Kamimura Teppei, Nakamori Masahiro, Naito Hiroyuki, Aoki Shiro, Nezu Tomohisa, Imamura Eiji, Mizoue Tatsuya, Wakabayashi Shinichi, Masuda Takeshi, Hattori Noboru, Maruyama Hirofumi, Hosomi Naohisa
Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi, Minami-ku, Hiroshima-City, Hiroshima, Japan.
Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
Eur Geriatr Med. 2023 Feb;14(1):211-217. doi: 10.1007/s41999-023-00744-7. Epub 2023 Jan 14.
Pneumonia is the leading cause of mortality and morbidity in aging populations. Major causes of pneumonia in older adults are swallowing dysfunction and decreased airway clearance capacity, including an impaired cough reflex. Maximal tongue pressure is useful for evaluating swallowing function, and peak expiratory flow indirectly reflects cough strength. However, it is unclear whether they can predict pneumonia development in older adults. In this study, we investigated whether tongue pressure and peak expiratory flow could predict pneumonia development in older adults.
This two-center prospective observational study included older adults aged 65 years or older without respiratory disease or head and neck cancer. We enrolled 383 consenting participants, many of whom had a history of stroke, and followed them for 2 years. The association between time to pneumonia development and tongue pressure or peak expiratory flow at enrollment was examined in a Cox proportional hazards model.
The mean age of the participants was 77.1 ± 6.2 years, and 36.0% of them were women. The mean tongue pressure was 35.4 ± 10.5 kPa and median peak expiratory flow was 218 L/min at enrollment. Six patients developed pneumonia during the study period. A low peak expiratory flow at enrollment was significantly associated with pneumonia development in the multivariate Cox proportional hazards model, but this association was not observed for tongue pressure.
Decreased peak expiratory flow may predict pneumonia development in older adults. Future studies should investigate interventions for peak expiratory flow improvement.
肺炎是老年人群死亡和发病的主要原因。老年人肺炎的主要病因是吞咽功能障碍和气道清除能力下降，包括咳嗽反射受损。最大舌压有助于评估吞咽功能，而呼气峰值流速间接反映咳嗽强度。然而，尚不清楚它们是否能预测老年人肺炎的发生。在本研究中，我们调查了舌压和呼气峰值流速是否能预测老年人肺炎的发生。
这项两中心前瞻性观察性研究纳入了65岁及以上无呼吸系统疾病或头颈癌的老年人。我们招募了383名同意参与的参与者，其中许多人有中风病史，并对他们进行了2年的随访。在Cox比例风险模型中检查肺炎发生时间与入组时舌压或呼气峰值流速之间的关联。
参与者的平均年龄为77.1±6.2岁，其中36.0%为女性。入组时平均舌压为35.4±10.5 kPa，呼气峰值流速中位数为218 L/min。在研究期间，有6名患者发生了肺炎。在多变量Cox比例风险模型中，入组时呼气峰值流速低与肺炎发生显著相关，但舌压未观察到这种关联。
呼气峰值流速降低可能预测老年人肺炎的发生。未来的研究应调查改善呼气峰值流速的干预措施。
