Rate of aspiration pneumonia in hospitalized Parkinson’s disease patients: a cross-sectional study

Abstract

BackgroundAspiration pneumonia is an important cause of morbidity and mortality in Parkinson’s disease (PD). Clinical characteristics of PD patients in addition to specific alterations in swallowing mechanisms contribute to higher swallowing times and impairment in the effective clearance of the airway. These issues may render patients more prone to dysphagia and aspiration events. We aimed to determine the frequency of aspiration events in a hospitalized PD cohort, and to report the number of in-hospital swallow evaluations.MethodsA retrospective single center chart review of 212 PD patients who had 339 hospital encounters was performed from January 2011 to March 2013. Demographics, clinical characteristics, and reasons for encounters were documented. The number of in-hospital aspiration events and the number of swallowing evaluations and also the implementation of aspiration precautions were recorded.ResultsThe cohort had a mean age of 74.1 (SD = 10.1) years with mean disease duration of 6 (SD = 6.3) years. Fifty-two hospital encounters (15.3 %) were related to a pulmonary cause. In-hospital aspiration pneumonia events were reported in 8 (2.4 %) of the total encounters. Swallow evaluations were performed in 25 % of all cases, and aspiration precautions were initiated in 32 % of the encounters. The data revealed that 1/8 patient had swallowing evaluations performed prior to an aspiration event.ConclusionsIn-hospital aspiration pneumonia events were reported in 2.4 % of the hospitalized PD cohort. Preventive measures and precautions were not routinely performed, however rates of aspiration were relatively low. The results highlight the need for more research into screening and monitoring of swallowing problems in PD patients during hospital encounters.

Follow-Up of Advanced Parkinson’s Disease Patients after Clinical or Surgical Emergencies: A Practical Approach

“…Pneumonia leading to sepsis is a widely recognized consequence of bulbar dysfunction and reduced mobility, while postural instability and falls lead to fractures and internal hemorrhages. PD patients have an almost four-fold increased risk of developing aspiration pneumonia when compared to the general population [ 18 ], while the prevalence of dysfunctional swallowing is higher than 50% [ 19 ]. Therefore, recognition of the potential additional harm added by a hospital admission due to falls, fractures, and infections, which can be a direct or indirect consequence of limitations derived from the advanced symptoms and signs of PD, raising the awareness of patients and caregivers, in addition to optimization of treatment is of fundamental importance.…”

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“…These findings suggest that swallowing impairment could partly result from direct damage to the ENS. Moreover, in view of the various aforementioned abnormalities, dysphagia is clearly linked to an increased risk of mortality by causing and/or exacerbating other PD-related complications such as aspiration pneumonia (estimated to account for 70% of the mortality rates among PD patients [36]), choking, malnutrition, unexplained weight loss, and dehydration [13, 66, 69, 71]. Unfortunately, the degree of dysphagia cannot be predicted by PD progression because it has no direct connection with the clinical severity of the disease as evaluated by motor criteria [31, 70].…”

Enteral feeding in neurological disorders

“…In the early stages, dysphagia can be asymptomatic;71 however, with disease progression it can pose serious clinical challenges 72. Patients with advanced dysphagia are prone to choking (up to 50% report choking in attempts to swallow)73 and aspiration, which increases the risk of pneumonia, a main cause of death in late-stage Parkinson's disease 74. Dysphagia, together with increased physical, cognitive and psychological impairment as the disease progresses, contributes greatly to a reduced oral nutritional intake.…”