Abstract
Objective
To investigate the association between the Simple Swallowing Provocation Test (SSPT)
and the incidence of aspiration pneumonia in patients with dysphagia in long-term
care (LTC) wards.
Design
The study design was a prospective cohort study. Participants were followed for 60
days from admission.
Setting
LTC wards.
Participants
Study participants were patients with dysphagia aged ≥65 years who were admitted to
LTC wards between August 2018 and August 2019. In total, 39 participants were included
in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were
divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal
group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age
and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale,
body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing
Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool.
Interventions
Not applicable.
Main Outcome Measures
The outcome was the incidence of aspiration pneumonia during the first 60 days of
hospitalization, and the predictive factor was SSPT: 0.4 mL.
Results
The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2%
in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary
variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in
an exposed group to the probability of an outcome in an unexposed group) was 2.29,
and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group.
Conclusions
Our findings suggest that the SSPT provides a valid index for the development of aspiration
pneumonia in older patients with dysphagia admitted to LTC wards.
Keywords
List of abbreviations:
ADL (activities of daily living), CI (confidence interval), LTC (long-term care), MASA (Mann Assessment of Swallowing Ability), SSPT (Simple Swallowing Provocation Test)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Ikeda K, Takatoshi I. Historical overview of pneumonia deaths in Japan. Ann Rep Tokyo Metr Inst Pub Health 2018:69:271-7.
- Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia: a retrospective cohort study.J Infect Chemother. 2014; 20: 436-442
- Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine.Stroke. 2003; 34: 975-981
- Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: a systematic review with meta-analysis.Sci Rep. 2016; 6: 38097
- Long-term mortality and prognostic factors in aspiration pneumonia.J Am Med Dir Assoc. 2019; 20: 1098-1104
- Risk factors for aspiration pneumonia in older adults.PLoS One. 2015; 10e0140060
- Pneumonia in stroke patients with oropharyngeal dysphagia: a six-month follow-up study.Neurol Sci. 2008; 29: 139-145
- Dysphagia and aspiration pneumonia in older adults.J Am Acad Nurse Pract. 2010; 22: 17-22
- Risk factors for aspiration pneumonia in frail older people: a systematic literature review.J Am Med Dir Assoc. 2011; 12: 344-354
- Dysphagia after stroke: incidence, diagnosis, and pulmonary complications.Stroke. 2005; 36: 2756-2763
- Dysphagia in acute stroke: incidence, burden and impact on clinical outcome.PLoS One. 2016; 11e0148424
- Dysphagia in nursing home residents: management and outcomes.J Am Med Dir Assoc. 2019; 20: 147-151
- An examination of factors related to aspiration and silent aspiration in older adults requiring long-term care in rural Japan.J Oral Rehabil. 2016; 43: 103-110
- Silent aspiration predicts mortality in older adults with aspiration pneumonia admitted to acute hospitals.Geriatr Gerontol Int. 2018; 18: 828-832
- Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review.J Adv Nurs. 2009; 65: 477-493
- Screening accuracy for aspiration using bedside water swallow tests: a systematic review and meta-analysis.Chest. 2016; 150: 148-163
- Valid items for screening dysphagia risk in patients with stroke: a systematic review.Stroke. 2012; 43: 892-897
- Early assessments of dysphagia and aspiration risk in acute stroke patients.Stroke. 2003; 34: 1252-1257
- Detection of aspiration and swallowing disorder in older stroke patients: simple swallowing provocation test versus water swallowing test.Arch Phys Med Rehabil. 2000; 81: 1517-1519
- Simple two-step swallowing provocation test for elderly patients with aspiration pneumonia.Lancet. 1999; 353: 1243
- Simple swallowing provocation test has limited applicability as a screening tool for detecting aspiration, silent aspiration, or penetration.Dysphagia. 2010; 25: 6-10
- A novel diagnostic test for the risk of aspiration pneumonia in the elderly.Chest. 2004; 125: 801-802
- High incidence of silent aspiration in elderly patients with community-acquired pneumonia.Am J Respir Crit Care Med. 1994; 150: 251-253
- Evaluation of swallowing in acute ischemic stroke patients using both a simple swallowing provocation test and a water swallowing test.Jpn J Stroke. 2010; 32: 254-260
- Evaluation of the screening tests for the aspiration pneumonitis in the care health center for the elderly.J Jpn Soc Respir Rehabil. 2008; 18: 59-65
- Classification of long-term care wards and their functional characteristics: analysis of national hospital data in Japan.BMC Health Serv Res. 2018; 18: 655
- Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP) [complete translation].Respir Investig. 2013; 51: 103-126
- Clinical characteristics of nursing and healthcare-associated pneumonia: a Japanese variant of healthcare-associated pneumonia.Intern Med. 2012; 51: 2537-2544
- Development of nursing and healthcare-associated pneumonia among cerebrovascular disorder patient in long-term care facility.J Jpn Soc Respir Care Rehabil. 2013; 23: 284-287
- MASA: the Mann Assessment of Swallowing Ability.Cengage Learning, New York2002
- Reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale.J Pain Symptom Manage. 2013; 46: 201-206
- Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients.Am J Clin Nutr. 2005; 82: 777-783
- The oral health assessment tool–validity and reliability.Aust Dent J. 2005; 50: 191-199
- [Characteristics and limitation of portable bedside swallowing test in elderly with dementia: comparison between the repetitive saliva swallowing test and the simple swallowing provocation test] [Japanese].Nihon Ronen Igakkai Zasshi. 2005; 42: 323-327
- Predictors of aspiration pneumonia in nursing home residents.Dysphagia. 2002; 17: 298-307
- Relationship between the Functional Independence Measure and Mann Assessment of Swallowing Ability in hospitalized patients with pneumonia.Geriatr Gerontol Int. 2018; 18: 1620-1624
- Assessment of aspiration risk in acute ischaemic stroke–evaluation of the simple swallowing provocation test.J neurol neurosurg psychiatry. 2008; 79: 312-314
Ministry of Health, Labour, and Welfare. Comprehensive survey of living conditions: 2019. Available at:https://www.e-stat.go.jp/stat-search/files?page=1&layout=datalist&toukei=00450061&tstat=000001141126&cycle=7&tclass1=000001141143&tclass2val=0. Accessed April 1, 2021.
- High incidence of pneumonia in elderly patients with basal ganglia infarction.Arch Intern Med. 1997; 157: 321-324
Ministry of Health, Labour, and Welfare. About examination about the way of medical treatment bed. Available at: https://www.mhlw.go.jp/stf/shingi2/0000145095.html. Accessed February 15, 2020.
Article info
Publication history
Published online: July 09, 2021
Accepted:
June 28,
2021
Received in revised form:
April 22,
2021
Received:
December 23,
2020
Footnotes
Disclosures: none
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
