Association Between the Swallowing Reflex and the Incidence of Aspiration Pneumonia in Patients With Dysphagia Admitted to Long-term Care Wards: A Prospective Cohort Study of 60 Days.

OBJECTIVE: To investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. DESIGN: The study design was a prospective cohort study. Participants were followed for 60 days from admission. SETTING: LTC wards. PARTICIPANTS: Study participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL. RESULTS: The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group. CONCLUSIONS: Our findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards.

Predictive factors associated with poor outcomes for older adult inpatients in the convalescent rehabilitation ward.

This study aimed to determine predictive factors associated with poor outcomes among older adult inpatients in the convalescent rehabilitation ward. We also examined the validity of factors that were identified as predictive of poor outcomes. Study subjects were 104 older adult inpatients in the convalescent rehabilitation ward, divided into two groups based on outcome at discharge. Group I included the outcomes of death or transfer to an acute care hospital and Group II included all other outcomes. Data were retrospectively collected from older adults' medical records, including: activities of daily living, swallowing grade, nutritional index, and blood biochemistry data. Logistic regression analysis was used to extract predictive factors associated with poor outcomes. Next, we calculated the Stratum-specific likelihood ratio (SSLR) for each extracted factor. Two items were extracted as predictive factors with AUCs ≥ 0.7 : N-terminal pro-brain natriuretic peptide (NT-proBNP) and days from onset to hospitalization. The SSLRs showed the risk for a poor outcome increased when NT-proBNP was ≥ 2500 pg / ml, and when there were ≥ 35 days from onset to hospitalization. Our findings suggest these predictive factors provide a valid index to predict poor outcomes among older adults from the early stage of admission. J. Med. Invest. 67 : 304-310, August, 2020.

[Relationship between the swallowing function and jaw-opening muscle strength in elderly cerebrovascular disease patients].

AIM: In this study, we aimed to clarify the relationship between the swallowing function and the jaw-opening force after cerebrovascular disease. METHODS: Elderly patients with a history of cerebrovascular disease with swallowing disability were enrolled in the present study. The swallowing function was evaluated using the Dysphagia Severity Scale (DSS), and the jaw-opening force was measured using Jaw-Opening Sthenometer (TK2014). The correlation between the DSS and jaw-opening force was analyzed using Spearman's correlation coefficient. Patients were also classified into three groups according to the DSS: normal, dysphagia, and aspiration groups. The jaw-opening forces of the three groups were compared using the Kruskal-Wallis test. RESULTS: Fifty-two patients (27 women, average age 78.8±8.2 years) were recruited. A significant negative correlation was found between the patient age and jaw-opening force in all subjects (r=-0.362, p=0.008) as well as in men (r=-0.548, p=0.005). A significant positive correlation was found between the DSS and jaw-opening force in all subjects (r=0.560, p=0.000) and in both men (r=0.636, p=0.001) and women (r=0.587, p=0.001). The jaw-opening force of the aspiration group was significantly lower than that of the normal group in all subjects (p=0.006), as well as in men (p=0.024) and women (p=0.015). CONCLUSIONS: The DSS and jaw-opening force may have a significant positive correlation. Furthermore, it was shown that the jaw-opening force of the aspiration group was significantly lower than that of the normal-swallowing group.