bs_bs_banner
Geriatr Gerontol Int 2016; 16: 556–560
ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH
Predictive factors for oral intake after aspiration pneumonia in older adults Ryo Momosaki,1.2 Hideo Yasunaga,2 Hiroki Matsui,2 Hiromasa Horiguchi,3 Kiyohide Fushimi4 and Masahiro Abo1 1
Department of Rehabilitation Medicine, The Jikei University School of Medicine, 2Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 3Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, and 4Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
Aim: The purpose of the present study was to clarify the predictive factors for achieving oral intake after aspiration pneumonia in elderly patients. Methods: This retrospective observational study used data from the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted to acute-care hospitals with aspiration pneumonia. The outcome was time to achieve total oral intake. We carried out Cox regression analysis to identify predictors for the early initiation of total oral intake. Results: Of 66 611 elderly patients with aspiration pneumonia, 59% achieved total oral intake within 30 days. Cox regression analysis showed that early initiation of total oral intake was associated with female sex and higher Barthel Index. Delayed initiation of total oral intake was associated with underweight, higher scores of pneumonia severity and comorbidities. Conclusion: We clarified prognostic factors for total oral intake in elderly aspiration pneumonia patients. Our findings will be helpful in nutritional care planning for elderly aspiration pneumonia patients. Geriatr Gerontol Int 2016; 16: 556–560. Keywords: aspiration pneumonia, dysphagia, elderly, oral intake.
Introduction Aspiration pneumonia (AP) is defined as pneumonia in a patient predisposed to aspiration because of dysphagia.1 AP is a potentially life-threatening disease that frequently occurs in elderly patients.1 Most AP patients, particularly among the elderly, have dysphagia and thus difficulty in oral intake.2–4 Several studies have assessed predictive factors for early initiation of oral intake in post-stroke patients. These studies showed that age, dysphagia severity and
Accepted for publication 4 March 2015. Correspondence: Dr Ryo Momosaki MD PhD MPH, Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan. Email: [email protected]
556 |
doi: 10.1111/ggi.12506
stroke severity were significant predictors of post-stroke resumption of oral intake.5–8 However, data are lacking on predictors for early initiation of oral intake after AP in the elderly. The purpose of the present study was to clarify the predictive factors for resuming oral intake in AP patients using a nationwide administrative claims database in Japan.
Materials and methods Data source The Diagnosis Procedure Combination (DPC) database is a national administrative claims and discharge abstract database in Japan.9 All 82 academic hospitals in Japan are obliged to participate in the DPC database, whereas participation by community hospitals is voluntary. The database includes the following information: patient age and sex; diagnoses, comorbidities on © 2015 Japan Geriatrics Society
Oral intake after aspiration pneumonia
admission and complications after admission recorded using the International Classification of Disease, 10th edition (ICD-10) codes; length of stay; procedures; discharge status; and unique identifiers of the participating hospitals. The database also includes details of pneumonia severity defined using the Age, Dehydration, Respiratory Failure, Orientation Disturbance and Blood Pressure scoring system, proposed by the Japanese Respiratory Society. This system is similar to the British Thoracic Society’s Confusion, Urea, Respiratory Rate, Blood Pressure and Age over 65 Years (CURB-65) score.10 In 2012, the discharge data of approximately 7 million inpatients were collected in the DPC database, accounting for approximately 50% of all acute-care inpatient admissions in Japan. The present study was based on a secondary analysis of the administrative claims data. Because of the anonymous nature of the data, informed consent was not required for this study, and it was approved by the institutional review board of The University of Tokyo.
Study population We identified patients aged ≥65 years who were admitted to the participating hospitals with a diagnosis of AP (ICD-10 code, J69), and were discharged between January 2011 and March 2012. AP is defined as pneumonia in patients predisposed to aspiration due to dysphagia.1 Dysphagia is generally assessed using a swallowing function test; for example, water swallowing test, repetitive saliva swallowing test, simple swallowing provocation test and videofluorography. If swallowing function is not assessed using these examinations, dysphagia is determined by overt symptoms of dysphagia or a medical history of aspiration. Pneumonia is generally diagnosed by the existence of pulmonary infiltration on chest radiograph or computed tomography, and systemic inflammation is determined by blood analyses for the white blood cell count and C-reactive protein. In the present study, diagnosis of AP was carried out by the attending physicians. We excluded the following patients: (i) those who resumed total oral intake on admission; and (ii) those who received enteral nutrition through a gastrostomy tube on admission. We extracted data from the database on factors that could affect the initiation of oral intake, including age, sex, body height and weight on admission, pneumonia severity, Barthel Index of activities of daily living on admission (scores for assessing self-care and mobility with a maximum score of 100),11 and comorbidities (malignancy, sepsis, cerebrovascular disease, oral disease, mental disorder, neurological disorder, heart disease, chronic lower respiratory disease and renal failure). We evaluated pneumonia severity using the Age, Dehydration, Respiratory Failure, Orientation Disturbance and Blood Pressure scoring system, © 2015 Japan Geriatrics Society
and included the following: age (men ≥ 70 years, women ≥ 75 years), dehydration (blood urea nitrogen ≥ 21 mg/dL), respiratory failure (pulse oximetry saturation ≤90%), consciousness disturbance and low blood pressure (systolic blood pressure ≤90 mmHg).10 We calculated the body mass index (BMI) and divided the patients into underweight (BMI
Geriatr Gerontol Int 2016; 16: 556–560
ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH
Predictive factors for oral intake after aspiration pneumonia in older adults Ryo Momosaki,1.2 Hideo Yasunaga,2 Hiroki Matsui,2 Hiromasa Horiguchi,3 Kiyohide Fushimi4 and Masahiro Abo1 1
Department of Rehabilitation Medicine, The Jikei University School of Medicine, 2Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 3Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, and 4Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
Aim: The purpose of the present study was to clarify the predictive factors for achieving oral intake after aspiration pneumonia in elderly patients. Methods: This retrospective observational study used data from the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted to acute-care hospitals with aspiration pneumonia. The outcome was time to achieve total oral intake. We carried out Cox regression analysis to identify predictors for the early initiation of total oral intake. Results: Of 66 611 elderly patients with aspiration pneumonia, 59% achieved total oral intake within 30 days. Cox regression analysis showed that early initiation of total oral intake was associated with female sex and higher Barthel Index. Delayed initiation of total oral intake was associated with underweight, higher scores of pneumonia severity and comorbidities. Conclusion: We clarified prognostic factors for total oral intake in elderly aspiration pneumonia patients. Our findings will be helpful in nutritional care planning for elderly aspiration pneumonia patients. Geriatr Gerontol Int 2016; 16: 556–560. Keywords: aspiration pneumonia, dysphagia, elderly, oral intake.
Introduction Aspiration pneumonia (AP) is defined as pneumonia in a patient predisposed to aspiration because of dysphagia.1 AP is a potentially life-threatening disease that frequently occurs in elderly patients.1 Most AP patients, particularly among the elderly, have dysphagia and thus difficulty in oral intake.2–4 Several studies have assessed predictive factors for early initiation of oral intake in post-stroke patients. These studies showed that age, dysphagia severity and
Accepted for publication 4 March 2015. Correspondence: Dr Ryo Momosaki MD PhD MPH, Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan. Email: [email protected]
556 |
doi: 10.1111/ggi.12506
stroke severity were significant predictors of post-stroke resumption of oral intake.5–8 However, data are lacking on predictors for early initiation of oral intake after AP in the elderly. The purpose of the present study was to clarify the predictive factors for resuming oral intake in AP patients using a nationwide administrative claims database in Japan.
Materials and methods Data source The Diagnosis Procedure Combination (DPC) database is a national administrative claims and discharge abstract database in Japan.9 All 82 academic hospitals in Japan are obliged to participate in the DPC database, whereas participation by community hospitals is voluntary. The database includes the following information: patient age and sex; diagnoses, comorbidities on © 2015 Japan Geriatrics Society
Oral intake after aspiration pneumonia
admission and complications after admission recorded using the International Classification of Disease, 10th edition (ICD-10) codes; length of stay; procedures; discharge status; and unique identifiers of the participating hospitals. The database also includes details of pneumonia severity defined using the Age, Dehydration, Respiratory Failure, Orientation Disturbance and Blood Pressure scoring system, proposed by the Japanese Respiratory Society. This system is similar to the British Thoracic Society’s Confusion, Urea, Respiratory Rate, Blood Pressure and Age over 65 Years (CURB-65) score.10 In 2012, the discharge data of approximately 7 million inpatients were collected in the DPC database, accounting for approximately 50% of all acute-care inpatient admissions in Japan. The present study was based on a secondary analysis of the administrative claims data. Because of the anonymous nature of the data, informed consent was not required for this study, and it was approved by the institutional review board of The University of Tokyo.
Study population We identified patients aged ≥65 years who were admitted to the participating hospitals with a diagnosis of AP (ICD-10 code, J69), and were discharged between January 2011 and March 2012. AP is defined as pneumonia in patients predisposed to aspiration due to dysphagia.1 Dysphagia is generally assessed using a swallowing function test; for example, water swallowing test, repetitive saliva swallowing test, simple swallowing provocation test and videofluorography. If swallowing function is not assessed using these examinations, dysphagia is determined by overt symptoms of dysphagia or a medical history of aspiration. Pneumonia is generally diagnosed by the existence of pulmonary infiltration on chest radiograph or computed tomography, and systemic inflammation is determined by blood analyses for the white blood cell count and C-reactive protein. In the present study, diagnosis of AP was carried out by the attending physicians. We excluded the following patients: (i) those who resumed total oral intake on admission; and (ii) those who received enteral nutrition through a gastrostomy tube on admission. We extracted data from the database on factors that could affect the initiation of oral intake, including age, sex, body height and weight on admission, pneumonia severity, Barthel Index of activities of daily living on admission (scores for assessing self-care and mobility with a maximum score of 100),11 and comorbidities (malignancy, sepsis, cerebrovascular disease, oral disease, mental disorder, neurological disorder, heart disease, chronic lower respiratory disease and renal failure). We evaluated pneumonia severity using the Age, Dehydration, Respiratory Failure, Orientation Disturbance and Blood Pressure scoring system, © 2015 Japan Geriatrics Society
and included the following: age (men ≥ 70 years, women ≥ 75 years), dehydration (blood urea nitrogen ≥ 21 mg/dL), respiratory failure (pulse oximetry saturation ≤90%), consciousness disturbance and low blood pressure (systolic blood pressure ≤90 mmHg).10 We calculated the body mass index (BMI) and divided the patients into underweight (BMI
