title: Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Research Unit, Consorci Sanitari del Maresme, Hospital de Mataró, Carretera de Cirera s/n, 08304, Mataró, Barcelona, Spain. mserra@csdm.cat.
authors.forename: Mateu
authors.initials: M
authors.lastname: Cabré
authors.forename: Mateu
authors.initials: M
authors.lastname: Serra-Prat
authors.forename: Ll
authors.initials: L
authors.lastname: Force
authors.forename: Jordi
authors.initials: J
authors.lastname: Almirall
authors.forename: Elisabet
authors.initials: E
authors.lastname: Palomera
authors.forename: Pere
authors.initials: P
authors.lastname: Clavé
mesh_terms: D000368:Aged; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D003371:Cough / Q000453:epidemiology; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D018737:Hand Strength / Q000502:physiology; D006757:Hospital Units; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D010100:Oxygen / Q000097:blood; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology*; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D014833:Voice Quality
chemical_list: D010100:Oxygen
keywords: Aspiration pneumonia.; Deglutition disorders; Dysphagia; Elderly; Patient readmission; Pneumonia