Abstract
BackgroundsAspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly.Methodology and Principal FindingsWe conducted an observational study using data from a nationwide survey of geriatric medical and nursing center in Japan. The study subjects included 9930 patients (median age: 86 years, women: 76%) who were divided into two groups: those who had experienced an episode of aspiration pneumonia in the previous 3 months and those who had not. Data on demographics, clinical status, activities of daily living (ADL), and major illnesses were compared between subjects with and without aspiration pneumonia. Two hundred and fifty-nine subjects (2.6% of the total sample) were in the aspiration pneumonia group. In the univariate analysis, older age was not found to be a risk factor for aspiration pneumonia, but the following were: sputum suctioning (odds ratio [OR] = 17.25, 95% confidence interval [CI]: 13.16–22.62, p < 0.001), daily oxygen therapy (OR = 8.29, 95% CI: 4.39–15.65), feeding support dependency (OR = 8.10, 95% CI: 6.27–10.48, p < 0.001), and urinary catheterization (OR = 4.08, 95% CI: 2.81–5.91, p < 0.001). In the multiple logistic regression analysis, the risk factors associated with aspiration pneumonia after propensity-adjustment (258 subjects each) were sputum suctioning (OR = 3.276, 95% CI: 1.910–5.619), deterioration of swallowing function in the past 3 months (OR = 3.584, 95% CI: 1.948–6.952), dehydration (OR = 8.019, 95% CI: 2.720–23.643), and dementia (OR = 1.618, 95% CI: 1.031–2.539).ConclusionThe risk factors for aspiration pneumonia were sputum suctioning, deterioration of swallowing function, dehydration, and dementia. These results could help improve clinical management for preventing repetitive aspiration pneumonia.
Highlights
Pneumonia is a leading cause of hospitalisation and mortality among older adults, those aged !85 years [1, 2]
We have previously reported that approximately 60% of hospitalized patients with community-acquired pneumonia (CAP) can be diagnosed with aspiration pneumonia [7]
Japanese Association of Geriatric Health Services Facilities (JAGHSF) has more than 3500 geriatric health services facilities (GHSFs) in its membership, which provide medical, nursing, and rehabilitation services for elderly under the long-term care insurance in Japan for people aged over 65 years
Summary
Pneumonia is a leading cause of hospitalisation and mortality among older adults, those aged !85 years [1, 2]. Several studies have indicated that 7–24% of CAP is due to aspiration [5, 6]. We have previously reported that approximately 60% of hospitalized patients with CAP can be diagnosed with aspiration pneumonia [7]. Previous studies have shown that the risk of aspiration pneumonia increases with age, if patients are residing in a nursing home, and if a patient’s status is complicated with many geriatric disorders [8]. Given that the average life span of Japanese women is 86 years, age itself may not be a risk factor for developing pneumonia
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