Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study

To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit. Observational prospective cohort study with data collection based on clinical databases and electronic clinical notes. All elderly individuals disch...

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Bibliographic Details
Published in:The journals of gerontology. Series A, Biological sciences and medical sciences Biological sciences and medical sciences, 2014-03, Vol.69 (3), p.330-337
Main Authors: Cabré, Mateu, Serra-Prat, Mateu, Force, Ll, Almirall, Jordi, Palomera, Elisabet, Clavé, Pere
Format: Article
Language:English
Subjects:
Aged
Cognition - physiology
Cohort Studies
Cough - epidemiology
Deglutition - physiology
Deglutition Disorders - epidemiology
Female
Follow-Up Studies
Geriatric Assessment - statistics & numerical data
Gerontology
Hand Strength - physiology
Hospital Units
Hospitalization
Hospitalization - statistics & numerical data
Humans
Male
Nutrition Assessment
Older people
Oxygen - blood
Patient Discharge - statistics & numerical data
Patient Readmission - statistics & numerical data
Pneumonia
Pneumonia - diagnosis
Pneumonia - epidemiology
Pneumonia, Aspiration - diagnosis
Pneumonia, Aspiration - epidemiology
Prospective Studies
Respiratory Aspiration - diagnosis
Respiratory Aspiration - epidemiology
Risk Factors
Spain - epidemiology
Survival Rate
Voice Quality
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Summary:To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit. Observational prospective cohort study with data collection based on clinical databases and electronic clinical notes. All elderly individuals discharged from an acute geriatric unit from June 2002 to December 2009 were recruited and followed until death or December 31, 2010. All individuals were initially classified according to the presence of oropharyngeal dysphagia assessed by bedside clinical examination. Main outcome measure was readmission for pneumonia. Clinical notes were reviewed by an expert clinician to verify diagnosis and classify pneumonia as aspiration or nonaspiration pneumonia. A total of 2,359 patients (61.9% women, mean age 84.9 y) were recruited and followed for a mean of 24 months. Dysphagia was diagnosed in 47.5% of cases. Overall, 7.9% of individuals were readmitted for pneumonia during follow-up, 24.2% of these had aspiration pneumonia. The incidence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years (95% CI 3.0-4.4) in individuals without dysphagia and 6.7 (5.5-7.8) in those with dysphagia, with an attributable risk of 3.02 readmissions per 100 person-years (1.66-4.38) and a rate ratio of 1.82 (1.41-2.36). Multivariate Cox regression showed an independent effect of oropharyngeal dysphagia, with a hazard ratio of 1.6 (1.15-2.2) for hospitalization for pneumonia, 4.48 (2.01-10.0) for aspiration pneumonia, and 1.44 (1.02-2.03) for nonaspiration pneumonia. Oropharyngeal dysphagia is a very prevalent and relevant risk factor associated with hospital readmission for both aspiration and nonaspiration pneumonia in the very elderly persons.
ISSN:1079-5006
1758-535X
DOI:10.1093/gerona/glt099