age ≥ 65 years hospitalized at Neurology Clinics of National Institute on Ageing, Ancona, Italy from 1st January 2018 to 31st December 2021. For each patient, the following data were collected: age, sex, use of medical devices, comorbidities, use of antipsychotic medications, development of HCAI. We included 1543 patients (41.4% males; median age 85 years [80-89]). According to multivariable analysis, age, stroke, duration of urinary catheter placement (for all p < 0.001) and midline placement (p = 0.035) resulted to be risk factors for HCAI, Diabetes resulted to be a protective factor for pneumonia (p = 0.041), while dementia and nasogastric tube were risks factor for this condition (p = 0.022 and p < 0.001, respectively). Urinary catheter was a risk factor for urinary tract infections (p < 0.001). Duration of placement of vascular catheters and use of antipsychotic drugs resulted to significantly increase the risk for bloodstream infections. Stroke, age and use of medical devices were confirmed to be risk factors for HCAI. Antipsychotic drugs resulted to increase risk for bloodstream infections. Further prospective studies will be needed to confirm these findings.

Prevalence and Characteristics of the Course of Dysphagia in Hospitalized Older Adults

Sarcopenic dysphagia (SD) is an emerging concern in geriatric medicine. This study aimed to identify the prevalence, progression, and distinct attributes of SD in patients in the Department of Geriatric Medicine. Older adult patients admitted between 2021 and 2022 were enrolled. The department conducts a comprehensive geriatric assessment (CGA) combined with a multidisciplinary team-based intervention, setting the standard for medical care. We diligently assessed the occurrence and development of dysphagia at both the admission and discharge phases. Of the 180 patients analyzed (38.9% male, mean age 86.0 ± 6.6 years), 22.8% were diagnosed with SD at admission, thrice the rate of other dysphagia variants. Only one patient had new-onset dysphagia during hospitalization, attributed to SD. Patients with SD showed a better recovery rate (18.9%) than those with other dysphagia types. Patients with diminished swallowing capacity had compromised nutritional profiles, diminished energy and protein consumption, and extended fasting durations. Although sarcopenia is a prevalent inducer of dysphagia in older adults, an integrated approach in geriatric medicine involving rehabilitation, nutrition, and dentistry is pivotal. Strategies rooted in CGA promise potential for addressing dysphagia.

Poor Social Functioning: A Potentially Modifiable Risk Factor for Pneumonia in the Elderly

Background Most risk factors for developing community-acquired pneumonia (CAP) are age-related and chronic medical conditions; modifying these factors can be challenging, especially in the elderly. Poor social functioning, however, has a negative impact on medical conditions but can be improved through interventions. Therefore, the social functioning domain of health-related quality of life (HRQOL) may be a modifiable risk factor for the development of CAP. This study investigated the association between poor social functioning and the incidence of CAP in elderly individuals. Methodology We conducted a retrospective cohort study using a dataset from 2018 to 2021, derived from an annual questionnaire-based survey of a cohort of community-dwelling people aged 75 years or older (the Sukagawa Study). The dataset included social functioning subscale scores of HRQOL obtained from the Eight-Item Short Form (SF-8) questionnaire. Health insurance claims data were matched with these HRQOL data. For each participant, the exposure (HRQOL) was measured, and outcomes (incidence of CAP) were observed yearly from 2018 through 2021. Results The four observation years had a total of 17,016 observation periods among 6,513 participants. The annual incidence rate of CAP was 0.90-1.77%. Lower social functioning was associated with a higher risk of CAP. Specifically, for each standard deviation difference in social functioning score, the adjusted rate ratio for CAP incidence was 1.26 (95% confidence interval (CI) = 1.08-1.48). In a subgroup analysis, the association between social functioning and CAP differed by sex (p = 0.037). Specifically, the adjusted rate ratio for CAP incidence was 1.41 (95% CI = 1.17-1.70) in men and 1.00 (95% CI = 0.76-1.35) in women. Conclusions Poor social functioning is an important risk factor for CAP in the elderly, especially in men. Interventions that improve social functioning may help to prevent CAP.

Biomechanical Parameters of Voice in Parkinson's Disease Patients

INTRODUCTION

Previous research on voice in Parkinson's disease (PD) has consistently demonstrated alterations in acoustic parameters, including fundamental frequency (F0), maximum phonation time, Shimmer, and Jitter. However, investigations into acoustic parameter alterations in individuals with PD are limited.

METHODS

We conducted an experimental study involving 20 PD patients (six women and fourteen men). Subjective measures of voice (VHI-30 scale and GRBAS) and objective measures using the OnlineLAB App tool for analyzing biomechanical correlates of voice were recorded. The app analyzed a total of 22 biomechanical parameters of voice.

RESULTS

The results of subjective measures were consistent with findings from previous studies. However, the results of objective measures did not align with studies that employed acoustic measures.

CONCLUSIONS

The biomechanical analysis revealed alterations in various parameters according to gender. These findings open up a new avenue of research in voice analysis for patients with PD, whether through acoustic or biomechanical analysis, aiming to determine whether the observed changes in these patients' voices are attributable to age or disease progression. This line of investigation will help elucidate the relative contribution of these factors to vocal alterations in PD patients and provide a more comprehensive understanding of the underlying mechanisms.

Identifying Risk Factors for Aspiration in Patients Hospitalized with Community-Acquired Pneumonia

Background

Aspiration pneumonia (AP) is difficult to diagnose and has poor outcomes. This case-control study aimed to explore the risk factors and delineate the antibiotic usage for AP.

Methods

Inpatients diagnosed with community-acquired pneumonia (CAP) from 2013 to 2017, enrolled in the urban employee basic medical insurance program in Beijing, were included and classified into the AP (N = 2,885) and non-AP (N = 53,825) groups. Risk factors were identified by logistic regression.

Results

Older age (compared to 18-64 years, OR for 65-79 years: 4.3, 95% CI: 3.8-4.9; OR for >80 years: 6.3, 95% CI: 5.6-7.2), male (OR: 1.4, 95% CI: 1.3-1.5), cerebrovascular disease (OR: 3.1, 95% CI: 2.8-3.5), dementia (OR: 2.0, 95% CI: 1.8-2.1), vomiting (OR: 1.4, 95% CI: 1.2-1.7), Parkinson's disease (OR: 2.1, 95% CI: 1.8-2.4), and epilepsy (OR: 3.2, 95% CI: 2.8-3.7) were associated with an increased risk of AP. 92.8% of the AP patients received antibiotic therapy. Among them, patients treated with broad-spectrum antibiotics, antibiotics for injection, and combined antibiotics accounted for 93.3%, 97.9%, and 81.7%, respectively.

Conclusions

Older age, male, and several comorbidities were independent risk factors for AP, and combined antibiotics treatments are common, which merits attention in accurate detection of AP in a high-risk population.

Long-Term Survival After Aspiration Pneumonia in Older Inpatients: A Comparative Study

OBJECTIVES

Aspiration pneumonia (AsP), a leading cause of death in older people, remains poorly studied. We aimed to evaluate short- and long-term prognosis after AsP in older inpatients.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

All consecutive patients aged ≥75 years hospitalized in a 62-bed acute geriatric unit during a 1-year period.

METHODS

We compared clinical characteristics and overall 2-year survival between patients with a main diagnosis of AsP, patients with other types of acute pneumonia (non-AsP), and patients hospitalized for another cause.

RESULTS

Among the 1774 patients hospitalized over 1 year (median age: 87 years, 41% female), 125 (7%) had a primary diagnosis of acute pneumonia, of whom 39 (31%) had AsP and 86 (69%) non-AsP. Patients with AsP were more frequently male, lived more frequently in a nursing home, and had a more frequent history of stroke or neurocognitive disorders. Mortality rates were much higher after AsP, reaching 31% at 30 days (vs 15% after Non-AsP and 11% in the rest of the cohort, P < .001), and 69% 2 years after admission (vs 56% and 49%, P < .001). After adjustment for confounders, AsP was significantly associated with mortality but non-AsP was not [adjusted hazard ratio (95% CI): 3.09 (1.72-5.57) at 30 days and 1.67 (1.13-2.45) at 2 years for AsP; 1.36 (0.77-2.39) and 1.14 (0.85-1.52) for non-AsP]. However, among patients who survived at 30 days, mortality did not significantly differ between the 3 groups (P = .1).

CONCLUSIONS AND IMPLICATIONS

In an unselected cohort of patients hospitalized in an acute geriatric unit, a third of AsP patients died within the first month after admission. However, among those surviving at 30 days, long-term mortality did not significantly differ from the rest of the cohort. These findings underline the importance of optimizing the early management of AsP.

The Association Between Low Body-Mass Index and Serious Post-endoscopic Adverse Events

BACKGROUND

Low body mass index (LBMI) was associated with longer colonoscopy procedure time and procedural failure, and commonly considered to be a risk factor for post-endoscopic adverse events, but evidence is lacking.

AIM

We aimed to assess the association between serious adverse events (SAE) and LBMI.

METHODS

A single center retrospective cohort of patients with LBMI (BMI ≤ 18.5) undergoing an endoscopic procedure was matched (1:2 ratio) to a comparator group (19 ≤ BMI ≤ 30). Matching was performed according to age, gender, inflammatory bowel disease or malignancy diagnoses, previous abdomino-pelvic surgery, anticoagulation therapy and type of endoscopic procedure. The primary outcome was SAE, defined as bleeding, perforation, aspiration or infection, following the procedure. The attribution between each SAE and the endoscopic procedure was determined. Secondary outcomes included each complication alone and endoscopy-attributed SAEs. Univariate and multivariate analyses were applied.

RESULTS

1986 patients were included (662 in the LBMI group). Baseline characteristics were mostly similar between the groups. The primary outcome occurred in 31/662 (4.7%) patients in the LBMI group and in 41/1324 (3.1%) patients in the comparator group (p = 0.098). Among the secondary outcomes, infections (2.1% vs. 0.8%, p = 0.016) occurred more frequently in the LBMI group. Multivariate analysis revealed an association between SAE and LBMI (OR 1.76, 95% CI 1.07-2.87), male gender, diagnosis of malignancy, high-risk endoscopic procedure, age > 40 years, and ambulatory setting.

CONCLUSION

Low BMI was associated with higher post-endoscopic serious adverse events. Special attention is required when performing endoscopy in this fragile patient population.

In-hospital mortality for aspiration pneumonia in a tertiary teaching hospital: A retrospective cohort review from 2008 to 2018

BACKGROUND

Aspiration pneumonia is a preventable condition that has higher rates of recurrence and mortality compared to non-aspiration pneumonia. The primary objective of the study was to examine independent patient factors that are associated with mortality in those requiring acute admission for aspiration pneumonia at a tertiary institution. Secondary goals of the study were to review whether factors such as mechanical ventilation and speech language pathology intervention can impact patient mortality, length of stay (LOS), and costs relating to hospitalization.

METHODS

Patients older than 18 years of age who were admitted with a primary diagnosis of aspiration pneumonia from January 1, 2008 to December 31, 2018 at Unity Health Toronto-St. Michael's hospital in Toronto, Canada, were included in the study. Descriptive analyses were performed on patient characteristics using age as a continuous variable as well as a dichotomous variable with age 65 as a cut-off. Multivariable logistic regression was used to identify independent factors that contributed to in-hospital mortality and Cox proportional-hazard regression was used to identify independent factors that affected LOS.

RESULTS

A total of 634 patients were included in this study. 134 (21.1%) patients died during hospitalization with an average age of 80.3 ± 13.4. The in-hospital mortality did not change significantly over the ten-year period (p = 0.718). Patients who died had longer LOS with a median length of 10.5 days (p = 0.012). Age [Odds Ratio (OR) 1.72, 95% Confidence Interval (95% CI) 1.47-2.02, p < 0.05] and invasive mechanical ventilation (OR 2.57, 95% CI 1.54-4.31, p < 0.05) were independent predictors of mortality while female gender was found to be a protective factor (OR 0.60, 95% CI 0.38-0.92, p = 0.02). Elderly patients had five times higher risk of dying during their hospital course when compared to younger patients [Hazard Ratio (HR) 5.25, 95% CI 2.99-9.23, p < 0.05).

CONCLUSION

Elderly patients are a high-risk population for developing aspiration pneumonia and are at higher risk of death when hospitalized for this condition. This warrants improved preventative strategies in the community. Further studies involving other institutions and creating a Canada-wide database are required.

Health Care-Associated Infections in Older Adults: Epidemiology and Prevention

Health care-associated infections (HAIs) are a global public health threat, which disproportionately impact older adults. Host factors including aging-related changes, comorbidities, and geriatric syndromes, such as dementia and frailty, predispose older individuals to infection. The HAI risks from medical interventions such as device use, antibiotic use, and lapses in infection control follow older adults as they transfer among a network of interrelated acute and long-term care facilities. Long-term care facilities are caring for patients with increasingly complex needs, and the home-like communal environment of long-term care facilities creates distinct infection prevention challenges.

A registry study of oral health problems and preventive interventions among older persons receiving municipal healthcare - PROSENIOR

AIM

The aim was to identify planned and completed preventive interventions among older persons with oral health problems receiving municipal health care. A further aim was to determine the correspondence between oral health problems and planned preventive interventions among older persons with oral health problems receiving municipal health care.

DESIGN

Cross-sectional register study.

METHODS

Oral health data from the Swedish national quality registry, Senior Alert, were extracted for 4,024 older persons (≥65 years) receiving municipal health care in a county in Southern Sweden. Data were statistically analysed.

RESULTS

A large majority of older persons (97.4%) with assessed oral health problems had at least one planned preventive intervention, and approximately three quarters of the planned interventions were completed. There seemed to be a mismatch between type of oral health problems and preventive interventions as not all older persons had a planned preventive intervention related to their specific oral health problem.

The Relationship Between Menopause and Dysphagia: A Scoping Review

Purpose

Menopause marks the end of fertility and rapid decline of ovarian hormones in the female body, which corresponds to a myriad of changes to bodily systems, including the upper aerodigestive tract. Despite substantial evidence that menopause negatively impacts oral health, bones, and skeletal muscles, little research has examined these effects as they relate to swallowing. The purpose of this scoping review was to compile and summarize the existing literature investigating the relationship between menopause and swallowing-related structures and physiology.

Methods

Search terms were selected for three databases (PubMed, Scopus, and CINAHL) to gather relevant literature evaluating the relationship between menopause and swallowing-related anatomy as well as swallowing functions in both human and animal models. Relevant articles were reviewed, collated, and summarized to synthesize findings, identify gaps in the literature, and provide suggestions for future directions.

Results

This scoping review yielded 204 studies with the majority of these studies relating to one or more of the following categories: oral health, saliva, mandibular structures, and taste. Common oral symptoms reported in the literature included xerostomia, hyposalivation, tooth decay, inflammation of oral mucosa, and oral pain. Although literature supports that menopause adversely affects oral health, saliva, mandibular structures, and alters taste, a dearth of information was evident regarding how these hormone-dependent changes can adversely affect swallowing.

Conclusions

The relationship between menopause and swallowing has been overlooked by field of speech-language pathology. By identifying the major gaps in the literature, these results will inform future investigations evaluating relationships among ovarian hormones and swallowing.

Oral health-related multiple outcomes of holistic health in elderly individuals: An umbrella review of systematic reviews and meta-analyses

Background and aims

Along with an aging population, exploring the impact of oral health on holistic health and determining exact outcomes in elderly individuals are important in both scientific research and clinical practice. Significant increase in the number of systematic reviews shows that oral health can directly or indirectly affect the overall health of elderly people physically, mentally and socially. To systematically collate, appraise, and synthesize the current evidence, we carried out an umbrella review of the impacts of oral health on holistic health in elderly individuals.

Methods

A systematic reviews and meta-analyses search was performed in the major databases PubMed, MEDLINE, Web of Science and the Cochrane Library from inception to February 1, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The JBI (Joanna Briggs Institute) Critical Appraisal Checklist for Systematic Reviews and Research Syntheses was referred to assess methodological quality, and the GRADE (Grading of Recommendations, assessment, Development, and Evaluation working group classification) was used to assess the quality of evidence for each outcome included in the umbrella review.

Results

Out of 1,067 records, a total of 35 systematic reviews were included. Respiratory diseases, malnutrition, age-related oral changes, frailty, cognitive impairment, depression and poor quality of life were identified as seven key outcomes that affect the physical, mental and social health of elderly individuals. Meanwhile, three intervention measures of oral health were summarized as (i) more rigorous and universal scales, (ii) dental cleaning and denture installation, and (iii) improving self-awareness regarding oral care.

Conclusions

Evidence showed that oral health can significantly affect holistic health, and the diverse oral diseases directly lead to multiple health outcomes in elderly individuals. Clear high-quality evidence revealed that oral health is strongly associated with seven health outcomes covering physical, mental, and social levels, which directly corresponds to holistic health, and impacts the quality of life of elderly individuals. Such the results remind the importance of oral care in public health, and further studies need to be conducted to verity more specific association between oral health and other chronic diseases.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier: CRD42022315315.

Sex and Gender Differences in Bacterial Infections

There is a growing awareness of the importance of sex and gender in medicine and research. Women typically have stronger immune responses to self and foreign antigens than men, resulting in sex-based differences in autoimmunity and infectious diseases. In both animals and humans, males are generally more susceptible than females to bacterial infections. At the same time, gender differences in health-seeking behavior, quality of health care, and adherence to treatment recommendations have been reported. This review explores our current understanding of differences between males and females in bacterial diseases. We describe how genetic, immunological, hormonal, and anatomical factors interact to influence sex-based differences in pathophysiology, epidemiology, clinical presentation, disease severity, and prognosis, and how gender roles affect the behavior of patients and providers in the health care system.

The degree of recovery in swallowing ability in older inpatients with aspiration pneumonia is related to intramuscular adipose tissue of the quadriceps than to muscle mass

BACKGROUND & AIM

A recent study reported that the increase in intramuscular adipose tissue of the quadriceps in older inpatients is related to a decreasing degree of recovery in swallowing ability compared to the loss of muscle mass. However, whether the association remains true in case of aspiration pneumonia is unclear. Therefore, this study aimed to examine the relationship between the degree of recovery in swallowing ability and intramuscular adipose tissue in the quadriceps of older inpatients with aspiration pneumonia.

METHODS

This prospective study included 39 older patients with aspiration pneumonia. Swallowing ability was assessed using the Food Intake Level Scale (FILS). The indicators for the degree of recovery in swallowing ability were FILS at discharge and change in FILS. A greater change in FILS indicates a greater improvement in swallowing ability. Intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was used to determine whether the echo intensity of the quadriceps was independently and significantly related to FILS at discharge and the change in FILS. Independent variables were age, sex, days from disease onset, echo intensity and muscle thickness of the quadriceps, subcutaneous fat thickness of the thigh, FILS at admission, and number of units of rehabilitation therapy.

RESULTS

Echo intensity of the quadriceps (β = -0.363, p = 0.012) and FILS at admission (β = 0.556, p < 0.001) were independently and significantly associated with FILS at discharge (R2 = 0.760, f2 = 3.167, statistical power = 1.000). Similar variables (echo intensity of the quadriceps [β = -0.498, p = 0.012] and FILS at admission [β = -0.635, p < 0.001]) were independently and significantly related to change in FILS (R2 = 0.547, f2 = 1.208, statistical power = 0.998). Quadriceps muscle thickness was not independently and significantly related to FILS at discharge and change in FILS.

CONCLUSION

Our results indicate that intramuscular adipose tissue of the quadriceps in older inpatients with aspiration pneumonia is more strongly related to the degree of recovery in swallowing ability (that is, swallowing ability at discharge and change in swallowing ability) than muscle mass, and patients who have high intramuscular adipose tissue of the quadriceps at admission have a lower degree of recovery in swallowing ability.

Temporal characteristics of aspiration pneumonia in elderly inpatients: From resumption of oral intake to onset

Background

Elderly inpatients who develop fevers after resumption of oral intake are often considered to have aspiration pneumonia (AP) and be tentatively fasted. Fasting has been associated with prolonged hospital stays and decreased swallowing ability. The purpose of this study was to compare AP and other infections after resumption of oral intake in elderly inpatients and to identify the clinical characteristics.

Patients and methods

The records of patients who were admitted to a public tertiary hospital and referred for evaluation of swallowing disability were retrospectively reviewed to identify those who had developed AP, non-AP, or urinary tract infection (UTI) after resumption of oral intake. Eligible patients were enrolled consecutively in the study. The patient characteristics, physical findings, laboratory data, oral intake status at the time of onset of symptoms, and rate of discontinuation of oral intake after onset of infection were compared between the three types of infection.

Results

A total of 193 patients developed an infectious illness after resuming oral intake. Among them, 114 patients had a diagnosis of AP (n = 45), non-AP (n = 24), or UTI (n = 45). There were no significant differences in patient characteristics, physical findings or laboratory data between the group with AP and the other two groups. AP developed at a median of 6 (range 1–16) days after resumption of oral intake. The rate of discontinuation of oral intake was 91.1% in the AP group, 58.3% in the non-AP group, and 26.7% in the UTI group, respectively.

Conclusion

Infectious diseases other than AP should be considered in the differential diagnosis when nosocomial fever develops in elderly inpatients more than 17 days after resuming oral intake. Furthermore, nosocomial fever after resuming oral intake has many causes other than AP, and discontinuation of oral intake should be carefully considered.

The Relationship Between Dysphagia and Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis

BACKGROUND

Dysphagia is a common complication after stroke and is associated with the development of pneumonia. This study aimed to summarize the relationship between dysphagia and pneumonia in post-stroke patients.

MATERIALS AND METHODS

Articles published up to November 2021 were searched in the PubMed, Embase, Cochrane library, and Scopus databases. Studies that investigated the development of pneumonia in acute stroke patients with and without dysphagia were included. The methodological quality of individual studies was evaluated using the Risk Of Bias In Non-randomized Studies-of Interventions tool, and publication bias was evaluated using a funnel plot and Egger's test.

RESULTS

Of 5,314 studies, five studies were included in the meta-analysis. The results revealed that the incidence of pneumonia was significantly higher in the dysphagia group than in the non-dysphagia group (OR 9.60; 95% CI 5.75-16.04; p < 0.0001; I 2 = 78%). There was no significant difference in the mortality rate between the two groups (OR 5.64; 95% CI 0.83-38.18; p = 0.08; I 2 = 99%).

CONCLUSION

Dysphagia is a significant risk factor for pneumonia after stroke. The early diagnosis and treatment of dysphagia in stroke patients are important to prevent stroke-associated pneumonia.

Early Detection of Pneumonia with the Help of Dementia in Geriatric Hip Fracture Patients

Objective

To investigate the role of dementia in pneumonia among geriatric patients with hip fracture and further develop an algorithm for stratifying risk of developing postoperative pneumonia.

Methods

The algorithm was developed after retrospectively analyzing 1344 hip fracture patients in the National Clinical Research Center for Orthopedics, Sports Medicine, and Rehabilitation from 1992 to 2012. Twenty‐eight variables were analyzed for evaluating the ability to predict postoperative pneumonia. The validation of the algorithm was performed in the MIMIC‐III database after enrolling 235 patients.

Results

One thousand five hundred and seventy‐nine patients were enrolled, 4.69% patients had postoperative pneumonia in our hospital, and 17.02% suffered pneumonia in the MIMIC‐III database. Dementia patients had more postoperative pneumonia (12.68% vs 4.24%, P = 0.0075), as compared with patients without dementia. The algorithm included nine predictors: dementia, age, coronary heart disease, the American Society of Anesthesiologists score, surgical method, mechanical ventilation, anemia, hypoproteinemia, and high creatinine. Internal validation showed the algorithm with dementia could improve predictive performance, while external validation found the algorithm with or without dementia both had similar and good predictive ability.

Conclusions

The algorithm has the potential to be a pragmatic risk prediction tool to calculate risk of pneumonia in clinical practice and it may also be applicable in critically ill hip fracture patients with dementia.

Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia

Objective

To investigate the relationship between voluntary peak cough flow (PCF), oropharyngeal dysphagia, and pneumonia in patients who were evaluated with videofluoroscopic swallowing study (VFSS).

Methods

Patients who underwent both VFSS and PCF measurement on the same day were enrolled retrospectively (n=821). Pneumonia (n=138) and control (n=683) groups were assigned based on presence of pneumonia within 1 month from the date of VFSS assessment. In addition, sex, age (<65 and ≥65 years), preceding conditions, modified Barthel Index (MBI), Mini-Mental State Examination (MMSE), PCF value (<160, ≥160 and <270, and ≥270 L/min), and presence of aspiration/penetration on VFSS were reviewed.

Results

Pneumonia group was more likely to be male (n=108; 78.3%), ≥65 years (n=121; 87.7%), with neurodegenerative (n=25; 18.1%) or other miscellaneous diseases (n=50; 36.2%), and in poor functional level with lower value of MBI (39.1±26.59). However, MMSE was not significantly different in comparison to that of the control group. The pneumonia group was also more likely to have dysphagia (82.6%) and lower value of PCF (<160 L/min, 70.3%). In multivariable logistic regression analysis, male sex (odd ratio [OR]=6.62; 95% confidence interval [CI], 2.70–16.26), other miscellaneous diseases as preceding conditions (OR=2.52; 95% CI, 1.14–5.58), dysphagia (OR=3.82; 95% CI, 1.42–10.23), and PCF <160 L/min (OR=14.34; 95% CI, 1.84–111.60) were factors significantly related with pneumonia.

Conclusion

Impaired swallowing and coughing function showed an independent association with the development of pneumonia. Patients with PCF <160 L/min require more attention with lung care and should be encouraged with voluntary coughing strategy to prevent possible pulmonary complications.

Clinical Characteristics of Patients with Schizophrenia Maintained without Antipsychotics: A Cross-sectional Survey of a Case Series

Objective

While antipsychotics are necessary for relapse prevention in the treatment of schizophrenia in general, some minority of patients may be maintained without continuous antipsychotic treatment. However, the characteristics of such patients are not well known and previous reports have not evaluated key elements such as physical comorbidities and functioning.

Methods

Among 635 patients with schizophrenia who participated in a 12-year follow-up, those who were maintained without antipsychotic treatment for at least one year after the study were investigated. The patients underwent comprehensive assessments, including Positive and Negative Syndrome Scale (PANSS) for psychopathology, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) for physical comorbidities, and Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz), Barthel Index, and EuroQoL five dimensions (EQ5D) for function.

Results

Six patients were included (mean ± standard deviation age, 66.8 ± 17.4 years; 4 inpatients). The four inpatients were old (77.8 ± 4.8 years) and chronically ill (duration of illness, 49.3 ± 12.5 years) with a high PANSS score (total score, 118.0 ± 9.8; negative syndrome subscale, 41.3 ± 6.9), low functioning (FACT-Sz, 9.8 ± 3.6; Barthel Index, 8.8 ± 9.6), and serious physical comorbidities (CIRS-G, 15.5 ± 1.1). By contrast, the two outpatients were relatively young (45.0 ± 12.0 years) and clinically in good condition (PANSS total score, 44.5 ± 0.5; Barthel Index, 100 for both; EQ5D, 0.85 ± 0.04).

Conclusion

Although the number is limited, two types of patients with schizophrenia were identified who were free from ongoing antipsychotic treatment; 1) older chronic inpatients with serious physical comorbidities, and 2) younger outpatients with milder impairments. Future explorations are needed to identify those who will be successfully withdrawn from continuous antipsychotic treatment.

Severity of Dementia Is Associated with Increased Periodontal Inflamed Surface Area: Home Visit Survey of People with Cognitive Decline Living in the Community

No studies have measured the periodontal inflamed surface area in people with dementia, although periodontal disease is a major health issue in this group. This study aimed to determine the relationship between dementia severity and periodontal inflamed surface area. An interdisciplinary team, including a dentist and psychiatrist, conducted an in-home survey of older people living in the community. This cross-sectional study was designed as part of a larger cohort study. The interdisciplinary team visited 198 individuals with cognitive decline. We surveyed the clinical dementia rating, periodontal inflamed surface area, number of teeth, and other health issues. We used multiple linear regression analysis to assess the 75 people who were able to take part in all the visits. Number of teeth (Beta = 0.479, p < 0.001), clinical dementia rating (Beta = 0.258, p = 0.013), and age (Beta = 0.250, p = 0.017) were independently associated with periodontal inflamed surface area after adjusting for biological sex, depression, diabetes, collagen disease, visual disorder, and osteoporosis medication. To make communities more dementia-friendly, we must protect older people with dementia from developing poor oral health, which may require home visits for dental assessment.

Comparative Analysis of Relaxation Time Interval and Integrated Relaxation Pressure as Risk Factors for Aspiration in Patients With Oropharyngeal Dysphagia

Background/Aims

Integrated relaxation pressure (IRP) is an important metric for functional evaluation of the lower esophageal sphincter. However, the effectiveness of IRP for evaluation of upper esophageal sphincter (UES) function has not yet been clarified.

Methods

High-resolution manometry (HRM) was performed in 180 patients with dysphagia. For comparison, 26 asymptomatic subjects were also recruited. IRP of the UES was defined as means of 0.2, 0.25, or 0.3 seconds (sIRPs) of maximal deglutitive relaxation in a 0.4-second window (a new equation for IRP calculation was developed using MATLAB). Also, the relaxation time interval of the UES, and mesopharyngeal and hypopharyngeal contractility (as a contractile integral) were evaluated using HRM.

Results

In normal subjects, mean values of 0.2, 0.25, and 0.3 sIRPs differed significantly from each other (P < 0.05). They were not associated with the relaxation time interval of the UES. In contrast, in patients with dysphagia, mean values of 0.2, 0.25, and 0.3 sIRPs were strongly related to relaxation time intervals of the UES (P < 0.05), and mean values of 0.2, 0.25, and 0.3 sIRPs in patients with aspiration were significantly higher than those of patients without aspiration (P < 0.01). However, in multivariate regression analyses, the main risk factor for aspiration was only a shorter relaxation time interval.

Conclusions

IRP values were significantly higher in patients with dysphagia and aspiration. However, its usefulness as a predictive factor for aspiration was less than the relaxation time interval of the UES.

Evaluation of multi-component interventions for prevention of nosocomial pneumonia in older adults: a randomized, controlled trial

AIMS

To evaluate the efficacy of multi-component interventions for prevention of hospital-acquired pneumonia in older patients hospitalized in geriatric wards.

METHODS

A randomized, parallel-group, controlled trial was undertaken in patients aged 65 and above who were admitted to a tertiary hospital geriatric unit from January 1, 2016 to June 30, 2018 for an acute non-respiratory illness. Participants were randomized by to receive either a multi-component intervention (consisting of reverse Trendelenburg position, dysphagia screening, oral care and vaccinations), or usual care. The outcome measures were the proportion of patients who developed hospital-acquired pneumonia during hospitalisation, and mean time from randomization to the next hospitalisation due to respiratory infections in 1 year.

RESULTS

A total of 123 participants (median age, 85; 43.1% male) were randomized, (n = 59) to intervention group and (n = 64) to control group. The multi-component interventions did not significantly reduce the incidence of hospital-acquired pneumonia but did increase the mean time to next hospitalisation due to respiratory infection (11.5 months vs. 9.5 months; P = 0.049), and reduced the risk of hospitalisation in 1 year (18.6% vs. 34.4%; P = 0.049). Implementation of multi-component interventions increased diagnoses of oropharyngeal dysphagia (35.6% vs. 20.3%; P < 0.001) and improved the influenza (54.5% vs 17.2%; P < 0.001) and pneumococcal vaccination rates (52.5% vs. 20.3%; P < 0.001).

CONCLUSIONS

The nosocomial pneumonia multi-component intervention did not significantly reduce the incidence of hospital-acquired pneumonia during hospitalisation but reduce subsequent hospitalisations for respiratory infections.

CLINICAL TRIAL REGISTRATION

ClinicalTrial.gov, NCT04347395.

Assessment of oral health in elderly patients with dementia by measuring volatile sulfur compounds and its relationship with pneumonia development: A pilot study

BACKGROUND

This study aimed to clarify the involvement of anaerobes in aspiration pneumonia by measuring volatile sulfur compounds (VSCs), which are metabolites of anaerobic bacteria in the mouth.

METHODS

This study included 84 older adult patients (mean age, 82.5 ± 7.34 years) who had dementia and were hospitalized for more than 6 months. We measured the VSCs in the patient's mouth with Oral Chroma and obtained the data of pneumonia development in the past 6 months. We also evaluated the association or correlation of VSCs and some factors which might be the risk factors of aspiration pneumonia.

RESULTS

The development of pneumonia had no significant association with the VSCs in the patient's mouth.

CONCLUSION

The present pilot study suggests that anaerobes might not be the main causative pathogens of aspiration pneumonia in older adult patients.

Percutaneous Endoscopic Gastrostomy Reduces Aspiration Pneumonia Rate in Stroke Patients with Enteral Feeding in Convalescent Rehabilitation Wards

OBJECTIVES

The effect of percutaneous endoscopic gastrostomy (PEG) on the prevention of aspiration pneumonia and improvements in activities of daily living (ADL) for enteral feeding-dependent stroke patients is unclear. We sought to clarify differences in the rates of aspiration pneumonia and ADL improvement between stroke patients receiving PEG and those receiving nasogastric tube feeding (NGT) in convalescent rehabilitation wards.

METHODS

We assessed 10 years of data from the Kaga Regional Cooperation Clinical Pathway for Stroke, which covers patients in the southern district of Ishikawa Prefecture of Japan. Logistic regression analysis with propensity score adjustment was used to examine how the enteral feeding method affected aspiration pneumonia rates. Linear regression analysis, adjusted by propensity scores, was also performed to ascertain the effect of the enteral feeding method on ADL improvement.

RESULTS

Overall, 47 patients with PEG and 49 patients with NGT were analyzed. The incidence of aspiration pneumonia was 4.67 times higher in the NGT group than in the PEG group in the propensity score-adjusted logistic regression analysis (odds ratio 4.67, 95% confidence interval 1.30-16.67, P=0.02). The enteral feeding method had no significant effect on ADL improvement in the propensity score-adjusted linear regression analysis.

CONCLUSIONS

In convalescent rehabilitation wards, aspiration pneumonia was more likely to occur in stroke patients with NGT than in those with PEG; however, the enteral feeding method did not affect ADL improvement. These results provide a basis for determining the appropriate enteral feeding method for stroke patients who cannot take adequate nutrition orally during convalescence/rehabilitation.

Characteristics of aspiration pneumonia patients in acute care hospitals: A multicenter, retrospective survey in Northern Japan

BACKGROUND

Pneumonia is a common cause of illness and death of the elderly in Japan. Its prevalence is escalating globally with the aging of population. To describe the latest trends in pneumonia hospitalizations, especially aspiration pneumonia (AP) cases, we assessed the clinical records of pneumonia patients admitted to core acute care hospitals in Miyagi prefecture, Japan.

METHODS

A retrospective multi-institutional joint research was conducted for hospitalized pneumonia patients aged ≥20 years from January 2019 to December 2019. Clinical data of patients were collected from the medical records of eight acute care hospitals.

RESULTS

Out of the 1,800 patients included in this study, 79% of the hospitalized pneumonia patients were aged above 70 years. The most common age group was in the 80s. The ratio of AP to total pneumonia cases increased with age, and 692 out of 1,800 patients had AP. In univariate analysis, these patients had significantly older ages, lower body mass index (BMI), a lower ratio of normal diet intake and homestay before hospitalization, along with more AP recurrences and comorbidities. During hospitalization, AP patients had extended fasting periods, more swallowing assessments and interventions, longer hospitalization, and higher in-hospital mortality rate than non-AP patients. A total of 7% and 2% AP patients underwent video endoscopy and video fluorography respectively. In multivariate analysis, lower BMI, lower C-reactive protein, a lower ratio of homestay before hospitalization, a higher complication rate of cerebrovascular disease, dementia, and neuromuscular disease were noted as a characteristic of AP patients. Swallowing interventions were performed for 51% of the AP patients who had been hospitalized for more than two weeks. In univariate analysis, swallowing intervention improved in-hospital mortality. Lower AP recurrence before hospitalization and a lower ratio of homestay before hospitalization were indicated as characteristics of AP patients of the swallowing intervention group from multivariate analysis. Change in dietary pattern from normal to modified diet was observed more frequently in the swallowing intervention group.

CONCLUSION

AP accounts for 38.4% of all pneumonia cases in acute care hospitals in Northern Japan. The use of swallowing evaluations and interventions, which may reduce the risk of dysphagia and may associate with lowering mortality in AP patients, is still not widespread.

Predictors of Aspiration Pneumonia and Mortality in Patients with Dysphagia

OBJECTIVES/HYPOTHESIS

To identify risk factors for pneumonia incidence in patients with dysphagia undergoing a videofluoroscopic swallow study (VFSS) in an outpatient tertiary-care center.

STUDY DESIGN

Historical cohort study.

METHODS

All individuals undergoing a VFSS between 10/02/13 and 07/30/15 were identified and followed historically for 2 years. Demographic information, medical history, and fluoroscopic data were collected. The 2-year incidence of pneumonia was obtained from the medical records and telephone interview. The incidence of pneumonia and death were calculated and risk factors for pneumonia and mortality were ascertained.

RESULTS

689 patients were followed for 2 years. The mean age (±standard deviation) of the cohort was 65 (±15.5) years. 49% (338/689) were female. The most common causes of dysphagia were cricopharyngeus muscle dysfunction (270/689), head and neck cancer (175/689), and neurodegenerative disease (56/689). The incidence of pneumonia was 22% (153/689). The incidence of death was 11%. Multivariable logistic regression revealed that chronic obstructive pulmonary disorder [COPD] (odds ratio [OR] = 2.36, 95% confidence interval [CI]: 1.33-4.19), hypertension (OR = 1.82, 95% CI: 1.23-2.73), tracheotomy status (OR = 2.96, 95% CI: 1.09-7.99), and vallecular residue (OR = 1.88, 95% CI: 1.24-2.85) were all significantly associated with an elevated risk of pneumonia. Kidney disease (OR = 1.27, 95% CI: 1.02-9.9), COPD (OR = 3.27, 95% CI: 1.65-6.49), vallecular residue (OR = 2.35, 95% CI: 1.35-4.1), male gender (OR = 2.21, 95% CI: 1.25-3.92), and low body mass index (OR: 1.12, 95% CI: 1.06-1.19) were independent adjusted risk factors for death.

CONCLUSIONS

The incidence of aspiration pneumonia (22%) and death (11%) within 2-years of a VFSS was high. The greatest adjusted risk factors for incident pneumonia were tracheotomy (OR = 3.0), COPD (OR = 2.4) and vallecular residue (OR = 1.9). The greatest adjusted risk factors for death were COPD (OR = 3.3), vallecular residue (OR = 2.3), and male gender (OR = 2.2).

LEVEL OF EVIDENCE

4 Laryngoscope, 2021.

Aspiration-related pneumonia after Taser exposure - A multiple causations mechanism

Arrest-related deaths in the context of Conducted Electrical Weapon (CEW) deployment are rare. The evaluation of such complex events is a challenge for the forensic scientist. We present a case of a 49-year old man, who was exposed to a Taser X26P during a confrontation with the police. He lost consciousness, vomited, aspirated and died after having been hospitalized for several days at the ICU. Based on the patient´s medical history, autopsy findings, witness testimonies, and reliable clinical and toxicological blood parameters, the most probable cause and mechanisms of his death are discussed. The present work demonstrates, based on one case report, the possibilities as well as limitations of forensic assessment in CEW-related deaths.

Association Between the Swallowing Reflex and the Incidence of Aspiration Pneumonia in Patients With Dysphagia Admitted to Long-term Care Wards: A Prospective Cohort Study of 60 Days

OBJECTIVE

To investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards.

DESIGN

The study design was a prospective cohort study. Participants were followed for 60 days from admission.

SETTING

LTC wards.

PARTICIPANTS

Study participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL.

RESULTS

The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group.

CONCLUSIONS

Our findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards.

[Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German Respiratory Society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the Competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss Respiratory Society (SGP) and the Swiss Society for Infectious Diseases Society (SSI)]

The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.

Oropharyngeal dysphagia frequency in older adults living in nursing homes: an integrative review

PURPOSE

To synthesize the scientific knowledge on the frequency of oropharyngeal dysphagia in older adults living in nursing homes.

RESEARCH STRATEGIES

The study question followed the PECO strategy and the search was performed in the Pubmed/Medline, Web of Science, Scopus, LILACS and SciELO databases, using keywords and specific free terms.

SELECTION CRITERIA

articles with no time or language restrictions that reported the frequency of oropharyngeal dysphagia in older adults living in nursing homes and the diagnostic criteria.

DATA ANALYSIS

it was analyzed the population characteristics, the concept of "oropharyngeal dysphagia", the methods for identifying the outcome and the frequency of oropharyngeal dysphagia. The evaluation of the methodological quality of the articles followed the criteria of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

RESULTS

Fifteen articles were included. There was great variability in relation to the sample size, with a predominance of longevous old women. The concept of dysphagia, when mentioned, was heterogeneous. Diagnostic criteria were diverse and mostly comprised of questionnaires or clinical trials results. No studies used instrumental tests. The frequency of oropharyngeal dysphagia in the studied population ranged from 5.4% to 83.7%, being higher in studies that used clinical tests, but with greater precision of confidence intervals in studies that used questionnaires and large sample size.

CONCLUSION

The frequency of oropharyngeal dysphagia in older adults living in nursing homes has wide variability. Methodological discrepancies among studies compromise the reliability of frequency estimates and highlight the need for research with better defined and standardized methodological criteria.