Langmore Susan E, Skarupski Kimberly A, Park Pil S, Fries Brant E
Department of Neurology, University of California San Francisco, San Francisco, California.
Dysphagia. 2002 Fall;17(4):298-307. doi: 10.1007/s00455-002-0072-5.
Aspiration pneumonia is a serious problem for the elderly institutionalized person, often requiring transfer to a hospital and a lengthy stay there. It is associated with a high mortality rate and is very costly to the health care system. The current study sought to determine the key predictors of aspiration pneumonia in a nursing home population with the hope that health care providers could identify those residents at highest risk and focus more efforts on prevention of this serious disease. A cross-sectional, retrospective analysis was done, using the Minimum Data Set (MDS) nursing home assessment data for three states (New York, Mississippi, Maine) from 1993 to 1994 (N = 102842). Nursing home residents were aged 65+. Standardized MDS summary scales and their component items were used, including: the Activities of Daily Living (ADL) scale, the cognitive performance scale (CPS), and the Resource Utilization Groups (RUGs). Results of these analyses showed the prevalence of pneumonia among this population was 3% (n = 3118). Results from the logistic regression models indicated 18 significant predictors of aspiration pneumonia. The strongest to weakest predictors of pneumonia were, respectively, suctioning use, COPD, CHF, presence of feeding tube, bedfast, high case mix index, delirium, weight loss, swallowing problems, urinary tract infections, mechanically altered diet, dependence for eating, bed mobility, locomotion, number of medications, and age, while both CVA and tracheotomy care were inversely predictive of pneumonia. The emergence of these significant predictors suggested a different pathogenesis of pneumonia in the elderly nursing home resident from the acute care patient or the outpatient. Nursing home residents have chronic medical conditions that gradually lead to "decompensation" in functional status, nutritional status, and pulmonary clearance. Dysphagia and aspiration are common complications of their medical conditions and may slowly worsen as their status deteriorates. Alternatively, a sudden adverse event may dramatically increase the amount aspirated or the ability to resist infection and lead to sudden decompensation. Clinical staff must identify residents with dysphagia and aspiration and work to prevent decline in functional status in all residents. They must be aware of the dangers of adverse events that lead to sudden inactivity or illness and increase the risk of aspiration pneumonia. Prevention of this disease whenever possible will reduce costs, improve health outcomes, and improve our quality of care.
吸入性肺炎对于入住养老机构的老年人来说是一个严重问题，常常需要转至医院并在那里长时间住院。它与高死亡率相关，对医疗保健系统而言成本高昂。当前的研究旨在确定养老院人群中吸入性肺炎的关键预测因素，希望医疗保健提供者能够识别出风险最高的居民，并将更多精力集中于预防这种严重疾病。利用1993年至1994年三个州（纽约州、密西西比州、缅因州）的最低数据集（MDS）养老院评估数据进行了一项横断面回顾性分析（N = 102842）。养老院居民年龄在65岁及以上。使用了标准化的MDS汇总量表及其组成项目，包括：日常生活活动（ADL）量表、认知表现量表（CPS）和资源利用组（RUGs）。这些分析结果显示该人群中肺炎的患病率为3%（n = 3118）。逻辑回归模型的结果表明有18个吸入性肺炎的显著预测因素。肺炎的最强至最弱预测因素分别为使用吸痰、慢性阻塞性肺疾病（COPD）、充血性心力衰竭（CHF）、存在饲管、卧床不起、高病例组合指数、谵妄、体重减轻吞咽问题、尿路感染、饮食机械改变、进食依赖、床上活动能力、移动能力、用药数量和年龄，而脑血管意外（CVA）和气管切开护理与肺炎呈负相关预测。这些显著预测因素的出现表明，老年养老院居民肺炎的发病机制与急性护理患者或门诊患者不同养老院居民患有慢性疾病，这些疾病会逐渐导致功能状态、营养状况和肺部清除功能的“失代偿”。吞咽困难和误吸也是他们所患疾病的常见并发症，可能会随着他们状况的恶化而逐渐加重。或者，突发不良事件可能会极大地增加误吸量或抗感染能力，导致突然失代偿。临床工作人员必须识别出有吞咽困难和误吸的居民，并努力防止所有居民的功能状态下降。他们必须意识到导致突然活动减少或患病并增加吸入性肺炎风险的不良事件的危险性。尽可能预防这种疾病将降低成本、改善健康结果并提高我们的护理质量。
