Promoting factors of laryngeal penetrations in elderly

Abstract

Swallowing disorders are common among elderly patients. Laryngeal penetration is among the most serious complications, resulting in airway obstruction, aspiration pneumonia or pneumonitis. Early diagnosis is therefore very important. The main objective of this study is to identify factors associated with anamnestic and clinical onset of laryngeal penetration. The study population is constituted of 127 consecutive patients hospitalized in our geriatric department. All following parameters were assessed: the patient's home, the reason for hospitalization, the medical history, treatment, anthropometric and biological parameters (nutritional status), a comprehensive geriatric assessment, a speech-language ability assessment and water swallow test according to DePippo method. All these parameters were correlated with the outcome of nasopharyngeal endoscopy. A total of 127 patients (mean age of 84 ± 5 years) (average score of MMSE of 22) were evaluated. Most of them came from their home. The mean values of the Katz and Lawton scales were 9 ± 5.5 and 27 ± 8, respectively. About two third of patients had mood disorders (GDS > 1). A laryngeal penetration was present in 44% of cases. It occurred more frequently in patients taking neuroleptics, in those with a history of stroke, in case of extra-pyramidal syndrome or when the MMSE was pathological. The temporo-spatial disorientation, the presence of a salivary flow, the inability to perform adequately the different items of the speech-language evaluation and the failure to achieve proper water swallowing test were also related to the presence of laryngeal penetrations. With multivariate analysis, after adjusting for all significant variables, abnormal water swallowing test (P = 0.0002, OR 13) emerged as the sole independent parameter associated with laryngeal penetrations. Laryngeal penetration is associated with hospital mortality and impaired geriatric status. It could thus represent a marker of the overall frailty. In a frail geriatric population, the water-swallowing test helps to identify patients at risk of laryngeal penetration.