Predictors of Aspiration Pneumonia in the Elderly With Swallowing Dysfunction: Videofluoroscopic Swallowing Study

Ko, Joo Young; Shin, Dae Youp; Kim, Tae Uk; Kim, Seo Young; Hyun, Jung Keun; Lee, Seong Jae

doi:10.5535/arm.20180

Cited by 10 publications

(4 citation statements)

References 24 publications

(39 reference statements)

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“…A previous study found out that MPT is associated with triggering of pharyngeal swallowing and laryngeal elevation in Parkinson's disease [25]. Another previous study showed that prolonged pharyngeal transit time is a significant predictor of aspiration pneumonia in the elderly [26]. This is consistent with our study results, showing that MPT had a negative correlation with triggering of pharyngeal swallow, delayed pharyngeal transit time, and laryngeal elevation, which are important airway protective mechanism during deglutition.…”

Section: Correlation Between Mpt With Oral and Pharyngeal Dysphagia P...supporting

confidence: 92%

Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients

Seok

Kim

et al. 2023

Ann Rehabil Med

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Objective To determine correlations of alternation motor rate (AMR), sequential motor rate (SMR), and maximum phonation time (MPT) with the severity of dysphagia in subacute stroke patients.Methods This was a retrospective chart review study. Data of 171 subacute stroke patients were analyzed. Patient’s AMR, SMR, and MPT data were collected from their language evaluations. Video fluoroscopic swallowing study (VFSS) was done. Data of dysphagia scales including penetration-aspiration scale (PAS), American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, clinical dysphagia scale (CDS), and videofluoroscopic dysphagia scale (VDS) were obtained. AMR, SMR, and MPT were compared between a non-aspirator group and an aspirator group. Correlations of AMR, SMR, and MPT with dysphagia scales were analyzed.Results AMR ("ka"), SMR, and modified Rankin Scale were significant associated factors between non-aspirator group and aspirator group, while AMR ("pa"), AMR ("ta"), and MPT were not. AMR, SMR, and MPT showed significant correlations with PAS score, ASHA-NOMS scale, CDS, VDS oral, and VDS pharyngeal scores. The cut-off value for distinguishing non-aspirator group and aspiration group was 18.5 for AMR ("ka") (sensitivity of 74.4%, specificity of 70.8%) and 7.5 for SMR (sensitivity of 89.9%, specificity of 61.0%). AMR and SMR were significantly lower in before-swallow aspiration group.Conclusion Articulatory diadochokinetic tasks that can be easily performed at the bedside would be particularly helpful in determining the oral feeding possibility of subacute stroke patients who cannot undergo VFSS, which is the gold standard for dysphagia assessment.

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Section: Correlation Between Mpt With Oral and Pharyngeal Dysphagia P...supporting

confidence: 92%

Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients

Seok

Kim

et al. 2023

Ann Rehabil Med

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“…Regarding the relationship with other evaluations, a correlation was found between pyriform sinus residue and swallowing reflex initiation in C-Thick. Ko et al [ 25 ] reported that among patients with dysphagia, those with aspiration pneumonia had poor PAS, delayed swallowing reflex, and increased vallecula and pyriform sinus residue. Delayed swallowing reflex increases the risk of residual bolus in the vallecula or pyriform sinus.…”

Section: Discussionmentioning

confidence: 99%

Effects of Carbonated Thickened Drinks on Pharyngeal Swallowing with a Flexible Endoscopic Evaluation of Swallowing in Older Patients with Oropharyngeal Dysphagia

2022

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This study aimed to determine the efficacy of carbonated and sweetened drinks added to thickened liquids, which are routinely used for patients with dysphagia to improve dysphagia. Patients swallowed thin liquid (Thin), thickened liquid (Thick), carbonated thin drink (C-Thin), and carbonated thickened drink (C-Thick) in random order. Penetration and/or aspiration were scored using the Penetration–Aspiration Scale (PAS). The residue was scored using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). Swallowing reflex initiation was scored using the Hyodo score. The subjective difficulty of swallowing was scored on a face scale. We analyzed 13 patients with a mean age of 79.6 ± 9.6 years. PAS was significantly lower in the C-Thick group than the Thin group (p < 0.05). Swallowing reflex initiation was significantly different between the Thin and Thick (p < 0.01) groups; moreover, post hoc analysis revealed that it was significantly lower in the C-Thick group than the Thin group (p < 0.01). The subjective difficulty of swallowing in the C-Thick was significantly lower than the Thick group (p < 0.05). C-Thick was easier to swallow than Thick and may improve penetration and/or aspiration in older patients with dysphagia with complex diseases.

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“…5 Additionally, this leads to a compromised swallowing function. 6 Collectively, these factors are referred to as oral frailty, as indicated by Tanaka. 7 Oral frailty contributes to increased penetration, aspiration, and pharyngeal residue, 8 ultimately leading to colonization of the oral cavity and subsequent aspiration.…”

Section: Introductionmentioning

confidence: 99%

“…This condition is characterized by various factors, such as diminished occlusal force owing to the loss of teeth, 4 impaired tongue–lip motor function, reduced tongue pressure, and compromised chewing ability 5 . Additionally, this leads to a compromised swallowing function 6 . Collectively, these factors are referred to as oral frailty, as indicated by Tanaka 7 .…”

Section: Introductionmentioning

confidence: 99%

Tongue pressure during swallowing is an independent risk factor for aspiration pneumonia in middle‐aged and older hospitalized patients: An observational study

Chen,

Ku,

Lin

et al. 2023

Geriatrics Gerontology Int

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AimTo evaluate oral frailty features present in hospitalized older patients with aspiration pneumonia.MethodsWe enrolled hospitalized patients aged ≥50 years and classified them into three groups: the community‐acquired, aspiration, and non‐community‐acquired pneumonia groups. Oral frailty was defined as meeting three or more criteria from the following: choking, and decreased occlusal force, masticatory function, tongue–lip motor function, tongue pressure, and tongue pressure during swallowing.ResultsOf 168 patients enrolled, the incidence of aspiration pneumonia was 23.9% (17/71) in patients admitted with pneumonia as the primary diagnosis. The occlusal force and masticatory function were significantly poorer and tongue pressure and tongue pressure during swallowing were significantly lower in the aspiration pneumonia group than in the other two groups. A higher number of chronic comorbidities, poor oral health, and lower tongue pressure during swallowing were significantly associated with aspiration pneumonia. A tongue pressure during swallowing of <10.32 kPa might be a cutoff point for predicting the risk of aspiration pneumonia.ConclusionsHospitalized patients aged ≥50 years with multiple comorbidities, poor oral hygiene, and oral frailty during swallowing are at a higher risk of developing aspiration pneumonia, especially when their tongue pressure during swallowing is <10.32 kPa. Aspiration pneumonia is a preventable disease. Healthcare professionals should incorporate tongue pressure measurements or other screening tools into routine clinical practice to facilitate the early detection of this condition and intervention. Geriatr Gerontol Int 2023; ••: ••–••.

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Predictors of Aspiration Pneumonia in the Elderly With Swallowing Dysfunction: Videofluoroscopic Swallowing Study

Cited by 10 publications

References 24 publications

Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients

Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients

Effects of Carbonated Thickened Drinks on Pharyngeal Swallowing with a Flexible Endoscopic Evaluation of Swallowing in Older Patients with Oropharyngeal Dysphagia

Tongue pressure during swallowing is an independent risk factor for aspiration pneumonia in middle‐aged and older hospitalized patients: An observational study

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