PULMONARY ASPIRATION IN A LONG-TERM-CARE SETTING - CLINICAL AND LABORATORY OBSERVATIONS AND AN ANALYSIS OF RISK-FACTORS

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.