Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Kumamoto, Japan.
Department of Cancer Center, Aichi Medical University, Aichi, Japan.
Geriatr Gerontol Int. 2018 Feb;18(2):233-239. doi: 10.1111/ggi.13164. Epub 2017 Sep 21.
Hospital-associated dysphagia, characterized by deconditioning of swallowing as a result of hospitalization, is sometimes observed in patients with aspiration pneumonia (AP). Cognitive impairment is known as a negative factor in dysphagia rehabilitation. The present study aimed to examine the association between cognitive impairment and hospital-associated dysphagia in patients with AP receiving dysphagia rehabilitation.
A retrospective observational study was carried out in an acute geriatric hospital. A total of 249 AP patients receiving multidisciplinary individualized dysphagia rehabilitation were included. Patients were divided into four groups according to their Mini-Mental State Examination scores. The Functional Oral Intake Scale (FOIS) was used to assess swallowing ability, and hospital-associated dysphagia was defined as a FOIS decline of ≥1 or ≥2 levels. Body mass index and Barthel Index were obtained to assess nutritional status and activities of daily living.
The mean age was 85.6 ± 7.3 years, and 47% were men. Frequencies of hospital-associated dysphagia observed in lowest to highest Mini-Mental State Examination groups were 43.0%, 36.2%, 47.4% and 27.3% (P = 0.133), and 13.9%, 20.7%, 17.5% and 5.5% (P = 0.117) based on FOIS decline ≥1 or ≥2 levels, respectively. Multivariable regression model showed that the Mini-Mental State Examination score was not an independent determinant of FOIS at discharge (beta = 0.063, P = 0.378) after adjusting for age, sex, body mass index, Barthel Index, pneumonia severity, speech-language pathologist intervention, comorbidities, length of hospital stay and premorbid FOIS.
The severity of cognitive impairment has no impact on hospital-associated dysphagia in AP patients receiving dysphagia rehabilitation. A future interventional study will be expected to further validate our findings. Geriatr Gerontol Int 2018; 18: 233-239.
医院获得性吞咽困难是由于住院导致吞咽功能下降的一种表现，在吸入性肺炎（AP）患者中时有发生。认知障碍是吞咽困难康复的负面因素。本研究旨在探讨接受吞咽困难康复治疗的 AP 患者认知障碍与医院获得性吞咽困难之间的关系。
在一家急性老年医院进行回顾性观察性研究。共纳入 249 例接受多学科个体化吞咽困难康复治疗的 AP 患者。根据简易精神状态检查（MMSE）评分，患者分为四组。采用功能性口腔摄入量表（FOIS）评估吞咽能力，FOIS 下降≥1 或≥2 级定义为医院获得性吞咽困难。测定体重指数和巴氏指数以评估营养状况和日常生活活动能力。
患者平均年龄为 85.6±7.3 岁，47%为男性。MMSE 评分最低至最高组的医院获得性吞咽困难发生率分别为 43.0%、36.2%、47.4%和 27.3%（P=0.133），FOIS 下降≥1 或≥2 级的发生率分别为 13.9%、20.7%、17.5%和 5.5%（P=0.117）。多变量回归模型显示，调整年龄、性别、体重指数、巴氏指数、肺炎严重程度、言语治疗师干预、合并症、住院时间和预患病的 FOIS 后，MMSE 评分不是出院时 FOIS 的独立决定因素（β=0.063，P=0.378）。
认知障碍严重程度对接受吞咽困难康复治疗的 AP 患者的医院获得性吞咽困难无影响。未来的干预性研究将进一步验证我们的研究结果。
老年医学与老年病学杂志 2018；18：233-239
