Prandial aspiration and pneumonia in an elderly population followed over 3 years

Feinberg, Michael J.; Knebl, Janice; Tully, Joann

doi:10.1007/bf00417899

Cited by 84 publications

(47 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Societal factors, anxiety, food palatability, and the degree of hunger or satiety modify eating and swallowing rate in normal subjects [14][15][16][17][18]. Psychosocial factors influence the presence and timing of aspiration of elderly nursing home patients [19]. Conversely, many oral sensations, such as food textures, taste, temperature, and volume, may alter pre-oral feeding behavior.…”

Section: Pre-oral (Anticipatory) Stage: Interstage Relationshipsmentioning

confidence: 99%

Dysphagia—Ingestion or Deglutition?: A Proposed Paradigm

Leopold

Kagel

1997

Dysphagia

View full text Add to dashboard Cite

The current classifications of dysphagia are based on local structural or central nervous system pathology causing dysfunction of the aerodigestive tract. The result is a clinical science grounded in the analysis of the swallow with its lingual, pharyngeal, and esophageal stages. Adding bolus preparation to the swallowing paradigm improves but still constrains the study of dysphagia and treatment of the dysphagic patient. Those pre-oral facets of mealtime behavior that may evoke or exacerbate dysphagia remain beyond the existing classification boundaries imposed by the conceptual swallow and anatomic aerodigestive tract. We offer a more inclusive strategy for investigating dysphagia based on a five-stage process of ingestion: pre-oral (anticipatory), preparatory, lingual, pharyngeal, and esophageal. The first stage considers the interaction of pre-oral motor, cognitive, psychosocial, and somataesthetic elements engendered by the meal. The limited literature regarding the interaction of the pre-oral stage with other ingestion stages, in both normal subjects and patients with cortical, basal ganglia, and psychogenic diseases, is reviewed. The neurophysiologic and clinical justifications for embracing a pre-oral stage, and thus for the paradigm shift from deglutition to ingestion, are presented.

show abstract

Section: Pre-oral (Anticipatory) Stage: Interstage Relationshipsmentioning

confidence: 99%

Dysphagia—Ingestion or Deglutition?: A Proposed Paradigm

Leopold

Kagel

1997

Dysphagia

View full text Add to dashboard Cite

show abstract

“…Since dysphagia predisposes to aspiration, the relationship between dysphagia and aspiration pneumonia might appear obvious, but evidence for this has not always been found [31][32][33]. In fact, several studies of tube-fed patients who are taking no food or liquid by mouth have shown that tube feeding is associated with a higher rate of pneumonia than in patients who are eating [19,23,28,30,31,33,34]. A large body of literature has focused on the association between gastroesophageal reflux and aspiration [18,[35][36][37][38][39][40][41][42].…”

mentioning

confidence: 99%

Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

et al. 1998

View full text Add to dashboard Cite

Aspiration pneumonia is a major cause of morbidity and mortality among the elderly who are hospitalized or in nursing homes. Multiple risk factors for pneumonia have been identified, but no study has effectively compared the relative risk of factors in several different categories, including dysphagia. In this prospective outcomes study, 189 elderly subjects were recruited from the outpatient clinics, inpatient acute care wards, and the nursing home care center at the VA Medical Center in Ann Arbor, Michigan. They were given a variety of assessments to determine oropharyngeal and esophageal swallowing and feeding status, functional status, medical status, and oral/dental status. The subjects were followed for up to 4 years for an outcome of verified aspiration pneumonia. Bivariate analyses identified several factors as significantly associated with pneumonia. Logistic regression analyses then identified the significant predictors of aspiration pneumonia. The best predictors, in one or more groups of subjects, were dependent for feeding, dependent for oral care, number of decayed teeth, tube feeding, more than one medical diagnosis, number of medications, and smoking. The role that each of the significant predictors might play was described in relation to the pathogenesis of aspiration pneumonia. Dysphagia was concluded to be an important risk for aspiration pneumonia, but generally not sufficient to cause pneumonia unless other risk factors are present as well. A dependency upon others for feeding emerged as the dominant risk factor, with an odds ratio of 19.98 in a logistic regression model that excluded tube-fed patients.

show abstract

“…The reports of pneumonia were obtained from patient reflections, but it appears highly likely that the patients had suffered no pneumonia serious enough to require hospitalization. Since swallowing dysfunction causes aspiration, a relationship between swallowing dysfunction and aspiration pneumonia would appear highly likely, but there is no consistent evidence of this [20][21][22] not recover during the period until the follow up reported here. However, the results of the present study were determined by the retrospective study design, therefore to assess the post-surgical swallowing function after a further five years with the sample of the present study would be relevant to support the results of the present study.…”

Section: Discussionmentioning

confidence: 60%

Does Swallowing Function Recover in the Long Term in Patients With Surgically Treated Tongue Carcinomas?

Tei

Sakakibara

Yamazaki

et al. 2012

Journal of Oral and Maxillofacial Surgery

View full text Add to dashboard Cite

1Abstract Purpose: The present study aims to measure the post-surgical swallowing function in patients five years after operative treatment of tongue carcinoma.Patients and Methods: Using a retrospective cohort study design, the investigators enrolled post-surgical patients treated for tongue carcinomas in Hokkaido University Hospital. The primary outcome variable was the Oropharyngeal Swallow Efficiency (OPSE) determined by videoflluoroscopic evaluation and the OPSE at present was compared with that at discharge.Other variables included present nutritional status (Body Mass Index: BMI, Serum Albumin), dietary intake, self-rating of the present swallowing function, and the occurrence of pneumonia.Statistical analysis used the paired t-test and Spearman's rank correlation.Results: The swallowing function was assessed in 20 patients (11 males and 9 females) subjected to surgical treatment of tongue carcinomas; the median age was 70 years (range 56-90 years) at the present evaluation. The mean values of the liquid OPSE and paste OPSE at present were 26.6±21.2 and 21.9±22.5 respectively. The mean values of BMI and serum albumin at present were 22.2±3.4 and 4.5±0.3g/dl respectively. All patients had a full oral intake of foods, with a mean self-rated value of 6.4±2.5, an acceptable value as evaluated by the patients.Pneumonia requiring hospitalization had not occurred in these patients.Conclusions: Long-term follow-up of patients following operative treatment of tongue carcinomas demonstrate acceptable levels of oral function and nutritional status despite objective measures of poor swallowing efficiency assessed using a videofluoroscopy.

show abstract

Prandial aspiration and pneumonia in an elderly population followed over 3 years

Cited by 84 publications

References 28 publications

Dysphagia—Ingestion or Deglutition?: A Proposed Paradigm

Dysphagia—Ingestion or Deglutition?: A Proposed Paradigm

Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

Does Swallowing Function Recover in the Long Term in Patients With Surgically Treated Tongue Carcinomas?

Contact Info

Product

Resources

About