title: Swallowing impairment is a significant factor for predicting life prognosis of elderly at the end of life.
abstract: BACKGROUND
  In end-of-life care of elderly, the decision of care plan including gastrostomy is difficult frequently because of insufficient knowledge relating the life prognosis of elderly. It is important the families to decide correctly the life prognosis of elderly with geriatric diseases. Our purpose is to examine the significant factors for predicting life prognosis of elderly in end-of-life care.
  
  
  METHODS
  A total of 320 elderly patients was enrolled (male/female 151/169; averaged age: male 84.7 ± 5.9 year, female 86.8 ± 6.3 year) and retrospective analyses were performed. The elderly patients were classified as either: (1) with or without past illness of aspiration pneumonia; (2) with or without incidence of cerebrovascular disorder; (3) impaired or normal cognitive function; (4) impaired or normal swallowing function, and performed Kaplan-Meier survival analysis. Swallowing function was examined using video endoscopic (VE) evaluation method. The Kaplan-Meier analysis of the number of days from implementation of VE test (day 0) to death was evaluated with the log-rank Mantel-Cox test. The maximum follow-up time recorded was 180 days.
  
  
  RESULTS
  There were no significant differences in number of days when divided with or without past illness of aspiration pneumonia, cerebrovascular disorder and impaired cognitive function. The survival probabilities of elderly with impaired swallowing function were significant lower than in elderly with the normal function.
  
  
  CONCLUSIONS
  For judgement of life prognosis, the condition of being frail such as impaired swallowing function might be a useful factor, and the viewpoint would contribute to decide the treatment plan for the good end-of-life care of elderly.
authors.affiliation: Department of Periodontology and Endodontology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8504, Japan. naruishi@tokushima-u.ac.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Naruishi
authors.affiliation: Department of Periodontology and Endodontology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8504, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Nishikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D060825:Cognitive Dysfunction / Q000453:epidemiology; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000401:mortality* / Q000628:therapy; D005260:Female; D000073496:Frailty / Q000453:epidemiology; D005774:Gastrostomy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D011015:Pneumonia, Aspiration / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D013727:Terminal Care / Q000379:methods*
keywords: Elderly; End-of-life care; Life prognosis; Swallowing impairment