N. Pick et al., PULMONARY ASPIRATION IN A LONG-TERM-CARE SETTING - CLINICAL AND LABORATORY OBSERVATIONS AND AN ANALYSIS OF RISK-FACTORS, Journal of the American Geriatrics Society, 44(7), 1996, pp. 763-768
OBJECTIVE: To determine the incidence and risk factors associated with
aspiration in a high risk group in a long-term care setting. DESIGN:
A prospective study of demographic, nutritional, clinical, dental, and
survival characteristics in 69 patients who suffered 98 aspiration ev
ents from May 1, 1990, to December 31, 1990. Demographic and nutrition
al data from 192 patients who did not aspirate were collected from Sep
tember 1991 to December 1991. SETTING: A long-term care VA facility. P
ATIENTS: Long-term care residents, most of whom were neurologically de
bilitated. MEASUREMENTS: The incidence of aspiration was measured and
the clinical and microbiological characteristics of aspiration-associa
ted nosocomial pneumonia described. Mortality and demographic, clinica
l, and nutritional characteristics were compared between patients who
aspirated and those who did not. MAIN RESULTS: Twenty-five percent of
the study group aspirated during the 8-month observational period, and
56% of the aspiration events progressed to roentgenographically prove
n cases of nosocomial pneumonia. Six bacteremic episodes were document
ed, and results of sputum cultures were consistent with mixed Gram-pos
itive and Gram-negative infections. During the study period, patients
who aspirated were at three times the risk of dying compared with pati
ents who did not aspirate. Three years later, only 17% of the original
group of patients who aspirated were still alive compared with 60% of
the patients who had not aspirated. Multivariate analysis identified
tube feeding, presence of a hyperextended neck or contractions, malnut
rition, and the use of benzodiazepines and anticholinergics as risk fa
ctors. CONCLUSIONS: Pulmonary aspiration is a common and serious event
in neurologically impaired long-term care patients. Some risk factors
are amenable to change.