Factors involved in the discontinuation of oral intake in elderly patients with recurrent aspiration pneumonia: a multicenter study

Abstract

Tsuneaki Kenzaka,1,2 Taro Takeshima,3 Koki Kosami,2 Ayako Kumabe,2 Yuki Ueda,2 Takeshi Takahashi,4 Yuya Yamamoto,5 Yurika Hayashi,5 Akihito Kitao,5 Masanobu Okayama6 1Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, 2Division of General Medicine, 3Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, 4Department of Community and Family Medicine, Yuzawa Community Medical Center, Yuzawa, 5Department of General Medicine, Toyooka Public Hospital, Toyooka, 6Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan Purpose: To assess the factors involved in oral intake discontinuation in elderly patients with recurrent aspiration pneumonia. Patients and methods: This study included patients with pneumonia who were treated at Jichi Medical University Hospital between 2007 and 2013, at Toyooka Public Hospital between 2011 and 2013 and at Yuzawa Community Medical Center between 2010 and 2012. We consecutively enrolled patients with aspiration pneumonia. The primary study point was oral intake discontinuation after the initiation of oral intake during hospitalization in cases of recurrent aspiration. Various parameters were recorded at admission, at the initiation of intake, and during hospitalization; these parameters were statistically evaluated. Results: A total of 390 patients were assigned to either a “no reaspiration of intake” group (n=310) or a “reaspiration of intake” group (n=80), depending on whether intake was discontinued owing to aspiration during hospitalization. At admission, the following items significantly differed between the groups: level of consciousness, respiratory rate, oxygen saturation, CURB-65 score, extent of infiltration/opacity on chest radiography, albumin levels, blood urea nitrogen levels, and application of swallowing function assessment. At the initiation of intake, level of consciousness, pulse rate, and albumin levels significantly differed between the groups. The following items did not significantly differ between groups: systolic blood pressure, pulse rate, C-reactive protein, bacteremia, use of ventilator at admission, oxygen administration, respiratory rate, and systolic blood pressure at initiation of intake. Multivariate analysis revealed that application of swallowing function assessment, level of consciousness at the initiation of intake, and extent of infiltration/opacity on chest radiography were significant predictive variables for discontinuation of intake. Conclusion: A low level of consciousness at the initiation of intake and a greater extent of infiltration/opacity on chest radiography and the application of a swallowing function are important factors. These factors may be helpful to determine a suitable timing for resumption of oral intake. Keywords: assessment of swallowing function, level of consciousness, recurrent aspiration, resumption of oral intake

Keywords

• aspiration pneumonia
• assessment of swallowing function
• level of consciousness
• recurrent aspiration
• resumption of oral intake