Pilot study of 12-month outcomes of nursing home patients with aspiration on videofluoroscopy

Publisher Website
Google Scholar
Abstract
The 12-month clinical outcomes of nursing home patients who underwent videofluoroscopic swallowing evaluation was determined. A retrospective review of 40 patients in a teaching nursing home who had videofluoroscopic swallowing studies from 1987 through 1989 was performed. Clinical outcomes measured included feeding tube placement, rehospitalization within 1 year, prolonged nursing home stay (>6 months), pneumonia, and pneumonia death. It was determined if outcomes were associated with the presence of aspiration on videofluoroscopy and subsequent feeding tube placement. In the 12-month follow-up period, 17 of 40 patients (43%) who underwent videofluoroscopic swallowing evaluation developed pneumonia and 18 of 40 (45%) died. Twenty-two patients demonstrated aspiration on videofluoroscopy. Increased rehospitalization was the only outcome measure that was associated with the presence of aspiration on videofluoroscopy (p≤0.05). Of 22 patients with aspiration, 15 had feeding tubes placed. This group had a higher rate of pneumonia (p≤0.05) and pneumonia death (p≤0.05) compared with the 7 patients with aspiration who did not receive feeding tubes. Patients with nasogastric tubes had a higher death rate (7/9) than patients with gastrostomy tubes (2/8; p≤0.05), but similar rates of rehospitalization and pneumonia. Nursing home patients who underwent videofluoroscopic swallowing evaluation had poor clinical outcomes at 12 months, regardless of their test results. Though limited by its small size and retrospective nature, this pilot study questions whether videofluoroscopic swallowing studies accurately identify patients at risk for developing aspiration pneumonia and whether feeding tubes prevent aspiration or improve clinical outcomes. A larger, prospective study is needed to address these issues.