Abstract
ObjectiveNasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are widely used techniques to feed older patients with oropharyngeal dysphagia. Aspiration pneumonia is the most common cause of death in these patients. This study aimed to evaluate the role of oropharyngeal dysphagia in older patients on long-term enteral feeding for risk stratification of pneumonia requiring hospitalization.MethodsWe performed modified flexible endoscopic evaluation of swallowing to evaluate oropharyngeal dysphagia in older patients and conducted prospective follow-up for pneumonia requiring hospitalization. A total of 664 oral-feeding patients and 155 tube-feeding patients were enrolled. Multivariate Cox analysis was performed to identify risk factors of pneumonia requiring hospitalization.ResultsMultivariate analyses showed that the risk of pneumonia requiring hospitalization significantly increased in older patients and in patients with neurological disorders, tube feeding, and oropharyngeal dysphagia. Subgroup analysis revealed that the risk of pneumonia requiring hospitalization was significantly lower in patients with PEG than in those with NGT among the patients with oropharyngeal dysphagia (adjusted hazard ratio 0.26, 95% confidence interval: 0.11–0.63, P = 0.003).ConclusionsFor older patients with oropharyngeal dysphagia requiring long-term enteral tube feeding, PEG is a better choice than NGT. Further research is needed to elucidate the role of oropharyngeal dysphagia in enteral feeding in older patients.
Highlights
Population aging is a global issue, and it is estimated that the older population will reach approximately 1.5 billion in 2050 [1]
As more residues in the pharyngolaryngeal region were reported in those with nasogastric tube (NGT) due to NGT passes through the upper esophageal sphincter [29,30,31,32], we hypothesized that oropharyngeal dysphagia significantly increased the risk of pneumonia requiring hospitalization in older patients with NGT, and that percutaneous endoscopic gastrostomy (PEG) is recommended in preference to NGT for patients with oropharyngeal dysphagia requiring long-term tube feeding
Multivariate analyses showed that the risk of pneumonia requiring hospitalization was significantly increased in patients with older ages, neurological disorders, tube feeding, and oropharyngeal dysphagia (Table 2)
Summary
Population aging is a global issue, and it is estimated that the older population will reach approximately 1.5 billion in 2050 [1]. Degeneration and multiple comorbidities accompany as people age, and approximately 13%–81% of older patients are affected by oropharyngeal dysphagia [1,2,3,4]. This condition is common in patients with neurological disorders [3, 4]. Patients with oropharyngeal dysphagia may require enteral tube feeding if they cannot meet their nutritional needs orally [5] Such patients may face greater socioeconomic issues as the prevalence rates of stroke, dementia, and esophageal motility disorder increase with older age [4, 6, 7].
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