title: Comparison of 2 interventions for liquid aspiration on pneumonia incidence: a randomized trial.
abstract: 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.
authors: William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, and University of Wisconsin, Madison, Wisconsin 53705, USA.
authors: JoAnne
authors: J
authors: Robbins
authors: Gary
authors: G
authors: Gensler
authors: Jacqueline
authors: J
authors: Hind
authors: Jeri A
authors: JA
authors: Logemann
authors: Anne S
authors: AS
authors: Lindblad
authors: Diane
authors: D
authors: Brandt
authors: Herbert
authors: H
authors: Baum
authors: David
authors: D
authors: Lilienfeld
authors: Steven
authors: S
authors: Kosek
authors: Donna
authors: D
authors: Lundy
authors: Karen
authors: K
authors: Dikeman
authors: Marta
authors: M
authors: Kazandjian
authors: Gary D
authors: GD
authors: Gramigna
authors: Susan
authors: S
authors: McGarvey-Toler
authors: Patricia J
authors: PJ
authors: Miller Gardner
mesh_terms: 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