Cognitive impairment has no impact on hospital-associated dysphagia in aspiration pneumonia patients.
AIM
Hospital-associated dysphagia, characterized by deconditioning of swallowing as a result of hospitalization, is sometimes observed in patients with aspiration pneumonia (AP). Cognitive impairment is known as a negative factor in dysphagia rehabilitation. The present study aimed to examine the association between cognitive impairment and hospital-associated dysphagia in patients with AP receiving dysphagia rehabilitation.


METHODS
A retrospective observational study was carried out in an acute geriatric hospital. A total of 249 AP patients receiving multidisciplinary individualized dysphagia rehabilitation were included. Patients were divided into four groups according to their Mini-Mental State Examination scores. The Functional Oral Intake Scale (FOIS) was used to assess swallowing ability, and hospital-associated dysphagia was defined as a FOIS decline of ≥1 or ≥2 levels. Body mass index and Barthel Index were obtained to assess nutritional status and activities of daily living.


RESULTS
The mean age was 85.6 ± 7.3 years, and 47% were men. Frequencies of hospital-associated dysphagia observed in lowest to highest Mini-Mental State Examination groups were 43.0%, 36.2%, 47.4% and 27.3% (P = 0.133), and 13.9%, 20.7%, 17.5% and 5.5% (P = 0.117) based on FOIS decline ≥1 or ≥2 levels, respectively. Multivariable regression model showed that the Mini-Mental State Examination score was not an independent determinant of FOIS at discharge (beta = 0.063, P = 0.378) after adjusting for age, sex, body mass index, Barthel Index, pneumonia severity, speech-language pathologist intervention, comorbidities, length of hospital stay and premorbid FOIS.


CONCLUSIONS
The severity of cognitive impairment has no impact on hospital-associated dysphagia in AP patients receiving dysphagia rehabilitation. A future interventional study will be expected to further validate our findings. Geriatr Gerontol Int 2018; 18: 233-239.
['Maeda|Keisuke|K|http://orcid.org/0000-0001-7132-7818', 'Wakabayashi|Hidetaka|H|http://orcid.org/0000-0002-0364-0818', 'Shamoto|Hiroshi|H|', 'Akagi|Junji|J|']
D000368:Aged D000369:Aged, 80 and over D060825:Cognitive Dysfunction D003680:Deglutition Disorders D005260:Female D006760:Hospitalization D006801:Humans D008297:Male D011015:Pneumonia, Aspiration D012189:Retrospective Studies
hospital-associated dysphagia dysphagia rehabilitation advanced dementia hospital-associated deconditioning