Careful history taking detects initially unknown underlying causes of aspiration pneumonia

Abstract

AimThe majority of pneumonia in the elderly is attributed to aspiration. Identifying the cause of aspiration is essential for efficient treatment and prevention. However, the methodology on how to investigate the causes is not established. Therefore, we studied cases that were initially admitted for pneumonia and were newly diagnosed with an underlying cause of aspiration. This is the first study to analyze such cases collectively.MethodsThis was a retrospective study. Patients aged 65 years or older admitted for pneumonia from October 2012 to November 2018 and were newly diagnosed with a cause of aspiration after admission was included. Patients were excluded if they had hospital‐acquired pneumonia, interstitial lung disease, or obstructive pneumonia or were immunocompromised.ResultsIn total, 4043 patients were admitted for pneumonia and 125 cases who were newly diagnosed with causes of aspiration after admission were included in the study. This constituted 30.7% of suspected aspiration pneumonia cases in which there was no known cause of aspiration on admission. The most common conditions newly identified were neurologic disorders, upper gastrointestinal disorders, drug‐induced conditions, and head and neck disease. Some were lethal. The diagnosis enabled treatment of the underlying condition and prevention of aspiration in most cases. The most common sign that lead to the diagnosis was symptoms seen from admission, followed by chronic symptoms.ConclusionIn 30.7% of those with suspected aspiration pneumonia with an unknown cause, a cause of aspiration was newly diagnosed. Careful history taking concerning neurological, gastrointestinal and drug‐induced disorders is essential in elderly patients with pneumonia. Geriatr Gerontol Int 2020; 20: 785–790.

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

“…Deterioration in immune system functions, known as immunosenescence, is also well documented in the older adult population and is acerbated by poor nutritional status [10,11]. Sarcopenia and immunosenescence are presented as predisposing factors to aspiration pneumonia in frail older adult populations [12][13][14][15][16] further complicating the evaluation of the causes of recurrent aspiration pneumonia in this population. Providing nutritious and safe texture modified foods are key elements in mitigating dysphagia impacts ( Figure 1).…”

Hemorrhaging from an Intramedullary Cavernous Malformation Diagnosed Due to Recurrent Pneumonia and Diffuse Aspiration Bronchiolitis

“…However, these less-symptomatic conditions are nonetheless life-threatening when left unnoticed. In our previous study, 30.7% of cases suspected of having aspiration pneumonia were later diagnosed with a causative condition of aspiration that was initially unrecognized, 9.6% of which were acute stroke (2). This highlights the importance of considering brainstem lesions in patients with suspected dysphagia, regardless of the patient's general condition.…”

“…However, the underlying swallowing disorder and the causal relationship between them were unclear. It is important for physicians to be aware of the different entities causing pneumonia and to be able to investigate the causes efficiently (2).…”

“…Even when aspiration is suspected, the cause remains undiagnosed or uninvestigated in many cases. In our previous study, 30.7% of those suspected of having aspiration pneumonia were later diagnosed with a causative condition of aspiration that was initially left unrecognized (2).…”

A Need for a Diagnostic Management Protocol in Barium Aspiration

“…We previously performed a study of elderly patients who were suspected of having aspiration pneumonia (8). Among those who had no apparent cause of aspiration, 30.7% were later diagnosed with a new condition causing aspiration.…”