Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia

Objective: to assess the prevalence and the prognostic significance of oropharyngeal dysphagia among elderly patients with pneumonia. Design: a prospective cohort study. Setting: an acute geriatric unit in a general hospital. Subjects: a total of 134 elderly patients (> 70 years) consecutively admitted with pneumonia. Methods: clinical bedside assessment of oropharyngeal dysphagia and aspiration with the water swallow test were performed. Demographic and clinical data, Barthel Index, Mini Nutritional Assessment, Charlson Comorbidity Index, Fine's Pneumonia Severity Index and mortality at 30 days and 1 year after admission were registered. Results: of the 134 patients, 53% were over 84 years and 55% presented clinical signs of oropharyngeal dysphagia; the mean Barthel score was 61 points indicating a frail population. Patients with dysphagia were older, showed lower functional status, higher prevalence of malnutrition and comorbidities and higher Fine's pneumonia severity scores. They had a higher mortality at 30 days (22.9% vs. 8.3%, P = 0.033) and at 1 year of follow-up (55.4% vs. 26.7%, P = 0.001). Conclusions: oropharyngeal dysphagia is a highly prevalent clinical finding in elderly patients with pneumonia and is an indicator of disease severity in older patients with pneumonia.