Analysis of clinical outcomes in elderly patients with impaired swallowing function.

Hideki Terai,Sohei Nakayama,Kaori Muraoka,Hatsuho Seki,Jason Chia-Hsun Hsieh,Kenichiro Wakabayashi,Yukio Suzuki,Yuka Kagoshima,Yusuke Suzuki,Masatsugu Mitsuhashi,Keeya Sunata

doi:10.1371/journal.pone.0239440

Abstract

Japan is the world's leading aging society, and increasing medical expenses for elderly people is an urgent issue. Since aspiration pneumonia in elderly people with impaired swallowing function is a huge problem in Japan, their expected long-term clinical course should be clarified. Accordingly, we collected data from 991 elderly (≥75 years old) patients whose swallowing function was evaluated by Kitasato Institute Hospital's speech therapists (January 1, 2010 to December 31, 2017). We analyzed the relationship between swallowing function and the subjects' long-term prognosis. To clarify the prognostic factors of patients with dysphagia, we obtained their clinical information (age, gender, activities of daily living, nutritional status, availability of alternative feeding pathways such as percutaneous endoscopic gastrostomy, and cognitive function). We confirmed 372 death cases and stratified the cases into three groups using Fujishima's swallowing ability grade, which is used to predict elderly people's real-world life expectancy. Results showed the median survival days were 331 and 952 days in Groups I (Grades 1-3, n = 308) and II (Grades 4-6, n = 153), respectively, whereas the median survival days for Group III (Grades 7-10, n = 530) could not be calculated. We conducted a multivariate analysis using the Cox proportional hazards model with Group I, which revealed that initial grade and percutaneous endoscopic gastrostomy were significant prognostic factors for the subjects' long-term survival. Nevertheless, further discussion is necessary, particularly to determine advanced care planning regarding indications for alternative feeding pathways in elderly patients with severe dysphagia, since percutaneous endoscopic gastrostomy could significantly prolong their survival.

Highlights

The following clinical data were collected from medical records retrospectively, until December 31, 2018, based on earlier reports [6, 13,14,15]: age, gender, initial swallowing ability grade (Fujishima’s swallowing ability grade), residence before admission, activities of daily living (ADL), existence of an alternative feeding pathway such as percutaneous endoscopic gastrostomy (PEG) or a central venous (CV) port, cognitive function, existence of close relatives as key persons, and survival outcome
The number of deaths from pneumonia has been increasing in Japan because of the increase in proportion and number of elderly people among the nation’s population
We have shown that PEG significantly extended life expectancy in patients with very severe dysphagia alone

Summary

Introduction

According to the Statistics Bureau of the Japanese Ministry of Internal Affairs and Communications, Japan has a rapidly aging society, with increasing life expectancy and decreasing birth. Clinical outcome and swallowing function in elderly patients. T. and a research grant from the Foundation for Total Health Promotion to H.T. The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

Methods

Results

Conclusion