Protection of silent aspiration in the elderly

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To examine the possible relationship between the location of telencephalic infarctions and the incidence of pneumonia, we retrospectively assessed central nervous system morbidity associated with pneumonia in 276 patients 65 years of age or older admitted to a long-term care facility. Patients involved in this study were monitored to determine if they sustained an affecting telencephalic structures. The average duration of observation for all patients was 22 months, and stroke patients were followed for over one year. The incidence of pneumonia was 2.66 times higher in patients with unilateral basal ganglia infarcts (27.4% ; p<0.01) and 4.56 times higher in patients with bilateral basal ganglia strokes (47.0% ; p<0.001) compared to all the other patient groups combined (10.3%). Since patients with basal ganglia infarcts also had a delayd swallowing reflex associated with a higher incidence of silent aspiration during sleep, we speculate that basal ganglia strokes might predispose these patients to develop pneumonia due to frequent aspiration during sleep.