Oropharyngeal Dysphagia is a Risk Factor for Readmission for Pneumonia in the Very Elderly Persons: Observational Prospective Study
Oropharyngeal Dysphagia is a Risk Factor for Readmission for Pneumonia in the Very Elderly Persons: Observational Prospective Study
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DOI：
10.1093/gerona/glt099
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发表时间：
2014-03-01
影响因子：
5.1
通讯作者：
Clave, Pere
中科院分区：
文献类型：
--
作者：
Cabre, Mateu;Serra-Prat, Mateu;Clave, Pere
背景。确定口咽吞咽困难是否是急性老年病房出院老年人肺炎再入院的危险因素。方法。观察性前瞻性队列研究，基于临床数据库和电子临床记录收集数据。招募2002年6月至2009年12月从急性老年病房出院的所有老年人并进行随访，直至死亡或2010年12月31日。所有个体根据床边临床检查评估的口咽吞咽困难的存在情况进行初步分类。主要结果指标是因肺炎再次入院。由临床专家审查临床记录以验证诊断并将肺炎分类为吸入性或非吸入性肺炎。结果。总共招募了 2,359 名患者（61.9% 为女性，平均年龄 84.9 岁），并进行了平均 24 个月的随访。 47.5% 的病例被诊断为吞咽困难。总体而言，7.9% 的患者在随访期间因肺炎再次入院，其中 24.2% 患有吸入性肺炎。无吞咽困难个体因肺炎再入院的发生率为每100人年3.67次（95% CI 3.0-4.4），有吞咽困难个体为6.7次（5.5-7.8），归因风险为每100人年3.02次再入院（1.66-4.38），比率为1.82 （1.41-2.36）。多变量Cox回归显示口咽吞咽困难具有独立影响，因肺炎住院的风险比为1.6（1.15-2.2），吸入性肺炎住院的风险比为4.48（2.01-10.0），非吸入性肺炎住院的风险比为1.44（1.02-2.03）。结论。口咽吞咽困难是一种非常普遍且相关的危险因素，与老年人因吸入性和非吸入性肺炎再次入院相关。
Background. To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit.Methods. 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.Results. 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.Conclusion. 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.