Does Dysphagia Predict Inpatient Morbidity and Mortality in Geriatric Patients Admitted for Aspiration Pneumonia?

Abstract

Background Aspiration pneumonia is common in older adults admitted for community-acquired pneumonia and is associated with significant morbidity and mortality. Factors that put this population at higher risk of aspiration include cognitive impairment, neuromuscular dysfunction, and dysphagia. This study aimed to determine whether a concurrent diagnosis of dysphagia conferred a higher risk of complications in the elderly admitted for aspiration pneumonia. Methods The National Inpatient Sample 2001-2013 database was queried for patients, aged 65 or older, with a diagnosis of aspiration pneumonia using International Classification of Diseases, Ninth Revision (ICD-9) codes. Sepsis, respiratory failure, and intubation were identified with their respective ICD-9 codes. A chi-square test and binary logistic regression analysis were used to examine socio-demographic and complication variables, with a significance level of α <0.001. Results A total of 1,097,325 patients were admitted for aspiration pneumonia, of which 349,861 (24.2%) had dysphagia. After incorporating socio-demographic variables, the dysphagia group had a significantly lower likelihood of having sepsis (OR=0.72), respiratory failure (OR=0.92), intubation (OR=0.52), and inpatient mortality (OR = 0.59). Patients with dysphagia had a significantly higher likelihood of increased length of stay (OR=1.24). Conclusions Elderly patients admitted with aspiration pneumonia with a co-diagnosis of dysphagia were less likely to have inpatient morbidity and mortality compared to their counterparts. This may be due to improved speech evaluation and treatment in patients with dysphagia allowing for better control of macro and micro aspiration. Future research is needed to examine if universal speech therapy can reduce hospitalization and long-term mortality for such patients.

Dysphagia in Ischaemic Stroke Patients: One Centre Retrospective Study

“…It is likely that an independent indicator of worsened health during the recovery period after a stroke. Furthermore, it may cause complications such as malnutrition, dehydration, aspiration, pneumonia, and death [ 4 , 14 , 15 ].…”

“…One of the most common complications of a stroke is the occurrence of respiratory infections. Pneumonia often takes on an aspiration character and results from neurogenic dysphagia of sudden onset [ 4 , 14 , 15 , 16 ]. During the acute phase of a stroke, pneumonia can often occur due to neurogenic dysphagia with sudden onset.…”

“…Early detection of swallowing disorders in stroke patients is crucial for adjusting a safe diet, selecting appropriate speech therapy exercises to improve swallowing function, and reducing the risk of pulmonary complications. Dysphagia is a significant diagnostic and care problem, requiring the involvement and cooperation of an entire therapeutic team (physician, nurse, physiotherapist, speech therapist, and psychologist) [ 4 , 14 , 15 , 16 , 17 ].…”

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

“…A recent study of geriatric patients (age ≥ 65 years) admitted to a Danish acute medical unit revealed a 43.1% prevalence of dysphagia [3], while another study found it to be 30.7% in hospitalized patients [4]. Geriatric patients are at a higher risk of aspiration due to cognitive impairment, neuromuscular dysfunction, and dysphagia [5,6]. In stroke patients, the risk of developing pneumonia is higher in those with dysphagia, and the risk of pneumonia is even higher in patients who are observed to aspirate [7].…”