Research Unit, Consorci Sanitari del Maresme, Hospital de Mataró, Carretera de Cirera s/n, 08304, Mataró, Barcelona, Spain.
J Gerontol A Biol Sci Med Sci. 2014 Mar;69(3):330-7. doi: 10.1093/gerona/glt099. Epub 2013 Jul 5.
To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit.
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.
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.
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.
确定老年人从急性老年病房出院后是否存在口咽吞咽困难与肺炎再入院相关。
这是一项观察性前瞻性队列研究，数据收集基于临床数据库和电子临床记录。2002 年 6 月至 2009 年 12 月期间，所有从急性老年病房出院的老年人被招募并随访至死亡或 2010 年 12 月 31 日。所有患者最初根据床边临床检查评估的口咽吞咽困难情况进行分类。主要结局指标为肺炎再入院。临床记录由专家临床医生进行审查以验证诊断，并将肺炎分类为吸入性或非吸入性肺炎。
共招募 2359 例患者（61.9%为女性，平均年龄 84.9 岁），平均随访 24 个月。47.5%的患者诊断为吞咽困难。在随访期间，共有 7.9%的患者因肺炎再入院，其中 24.2%的患者为吸入性肺炎。无吞咽困难的患者肺炎再入院的发生率为每 100 人年 3.67 次（95%CI 3.0-4.4），而有吞咽困难的患者为 6.7 次（5.5-7.8），每 100 人年有 3.02 次可归因于吞咽困难（1.66-4.38），且率比为 1.82（1.41-2.36）。多变量 Cox 回归显示口咽吞咽困难是一个独立的危险因素，肺炎住院的风险比为 1.6（1.15-2.2），吸入性肺炎为 4.48（2.01-10.0），非吸入性肺炎为 1.44（1.02-2.03）。
口咽吞咽困难是一个非常普遍和相关的危险因素，与非常老年患者的肺炎再入院，包括吸入性和非吸入性肺炎均相关。
