Comparison of 2 interventions for liquid aspiration on pneumonia incidence: a randomized trial.
BACKGROUND
Aspiration pneumonia is common among frail elderly persons with dysphagia. Although interventions to prevent aspiration are routinely used in these patients, little is known about the effectiveness of those interventions.


OBJECTIVE
To compare the effectiveness of chin-down posture and 2 consistencies (nectar or honey) of thickened liquids on the 3-month cumulative incidence of pneumonia in patients with dementia or Parkinson disease.


METHODS
Randomized, controlled, parallel-design trial in which patients were enrolled for 3-month periods from 9 June 1998 to 19 September 2005.


METHODS
47 hospitals and 79 subacute care facilities.


METHODS
515 patients age 50 years or older with dementia or Parkinson disease who aspirated thin liquids (demonstrated videofluoroscopically). Of these, 504 were followed until death or for 3 months.


METHODS
Participants were randomly assigned to drink all liquids in a chin-down posture (n = 259) or to drink nectar-thick (n = 133) or honey-thick (n = 123) liquids in a head-neutral position.


METHODS
The primary outcome was pneumonia diagnosed by chest radiography or by the presence of 3 respiratory indicators.


RESULTS
52 participants had pneumonia, yielding an overall estimated 3-month cumulative incidence of 11%. The 3-month cumulative incidence of pneumonia was 0.098 and 0.116 in the chin-down posture and thickened-liquid groups, respectively (hazard ratio, 0.84 [95% CI, 0.49 to 1.45]; P = 0.53). The 3-month cumulative incidence of pneumonia was 0.084 in the nectar-thick liquid group compared with 0.150 in the honey-thick liquid group (hazard ratio, 0.50 [CI, 0.23 to 1.09]; P = 0.083). More patients assigned to thickened liquids than those assigned to the chin-down posture intervention had dehydration (6% vs. 2%), urinary tract infection (6% vs. 3%), and fever (4% vs. 2%).


CONCLUSIONS
A no-treatment control group was not included. Follow-up was limited to 3 months. Care providers were not blinded, and differences in cumulative pneumonia incidence between interventions had wide CIs.


CONCLUSIONS
No definitive conclusions about the superiority of any of the tested interventions can be made. The 3-month cumulative incidence of pneumonia was much lower than expected in this frail elderly population. Future investigation of chin-down posture combined with nectar-thick liquid may be warranted to determine whether this combination better prevents pneumonia than either intervention independently.
Robbins
JoAnne
J
William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, and University of Wisconsin, Madison, Wisconsin 53705, USA.
Gensler
Gary
G
Hind
Jacqueline
J
Logemann
Jeri A
JA
Lindblad
Anne S
AS
Brandt
Diane
D
Baum
Herbert
H
Lilienfeld
David
D
Kosek
Steven
S
Lundy
Donna
D
Dikeman
Karen
K
Kazandjian
Marta
M
Gramigna
Gary D
GD
McGarvey-Toler
Susan
S
Miller Gardner
Patricia J
PJ
D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000150:complications*; D003704:Dementia / Q000150:complications*; D004326:Drinking; D005260:Female; D016330:Frail Elderly; D006722:Honey; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D010349:Patient Compliance; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000517:prevention & control*; D011187:Posture; D012307:Risk Factors