Department of Oral and Maxillofacial Surgery, Noto General Hospital, Ishikawa, Japan.
Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Oral Rehabil. 2020 Jan;47(1):53-60. doi: 10.1111/joor.12861. Epub 2019 Aug 26.
Food boluses in the pharynx without enough bolus formation sometimes cause aspiration among older adults; however, the relationship between food bolus-forming ability and incidence of aspiration pneumonia is unclear.
To investigate the relationship between food bolus-forming ability and incidence of aspiration pneumonia by evaluating the condition of chew-swallow managing food transported into the pharynx.
A prospective observational study conducted in a nursing home for the elderly between April 2016 and February 2018. Seventy-three residents who swallowed thickened liquids and consistent boluses without aspiration were included. Food boluses were graded into three categories in the pharynx using videoendoscopic evaluation. Boluses that retained their original shape were defined as Grade 1. A mixture of large and small boluses was defined as Grade 2. Boluses that had completely transformed into a paste were defined as Grade 3. The relationship between the bolus formation grade and incidence of aspiration pneumonia over 6-month follow-up was investigated.
Seventeen residents developed aspiration pneumonia. The incidence rate of aspiration pneumonia was highest among residents with Grade 1 boluses, at an incidence rate of .187 cases per person-month (95% confidence interval (CI): 0.097-0.359). Cox regression showed residents with Grade 1 boluses had a hazard ratio of 4.548 (1.393-14.85) for incidence of aspiration pneumonia compared with residents who had Grade 2 or 3 boluses.
Insufficient food bolus-forming ability predicted high incidence of aspiration pneumonia. Healthcare professionals should evaluate the food bolus-forming ability, as well as swallowing function, to prevent aspiration pneumonia.
咽部食物团块形成不足有时会导致老年人发生吸入；然而，食物团块形成能力与吸入性肺炎的发生率之间的关系尚不清楚。
通过评估进入咽部的食物运送的咀嚼-吞咽管理能力，调查食物团块形成能力与吸入性肺炎发生率之间的关系。
这是一项 2016 年 4 月至 2018 年 2 月在养老院进行的前瞻性观察研究。纳入了 73 名吞咽浓稠液体和一致团块且无吸入的居民。使用视频内镜评估将食物团块在咽部分为 3 个等级。保留原始形状的团块定义为 Grade 1；大小不一的团块混合定义为 Grade 2；完全变成糊状的团块定义为 Grade 3。研究了团块形成等级与 6 个月随访期间吸入性肺炎发生率之间的关系。
17 名居民发生吸入性肺炎。Grade 1 团块的居民吸入性肺炎发生率最高，发生率为.187 例/人-月（95%置信区间（CI）：0.097-0.359）。Cox 回归显示，与 Grade 2 或 3 团块的居民相比，Grade 1 团块的居民发生吸入性肺炎的风险比为 4.548（1.393-14.85）。
食物团块形成能力不足预测吸入性肺炎发生率高。医护人员应评估食物团块形成能力以及吞咽功能，以预防吸入性肺炎。
