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Xu H, Zhang R, Zhang X, Cheng Y, Lv L, Lin L. Microbiological Profile of Patients with Aspiration Pneumonia Identified by Combined Detection Methods. Infect Drug Resist 2024; 17:2077-2088. [PMID: 38813526 PMCID: PMC11135560 DOI: 10.2147/idr.s461935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024] Open
Abstract
Purpose Aspiration pneumonia (AP) challenges public health globally. The primary aim of this study was to ascertain the microbiological profile characteristics of patients with AP evaluated by combined detection methods, including conventional microbiological tests (CMTs), chips for complicated infection detection (CCID), and metagenomic next-generation sequencing (mNGS). Patients and Methods From June 2021 to March 2022, a total of thirty-nine patients with AP or community-acquired pneumonia with aspiration risk factors (AspRF-CAP) from 3 hospitals were included. Respiratory specimens, including bronchoalveolar lavage fluid (BALF), sputum, and tracheal aspirate, were collected for microorganism detection. Results Patients with AP were more inclined to be older, to have a shorter duration from illness onset to admission, to have a higher prevalence of different underlying diseases, particularly diabetes mellitus, chronic heart disease, and cerebrovascular disease, and to have a higher CURB-65 score (all P < 0.05). A total of 213 and 31 strains of microorganisms were detected in patients with AP and AspRF-CAP, respectively. The most common pathogens in AP were Corynebacterium striatum (17/213, 7.98%), Pseudomonas aeruginosa (15/213, 7.04%), Klebsiella pneumoniae (15/213, 7.04%), and Candida albicans (14/213, 6.57%). Besides, the most common pathogens in AspRF-CAP were Candida albicans (5/31, 16.13%), Pseudomonas aeruginosa (3/31, 9.68%) and Klebsiella pneumoniae (3/31, 9.68%). Moreover, Klebsiella pneumoniae (7/67, 10.45%) and Candida glabrata (5/67, 7.46%) were the most common pathogens among the 9 non-survived patients with AP. Conclusion The prevalent pathogens detected in cases of AP were Corynebacterium striatum, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans. Early combined detection methods for patients with AP enhance the positive detection rate of pathogens and potentially expedites the initiation of appropriate antibiotic therapeutic strategies.
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Affiliation(s)
- Hui Xu
- Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Ruixue Zhang
- Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Xiaoxue Zhang
- Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Yueguang Cheng
- Department of Emergency, Beijing Jingmei Group General Hospital, Beijing, People’s Republic of China
| | - Liping Lv
- Department of Interventional Pulmonology, Anhui Chest Hospital, Hefei, People’s Republic of China
| | - Lianjun Lin
- Department of Geriatrics, Peking University First Hospital, Beijing, People’s Republic of China
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Patel J, Sohal A, Chaudhry H, Kalra S, Kohli I, Singh I, Dukovic D, Yang J. Predictors and impact of aspiration pneumonia in patients undergoing esophagogastroduodenoscopy: national inpatient sample 2016-2020. Eur J Gastroenterol Hepatol 2024; 36:298-305. [PMID: 38179867 DOI: 10.1097/meg.0000000000002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
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.
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Affiliation(s)
- Jay Patel
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, Washington
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco-Fresno, California, USA
| | - Shivam Kalra
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Isha Kohli
- Department of Graduate Public Health, Icahn School of Medicine, Mount Sinai, New York
| | - Ishandeep Singh
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dino Dukovic
- Department of Internal Medicine, Ross University School of Medicine, Bridgetown, Barbados
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, Texas, USA
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Honda Y, Homma Y, Nakamura M, Ojima T, Saito K. Extremely Poor Post-discharge Prognosis in Aspiration Pneumonia and Its Prognostic Factors: A Retrospective Cohort Study. Dysphagia 2024:10.1007/s00455-023-10665-z. [PMID: 38388805 DOI: 10.1007/s00455-023-10665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/26/2023] [Indexed: 02/24/2024]
Abstract
There is little evidence regarding the long-term prognosis of patients with aspiration pneumonia. This study aimed to investigate post-discharge survival time and prognostic factors in older patients hospitalized for aspiration pneumonia. This retrospective cohort study included patients aged ≥ 65 years hospitalized for aspiration pneumonia and discharged alive from a tertiary care hospital in Japan between April 2009 and September 2014. Candidate prognostic factors were patient's age, sex, body mass index (BMI), performance status, chronic conditions, CURB-65 score, serum albumin level, hematocrit concentration, nutritional pathway at discharge, and discharge location. Kaplan-Meier curves were determined and multivariable survival analysis using Cox regression model was performed to analyze the effect of each factor on mortality. In total, 209 patients were included in this study. The median age was 85 years, 58% of the patients were males, 33% had a performance status of 4 and 34% were discharged home. Among the patients, 65% received oral intake, 23% received tube feeding, and 21% received parenteral nutrition at discharge. During the follow-up period, 77% of the patients died, and the median post-discharge survival time was 369 days. Besides male sex and low BMI, tube feeding (adjusted hazard ratio (aHR) = 1.70, 95% confidence interval (CI) 1.11-2.59) and parenteral nutrition (aHR = 4.42, 95% CI 2.57-7.60) were strongly associated with mortality. Long-term prognosis of patients hospitalized for aspiration pneumonia was extremely poor. The nutritional pathway at discharge was a major prognostic factor. These results may be useful for future care and research.
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Affiliation(s)
- Yuki Honda
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu, Shizuoka, 430-8558, Japan.
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kazuhito Saito
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu, Shizuoka, 430-8558, Japan
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Cheng H, Deng X, Li J, Tang Y, Yuan S, Huang X, Wang Z, Zhou F, Lyu J. Associations Between Dysphagia and Adverse Health Outcomes in Older Adults with Dementia in Intensive Care Units: A Retrospective Cohort Study. Clin Interv Aging 2023; 18:1233-1248. [PMID: 37554511 PMCID: PMC10405813 DOI: 10.2147/cia.s409828] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/17/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Dysphagia is common in elderly patients with dementia and is one of the common clinical geriatric syndromes. It imposes a heavy burden on patients and their caregivers and is becoming an important public health problem. This study examined the association between dysphagia in older dementia patients in the ICU and the subsequent adverse health outcomes they experience. PATIENTS AND METHODS A retrospective analysis of adults (≥65 years) with dementia in ICUs of a Boston tertiary academic medical center was conducted. Using the International Classification of Diseases' Ninth and Tenth Revisions, dementia patients were identified. The study cohort comprised 1009 patients, median age 84.82 years, 56.6% female, predominantly White (72.9%). Patients were grouped based on swallowing function: dysphagia (n=282) and no-dysphagia (n=727). Dysphagia was identified via positive bedside swallowing screening. Primary outcomes were 90- and 180-day mortality, secondary outcomes included aspiration pneumonia, pressure injury, and delirium. Cohort characteristics were compared using the Wilcoxon rank-sum and chi-square tests. Dysphagia and outcomes correlations were examined via Kaplan-Meier survival analysis, Cox proportional-hazards regression models, logistic regression models, and subgroup analysis. RESULTS After adjusting for covariates, the results from multivariate Cox proportional-hazards regression indicated that dysphagia was significantly associated with increased 90-day (HR=1.36, 95% CI=1.07-1.73, E-value=1.78) and 180-day (HR=1.47, 95% CI=1.18-1.82, E-value=1.94) mortality; the multifactorial logistic regression results indicated that dysphagia was associated with significant increases in pressure injury (OR=1.58, 95% CI=1.11-2.23, E-value=1.83) and aspiration pneumonia occurrence (OR=4.04, 95% CI=2.72-6.01, E-value=7.54), but was not significantly associated with delirium prevalence (OR=1.27, 95% CI=0.93-1.74). CONCLUSION Dysphagia is likely to increase the risk of adverse health outcomes in older adults with dementia in ICU, and these adverse outcomes mostly include 90- and 180-day mortality, aspiration pneumonia, and pressure injury.
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Affiliation(s)
- Hongtao Cheng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Xingwen Deng
- Department of Medical Information, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Jieyao Li
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Yonglan Tang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Shiqi Yuan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Xiaxuan Huang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Zichen Wang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, People’s Republic of China
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5
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Zhang Y, Wang K, Yu H, Zhao T, Lin L, Qin X, Wu T, Chen D, Hu Y, Wu Y. Incidence and characteristics of aspiration pneumonia in adults in Beijing, China, 2011-2017. Public Health 2023; 220:65-71. [PMID: 37270854 DOI: 10.1016/j.puhe.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study aimed to estimate aspiration pneumonia (AP) incidence and describe comorbid characteristics and mortality in Beijing, China. STUDY DESIGN A historical cohort study was conducted based on medical claim records. METHODS Patients admitted with a primary diagnosis of AP were identified from approximately 12 million adults who enrolled in the Urban Employee Basic Medical Insurance program in Beijing, China, from January 2011 to December 2017. The incidences of AP and pneumonia with risk factors for aspiration (PRFA) were estimated by a Poisson distribution. The estimated annual percentage change was reported to represent the average percentage change in incidence per year. Characteristics and 6-month and 1-year all-cause mortality rates for AP and suspected AP patients were described and compared with community-acquired pneumonia (CAP). RESULTS The incidence rates of hospitalized AP and PRFA were 9.4 (95% confidence interval [CI]: 7.6, 11.3) and 102.9 (95% CI: 95.8, 110.3) per 100,000 person-years, respectively. The incidences increased rapidly with age and were stable across the observed years. Patients with AP and PRFA possessed a greater burden of comorbidities than CAP (mean age-adjusted Charlson comorbidity indices for AP: 7.72, PRFA: 7.83, and CAP: 2.84). The 6-month and 1-year all-cause mortality rates for those with AP and PRFA were higher than those for patients with CAP (6-month mortality, AP: 35.2%, PRFA: 21.8%, CAP: 11.1%; 1-year mortality, AP: 42.7%, PRFA: 26.6%, CAP: 13.2%). CONCLUSIONS The incidence of AP and PRFA in Beijing was reported, presenting a full picture of the disease burden. The results provide baseline information for AP prevention.
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Affiliation(s)
- Y Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - K Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - H Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - T Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - L Lin
- Geriatric Department, Peking University First Hospital, 100034, China
| | - X Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China
| | - T Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China
| | - D Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China
| | - Y Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China.
| | - Y Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China.
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6
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Maeda M, Kadokura M, Aoki R, Komatsu N, Kawakami M, Koyama Y, Watanabe K, Nishiyama M. A Fiber-Optic Non-Invasive Swallowing Assessment Device Based on a Wearable Pressure Sensor. SENSORS (BASEL, SWITZERLAND) 2023; 23:2355. [PMID: 36850956 PMCID: PMC9963261 DOI: 10.3390/s23042355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
We developed a wearable swallowing assessment device using a hetero-core fiber-optic pressure sensor for the detection of laryngeal movement during swallowing. The proposed pressure sensor (comfortably attached to the skin of the neck) demonstrated a high sensitivity of 0.592 dB/kPa and a linearity of R2 = 0.995 within a 14 kPa pressure band, which is a suitable pressure for the detection of laryngeal movement. In addition, since the fabricated hetero-core fiber-optic pressure sensor maintains appreciable sensitivity over the surface of the sensor, the proposed wearable swallowing assessment device can accurately track the subtle pressure changes induced by laryngeal movements during the swallowing process. Sixteen male subjects and one female subject were evaluated in a variety of age groups ranging from 30 to 60 years old. For all subjects, characteristic swallowing waveforms (with two valleys based on laryngeal movements consisting of upward, forward, backward, and downward displacements) were acquired using the proposed wearable swallowing assessment device. Since the denoted time of the first valley in the acquired waveform determines the "aging effect", significant differences in swallowing functions among the different age groups were ultimately determined based on the time of the first valley. Additionally, by analyzing each age group using the proposed device, due to p-values being consistently less than 0.05, swallowing times were found to exhibit statistically significant differences within the same groups.
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Affiliation(s)
- Masanori Maeda
- Information Systems Science Major, Graduate of Science and Engineering, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Miyuki Kadokura
- Information Systems Science Major, Graduate of Science and Engineering, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Ryoko Aoki
- Faculty of Nursing, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Noriko Komatsu
- Faculty of Nursing, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Masaru Kawakami
- School of Nursing, Jichi Medical University, 3311-159 Yakushiji, Shimotsuke, Tochigi 329-0431, Japan
| | - Yuya Koyama
- Department of Electrical and Electronic Engineering, Chiba Institute of Technology, 2-17-1 Tsudanuma, Narashino, Chiba 275-0016, Japan
| | - Kazuhiro Watanabe
- Department of Science and Engineering for Sustainable Innovation, Faculty of Science and Engineering, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Michiko Nishiyama
- Department of Science and Engineering for Sustainable Innovation, Faculty of Science and Engineering, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
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7
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Thu Hien NT, Thong TH, Tung LT, Khoi VH, Thu Hoai DT, Tinh TT, Van Huy N, Kien VD. Dysphagia and associated factors among patients with acute ischemic stroke in Vietnam. Ann Med Surg (Lond) 2022; 84:104887. [DOI: 10.1016/j.amsu.2022.104887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
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Smithard DG, Yoshimatsu Y. Pneumonia, Aspiration Pneumonia, or Frailty-Associated Pneumonia? Geriatrics (Basel) 2022; 7:115. [PMID: 36286218 PMCID: PMC9602119 DOI: 10.3390/geriatrics7050115] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Pneumonia is a common reason for admission afflicting frail older adults. Those who are the frailest are more likely to be provided with a diagnosis of aspiration pneumonia. This diagnosis has no clear definition and no clinical consensus. It is therefore time to stop attempting to differentiate between pneumonia type and use the term frailty-associated pneumonia.
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Affiliation(s)
- David G. Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London SE19 4QH, UK
- Centre for Exercise, Activity and Rehabilitation, University of Greenwich Southwood Site, London SE9 2UG, UK
| | - Yuki Yoshimatsu
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London SE19 4QH, UK
- Centre for Exercise, Activity and Rehabilitation, University of Greenwich Southwood Site, London SE9 2UG, UK
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9
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Yoshimatsu Y, Melgaard D, Westergren A, Skrubbeltrang C, Smithard DG. The diagnosis of aspiration pneumonia in older persons: a systematic review. Eur Geriatr Med 2022; 13:1071-1080. [PMID: 36008745 PMCID: PMC9409622 DOI: 10.1007/s41999-022-00689-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/09/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Community-acquired pneumonia (CAP) is highly common across the world. It is reported that over 90% of CAP in older adults may be due to aspiration. However, the diagnostic criteria for aspiration pneumonia (AP) have not been widely agreed. Is there a consensus on how to diagnose AP? What are the clinical features of patients being diagnosed with AP? We conducted a systematic review to answer these questions. METHODS We performed a literature search in MEDLINE®, EMBASE, CINHAL, and Cochrane to review the steps taken toward diagnosing AP. Search terms for "aspiration pneumonia" and "aged" were used. Inclusion criteria were: original research, community-acquired AP, age ≥ 75 years old, acute hospital admission. RESULTS A total of 10,716 reports were found. Following the removal of duplicates, 7601 were screened, 95 underwent full-text review, and 9 reports were included in the final analysis. Pneumonia was diagnosed using a combination of symptoms, inflammatory markers, and chest imaging findings in most studies. AP was defined as pneumonia with some relation to aspiration or dysphagia. Aspiration was inferred if there was witnessed or prior presumed aspiration, episodes of coughing on food or liquids, relevant underlying conditions, abnormalities on videofluoroscopy or water swallow test, and gravity-dependent distribution of shadows on chest imaging. Patients with AP were older, more frailer, and had more comorbidities than in non-AP. CONCLUSION There is a broad consensus on the clinical criteria to diagnose AP. It is a presumptive diagnosis with regards to patients' general frailty rather than in relation to swallowing function itself.
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Affiliation(s)
- Yuki Yoshimatsu
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK.
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK.
| | - Dorte Melgaard
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Albert Westergren
- The Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | | | - David G Smithard
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK
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Pellico-López A, Fernández-Feito A, Parás-Bravo P, Herrero-Montes M, Cayón-De Las Cuevas J, Cantarero D, Paz-Zulueta M. Differential characteristics of cases of patients diagnosed with pneumonia and delayed discharge for non-clinical reasons in Northern Spain. Int J Clin Pract 2021; 75:e14765. [PMID: 34473876 DOI: 10.1111/ijcp.14765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Delayed discharge for non-clinical reasons is related to a failure to plan for discharge and a lack of availability of intermediate care resources as an alternative to acute hospitalisation. The literature concerning the relationship with pneumonia is scarce. At present, the coronavirus pandemic is a new cause of complicated pneumonias that can further affect the functionality of the most fragile patients. OBJECTIVE The aim of this study was to understand what characteristics are typical of patients affected by pneumonia, compared with other cases of delayed discharge. METHODS A cross-sectional study was conducted. All cases of delayed discharge were studied at the hospitalisation units of a general university hospital in Northern Spain from 2007 to 2015. In order to compare the differential characteristics of the groups of patients with pneumonia with the total Student's T-test and Pearson's chi-square test (χ²) were used. RESULTS 170 patients were identified with a diagnosis of pneumonia and delayed discharge for non-clinical reasons during the study period. These cases accumulated a total of 4790 days of total stay, of which 1294 days corresponded to the prolonged stay. The mean age of the patients was 80.23 years. The mean DRG weight was 2.28 [SD 0.579], and 14.12% of patients with pneumonia and delayed discharge died. So, patients with pneumonia were older (P = .001), less complex (P = .001) and suffered greater deaths compared with the remaining patients (P = .001). CONCLUSIONS The sum of these factors has to do with comorbidities and complications associated with ageing and the characteristics of conditions such as aspiration pneumonia.
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Affiliation(s)
| | - Ana Fernández-Feito
- Faculty of Medicine and Health Sciences, Nursing Area, Department of Medicine, University of Oviedo, ISPA, Avda, Principado de Asturias, Spain
| | - Paula Parás-Bravo
- Faculty of Nursing, University of Cantabria, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Enfermería, Cantabria, Spain
| | - Manuel Herrero-Montes
- Faculty of Nursing, University of Cantabria, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Enfermería, Cantabria, Spain
| | - Joaquín Cayón-De Las Cuevas
- Faculty of Law, University of Cantabria, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Cantabria, Spain
| | - David Cantarero
- Department of Economics, University of Cantabria, Cantabria, Spain
- IDIVAL, Cantabria, Spain
| | - Maria Paz-Zulueta
- Faculty of Nursing, University of Cantabria, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Cantabria, Spain
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11
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Mucus, Microbiomes and Pulmonary Disease. Biomedicines 2021; 9:biomedicines9060675. [PMID: 34199312 PMCID: PMC8232003 DOI: 10.3390/biomedicines9060675] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 12/20/2022] Open
Abstract
The respiratory tract harbors a stable and diverse microbial population within an extracellular mucus layer. Mucus provides a formidable defense against infection and maintaining healthy mucus is essential to normal pulmonary physiology, promoting immune tolerance and facilitating a healthy, commensal lung microbiome that can be altered in association with chronic respiratory disease. How one maintains a specialized (healthy) microbiome that resists significant fluctuation remains unknown, although smoking, diet, antimicrobial therapy, and infection have all been observed to influence microbial lung homeostasis. In this review, we outline the specific role of polymerizing mucin, a key functional component of the mucus layer that changes during pulmonary disease. We discuss strategies by which mucin feed and spatial orientation directly influence microbial behavior and highlight how a compromised mucus layer gives rise to inflammation and microbial dysbiosis. This emerging field of respiratory research provides fresh opportunities to examine mucus, and its function as predictors of infection risk or disease progression and severity across a range of chronic pulmonary disease states and consider new perspectives in the development of mucolytic treatments.
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Nishida T, Yamabe K, Honda S. The Influence of Dysphagia on Nutritional and Frailty Status among Community-Dwelling Older Adults. Nutrients 2021; 13:nu13020512. [PMID: 33557341 PMCID: PMC7915146 DOI: 10.3390/nu13020512] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is a core symptom of the frailty cycle in older adults. The purpose of this study was to investigate whether dysphagia influences nutrition or frailty status in community-dwelling older adults. The study participants were 320 Japanese community-dwelling older adults aged ≥65 years. All participants completed a questionnaire survey that included items on age, sex, family structure, self-rated health, nutritional and frailty status, and swallowing function. Nutritional status was categorized as malnourished, at risk of malnutrition, and well-nourished based on the Mini Nutrition Assessment-Short Form. The participants were then classified into a malnutrition (malnourished/at risk) or a well-nourished group (well-nourished). Frailty was assessed using the Cardiovascular Health Study criteria. The participants were then divided into a frailty (frail/pre-frail) or a non-frailty group (robust). Dysphagia was screened using the 10-item Eating Assessment Tool. Multiple logistic regression analysis was conducted to determine whether dysphagia was associated with nutritional or frailty status. The results revealed that dysphagia influenced both nutrition (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 1.9-8.2) and frailty status (OR: 2.3; 95% CI: 1.0-5.2); therefore, the swallowing function would be an important factor for community-dwelling older adults on frailty prevention programs.
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Affiliation(s)
- Takahiro Nishida
- Sasebo-Yoshii Community Comprehensive Support Center, Sasebo 859-6305, Japan;
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan
| | | | - Sumihisa Honda
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan
- Correspondence: ; Tel.: +81-95-819-7945
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Romero-Gangonells E, Virgili-Casas MN, Dominguez-Rubio R, Povedano M, Pérez-Saborit N, Calvo-Malvar N, Barceló MA. Evaluation of Dysphagia in Motor Neuron Disease. Review of Available Diagnostic Tools and New Perspectives. Dysphagia 2020; 36:558-573. [PMID: 32797289 DOI: 10.1007/s00455-020-10170-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
Oropharyngeal dysphagia (OD) is highly prevalent (up to 80%) in patients with motor neuron disease (MND), influencing the prognosis of the disease. The clinical assessment of dysphagia is complex. There are assessment scales and screening questionnaires, but they have not been tested in patients with MND. In a sample of 46 patients with MND, the sensitivity and specificity of the EAT-10 and SwalQoL questionnaires, as well as the ALS-SS and FOIS scales, were tested and compared to the gold standard technique (videofluoroscopy, VFS). The patients were stratified using the DOSSc variable according to the video fluoroscopic examination with (n = 37) or without (n = 8) signs of dysphagia, and the results were compared with the scores obtained in the dysphagia questionnaires. None of the studied questionnaires was more sensitive than the others, but one stood out for its high specificity (= 1): the SwalQoL revised FS. The symptom frequency section of the SwalQoL questionnaire with some modifications, (SwalQoL revised FS) may be a useful tool in the clinical assessment of dysphagia because it's capable to detect the patients that really don't have dysphagia. The ALS-SS showed the greatest validity as a severity scale of dysphagia among the sample studied. A specific questionnaire for screening for dysphagia in MND needs to be developed. Until that time, the proposal is to use a combination of the existing questionnaires for other pathologies (EAT-10 and SwalQoL) and the specific scale for MND, the ALS-SS, to make an accurately clinical assessment of OD in MND patients before to perform a videofluoroscopy.
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Affiliation(s)
- Elisabet Romero-Gangonells
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
- Department of Endocrinology and Clinical Nutrition, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - M Núria Virgili-Casas
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
- Department of Endocrinology and Clinical Nutrition, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Raúl Dominguez-Rubio
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
| | - Mònica Povedano
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
| | - Núria Pérez-Saborit
- Department of Image Diagnosis and Nuclear Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Nahum Calvo-Malvar
- Department of Image Diagnosis and Nuclear Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Maria A Barceló
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain.
- Research Group On Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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Manabe T, Kotani K, Teraura H, Minami K, Kohro T, Matsumura M. Characteristic Factors of Aspiration Pneumonia to Distinguish from Community-Acquired Pneumonia among Oldest-Old Patients in Primary-Care Settings of Japan. Geriatrics (Basel) 2020; 5:E42. [PMID: 32645839 PMCID: PMC7555817 DOI: 10.3390/geriatrics5030042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Aspiration pneumonia (AsP), a phenotype of community-acquired pneumonia (CAP), is a common and problematic disease with symptomless recurrence and fatality in old adults. Characteristic factors for distinguishing AsP from CAP need to be determined to manage AsP. No such factorial markers in oldest-old adults, who are often seen in the primary-care settings, have yet been established. Methods: From the database of our Primary Care and General Practice Study, including the general backgrounds, clinical conditions and laboratory findings collected by primary care physicians and general practitioners, the records of 130 patients diagnosed with either AsP (n = 72) or CAP (n = 58) were extracted. Characteristic factors associated with the diagnosis of AsP were statistically compared between AsP and CAP. Results: The patients were older in the AsP group (median 90 years old) than in the CAP group (86 years old). The body temperature, heart rate, and diastolic blood pressure were lower in the patients with AsP than in those with CAP. Witnessed meal dysphagia by families and caregivers was reported only in AsP. Living in a nursing home, comorbidities of cerebral infarction and dementia (as positive factors) and hypertension (as a negative factor) were considered predictive to diagnose AsP in a stepwise logistic regression analysis. Conclusions: Among oldest-old adults in primary-care settings, living in a nursing home and the dysphagia risks are suggested to be characteristic factors for diagnosing AsP. Age and some relevant clinical information may help manage AsP and also be useful for families and caregivers.
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Affiliation(s)
- Toshie Manabe
- Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan; (T.M.); (H.T.)
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan; (T.M.); (H.T.)
| | - Hiroyuki Teraura
- Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan; (T.M.); (H.T.)
| | - Kensuke Minami
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke-City, Tochigi 329-0498, Japan;
| | - Takahide Kohro
- Data Science Center, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan;
| | - Masami Matsumura
- Division of General Medicine, Center of Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan;
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Hansen T, Kjaersgaard A. Item analysis of the Eating Assessment Tool (EAT-10) by the Rasch model: a secondary analysis of cross-sectional survey data obtained among community-dwelling elders. Health Qual Life Outcomes 2020; 18:139. [PMID: 32404203 PMCID: PMC7222581 DOI: 10.1186/s12955-020-01384-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/28/2020] [Indexed: 01/19/2023] Open
Abstract
Background The Eating Assessment Tool (EAT-10) is increasingly used to screen for self-perceived oropharyngeal dysphagia (OD) in community-dwelling elders. A summated EAT-10 total score ranges from 0 to 40, with a score ≥ 3 indicative of OD. When using cut-points of a summated score, important requirements for the measurements are specific objectivity, validity, and reliability. Analysis by the Rasch model allows investigation of whether scales like EAT-10 satisfy these requirements. Currently, a few studies have found that EAT-10 responses from clinical populations with OD do not adequately fit the Rasch model. Purpose The aim of this study was to determine whether measurements by EAT-10 fit the Rasch model when applied in screening self-perceived OD in non-clinical populations. Methods Secondary analysis was conducted on data from a cross-sectional survey of community-dwelling elders living in a municipal district of Tokyo, Japan, in which 1875 respondents completed the Japanese version of EAT-10 (J-EAT-10). Data were cleaned and recoded for the purpose of the analysis in this study, which resulted in inclusion of J-EAT-10 responses from 1144 respondents. Data were analyzed using RUMM2030 and included overall model fit, reliability, unidimensionality, threshold ordering, individual item and person fits, differential item functioning, local item dependency, and targeting. Results The analysis identified that the response categories from zero to four were not used as intended and did not display monotonicity, which necessitated reducing the five categories to three. Considerable floor effect was demonstrated and there was an inappropriate match between items’ and respondents’ estimates. The person separation reliability (PSI = 0.65) was inadequate, indicating that it is not possible to differentiate between different levels of OD. Several items displayed misfit with the Rasch model, and there were local item dependency and several redundant items. Conclusions J-EAT-10 performed less than optimally and exhibited substantial floor effect, low reliability, a rating scale not working as intended, and several redundant items. Different improvement strategies failed to resolve the identified problems. Use of J-EAT-10 in population-based surveys cannot therefore be recommended. For such purpose, alternative screening tools of self-perceived OD should be chosen or a new one should be developed and validated.
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Affiliation(s)
- Tina Hansen
- Division of Occupational Therapy, Faculty of Health and Technology, Copenhagen University College, Sigurdsgade 26, 2200, N Copenhagen, Denmark.
| | - Annette Kjaersgaard
- Department for Education, Hammel Neurorehabilitation Centre and University Research Clinic, Voldbyvej 15, 8450, Hammel, Denmark
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Nishida T, Yamabe K, Ide Y, Honda S. Utility of the Eating Assessment Tool-10 (EAT-10) in Evaluating Self-Reported Dysphagia Associated with Oral Frailty in Japanese Community-Dwelling Older People. J Nutr Health Aging 2020; 24:3-8. [PMID: 31886801 DOI: 10.1007/s12603-019-1256-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of the present study was to verify the associations between dysphagia as screened by the Eating Assessment Tool-10 (EAT-10) and indicators in the 100-mL water swallowing test (WST) or medical history among community-dwelling older people. STUDY DESIGN A cross-sectional study. SETTING AND PARTICIPANTS The study participants were 202 community-dwelling older Japanese adults aged ≥65 years. MEASUREMENTS We investigated the participants' basic attributes, including age, sex, body mass index, medical history (cerebrovascular disease, respiratory disease: chronic obstructive pulmonary disease [COPD], and history of pneumonia within the previous year), and number of prescribed medications. Dysphagia assessment was performed using the EAT-10 and the 100-mL WST as subjective and objective examinations, respectively. The 100-mL WST used four indicators (SC: swallowing capacity, VS: volume per swallow, TS: time per swallow, and choking signs). Patients with and without dysphagia according to the EAT-10 were divided into two groups according to a cutoff score of 3, and the two groups were then compared in terms of their characteristics including medical history and 100-mL WST indicators. A multiple logistic regression model was used to determine whether the indicators of the 100-mL WST or medical history were independently associated with dysphagia in the EAT-10. RESULTS The multiple logistic regression analysis revealed that dysphagia in the EAT-10 was independently associated with male sex (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 0.98-7.90), COPD (OR = 14.68; 95% CI = 3.14-68.85), and VS and TS in the 100-mL WST (OR = 0.85; 95% CI = 0.80-0.90 and OR = 3.03; 95% CI = 1.78-5.16, respectively). CONCLUSIONS Our results revealed that the EAT-10 was independently associated with the 100-mL WST and respiratory disease. We propose that swallowing rehabilitation incorporating respiratory training could be effective for older people screened using the EAT-10.
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Affiliation(s)
- T Nishida
- Sumihisa Honda, Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8520, Japan, TEL.: +81-95-819-7945, FAX.: +81-95-819-7907, E-mail:
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Nishida T, Yamabe K, Honda S. Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons. Gerodontology 2019; 37:185-190. [PMID: 31874118 DOI: 10.1111/ger.12455] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/15/2019] [Accepted: 12/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate which domains of frailty are associated with dysphagia in community-dwelling elderly persons. BACKGROUND Dysphagia is a common cause of aspiration pneumonia in frail elderly persons in Japan. Although frailty is considered to be multidimensional, it is unclear which domains of frailty affect dysphagia. METHODS The participants were 3475 independent Japanese elderly persons (≥65 years; 1555 men and 1920 women). A self-report questionnaire with a frailty checklist consisting of several domains (lifestyle, physical function, nutrition, oral function, homebound status, cognitive function and depressive mood) was used to determine the participants' characteristics. Dysphagia was defined as impaired swallowing in the oral function domain. To determine the associations between dysphagia and age, sex and the other domains on the frailty checklist, adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated using multiple logistic regression analysis. RESULTS The multiple logistic regression analysis showed that dysphagia was independently associated with female sex (AOR = 1.35; 95% CI = 1.08-1.68), chewing ability (AOR = 1.70; 95% CI = 1.32-2.18), oral dryness (AOR = 1.94; 95% CI = 1.48-2.54), physical function (AOR = 2.19; 95% CI = 1.66-2.90), cognitive function (AOR = 1.68; 95% CI = 1.34-2.12) and depressive mood (AOR = 1.82; 95% CI = 1.41-2.35). CONCLUSION Dysphagia was independently associated with oral, physical, cognitive and psychological frailty. These results suggest that frailty prevention strategy including swallowing training might be useful for community-dwelling independent elderly persons aged ≥65 years.
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Affiliation(s)
- Takahiro Nishida
- Sasebo-Yoshii Community Comprehensive Support Center, Sasebo, Japan.,Yamabe Dental Clinic, Sasebo, Japan.,Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Sumihisa Honda
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Jeon I, Jung GP, Seo HG, Ryu JS, Han TR, Oh BM. Proportion of Aspiration Pneumonia Cases Among Patients With Community-Acquired Pneumonia: A Single-Center Study in Korea. Ann Rehabil Med 2019; 43:121-128. [PMID: 31072078 PMCID: PMC6509581 DOI: 10.5535/arm.2019.43.2.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/10/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the proportion of aspiration pneumonia cases among patients with community-acquired pneumonia in Korea. Methods This retrospective study included patients with community-acquired pneumonia who had been admitted to the emergency department of a university-affiliated tertiary hospital in Gyeonggi Province, Korea between January 1, 2016 and December 31, 2016. Among these patients, those with aspiration pneumonia were identified using ICD-10 codes (J69.*). Patients with recurrent pneumonia were excluded, as were those who were immunocompromised. The proportion of cases of aspiration pneumonia was calculated, and the characteristics and clinical outcomes of patients with aspiration pneumonia and non-aspiration pneumonia were compared. Results The proportion of aspiration pneumonia cases among patients with community-acquired pneumonia was 14.2%. Patients with aspiration pneumonia were significantly more likely to be older (p<0.001) and male (p<0.001), and to have a higher confusion, uremia, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001) as compared to patients with non-aspiration pneumonia. They were also more likely to require admission to the intensive care unit (p<0.001) and a longer hospital stay (p<0.001). Conclusion Aspiration pneumonia accounts for 14.2% of all cases of community-acquired pneumonia in Korea. These data may contribute to the establishment of healthcare strategies for managing aspiration pneumonia among Korean adults.
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Affiliation(s)
- Inpyo Jeon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gwang Pyo Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
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Singer M, Conde-Martel A, Hemmersbach-Miller M, Ruiz-Hernández J, Arencibia Borrego J, Alonso Ortiz B. Mortality hospital of nonagenarian patients in Internal Medicine. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Singer M, Conde-Martel A, Hemmersbach-Miller M, Ruiz-Hernández JJ, Arencibia Borrego J, Alonso Ortiz B. Mortality hospital of nonagenarian patients in Internal Medicine. Rev Clin Esp 2017; 218:61-65. [PMID: 29224908 DOI: 10.1016/j.rce.2017.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/19/2017] [Accepted: 10/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe the predictors of hospital mortality in nonagenarian patients. PATIENTS AND METHOD We retrospectively studied 421 patients aged 90 years or older hospitalised in a department of internal medicine. Using logistic regression, we analysed the association between demographic, clinical and functional parameters and hospital mortality. RESULTS The mean age was 92.5 years (SD±2.5), and 265 (62.9%) of the patients were women. The main diagnoses were infectious diseases (257 patients, 61%) and heart failure (183, 43.5%), and the mean stay was 11.9 days (SD±8.6). During the hospitalisation, 96 patients died (22.8%). The predictors of mortality were age (P=.002), functional state (P=.006), comorbidity (P=.018) and diagnoses of pneumonia (P=.001), sepsis (P=.012) and respiratory failure (P<.001). CONCLUSION The hospital mortality of nonagenarian patients treated in internal medicine exceeds 20% and is associated with pneumonia, comorbidity burden and functional impairment.
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Affiliation(s)
- M Singer
- Universidad de Las Palmas de Gran Canaria, Las Palmas, España
| | - A Conde-Martel
- Universidad de Las Palmas de Gran Canaria, Las Palmas, España; Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España.
| | - M Hemmersbach-Miller
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| | - J J Ruiz-Hernández
- Universidad de Las Palmas de Gran Canaria, Las Palmas, España; Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| | - J Arencibia Borrego
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| | - B Alonso Ortiz
- Universidad de Las Palmas de Gran Canaria, Las Palmas, España; Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
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Noguchi S, Yatera K, Kato T, Chojin Y, Fujino Y, Akata K, Kawanami T, Sakamoto N, Mukae H. Impact of the number of aspiration risk factors on mortality and recurrence in community-onset pneumonia. Clin Interv Aging 2017; 12:2087-2094. [PMID: 29263657 PMCID: PMC5724415 DOI: 10.2147/cia.s150499] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction The clinical significance of the number of aspiration risk factors in patients with pneumonia is unknown as yet. In the present study, we clarify the significance of the number of aspiration risk factors for mortality and recurrence in pneumonia patients. Methods This study included 322 patients hospitalized with pneumonia between December 2014 and June 2016. We investigated associations between the number of aspiration risk factors present (orientation disturbance, bedridden, chronic cerebrovascular disease, dementia, sleeping medications and gastroesophageal disease) and 30-day and 6-month mortality, and pneumonia recurrence within 30 days. Results Patients were categorized by number of risk factors present into groups of 0–1, 2, 3, and 4 or more. Of a total of 322 patients, 93 (28.9%) had 0–1 risk factors, 112 (34.8%) had 2, 88 (27.3%) had 3, and 29 (9.0%) had 4 or more risk factors. The percentages of patients with recurrence of pneumonia were 13.0%, 33.0%, 43.2%, and 54.2% in the 0–1, 2, 3, and 4 or more risk factor groups, respectively. The percentages of patients with 30-day mortality were 2.2%, 5.4%, 11.4%, and 24.1%, and those of patients with 6-month mortality were 6.6%, 24.5%, 30.7%, and 50.0%, in the 0–1, 2, 3, and 4 or more risk factor groups, respectively. Conclusions The number of aspiration risk factors was associated with increases in both mortality and recurrence in pneumonia patients. Therefore, in clinical practice, physicians should consider not only the presence of aspiration risks but also the number of aspiration risk factors in these patients.
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Affiliation(s)
- Shingo Noguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tatsuji Kato
- Department of Respiratory Medicine, Tobata Kyoritsu Hospital, Kitakyushu, Japan
| | - Yasuo Chojin
- Department of Respiratory Medicine, Tobata Kyoritsu Hospital, Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kentaro Akata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshinori Kawanami
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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