title: Videoendoscopic assessment of swallowing function to predict the future incidence of pneumonia of the elderly.
abstract: The purpose of the present study was to examine what dysphagic signs identified by videoendoscopy (VE) could predict the incidence of pneumonia and body weight loss in elderly patients living in nursing homes. This study was performed at six nursing care facilities in Japan from March 2007 to February 2009. The 148 subjects (85·1 ± 8·0 years, male/female: 43/105) were evaluated for their feeding and swallowing movements by clinical and VE examinations during the consumption of a regular meal. The VE examination items included the existence/absence of pharyngeal residue, laryngeal penetration, and aspiration of food and saliva. The patients were followed-up for 3 months with individualized feeding therapy based on the results of the clinical/VE examination at baseline, and the incidence of pneumonia was examined as the primary outcome. In patients without pneumonia, the body weight change was also measured as a secondary outcome. The risk factors for pneumonia and body weight loss (of 3% or more) were identified among the clinical/VE examination items by a Cox proportional hazard analysis. Even with elaborative feeding therapy, 12 (8·1%) of the 148 patients developed pneumonia during the 3 months follow-up period. The existence of signs of 'silent aspiration of saliva' or 'aspiration of saliva' detected by VE examination was a significant risk factor for both pneumonia and a body weight loss of 3% or more. This study shows that 'aspiration of saliva' detected by VE is a significant risk factor for both pneumonia and body weight loss in elderly patients living in nursing homes.
authors.affiliation: Rehabilitation Clinic for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry at Tokyo, Dental Hospital, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Takahashi
authors.forename: T
authors.initials: T
authors.lastname: Kikutani
authors.forename: F
authors.initials: F
authors.lastname: Tamura
authors.forename: M
authors.initials: M
authors.lastname: Groher
authors.forename: T
authors.initials: T
authors.lastname: Kuboki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014741:Video Recording; D015431:Weight Loss