Impacto de la detección de la disfagia en la incidencia de neumonitis por aspiración y en los marcadores bioquímicos de desnutrición, en personas mayores hospitalizadas

Abstract

BACKGROUND: In developed countries, the mean age of population is progressively increasing. When old patients need to be hospitalized, they experience particular problems related to aging. Dysphagia is one of these problems, as the normal aging process determines changes in the normal swallowing. This disturbed swallowing may favour the development of aspiration pneumonia or interfere with adequate nutrition. HYPOTHESIS: The systematic evaluation of dysphagia by nurses in hospitalized old patients may prevent the dysphagia-related complications. OBJECTIVES: 1.-To analyze the ability of the systematic performance by nurses of a standardized swallow assessment (SSA) in old hospitalized patients (over 70 years) to prevent the development of aspiration pneumonia. 2.- To evaluate if this same intervention improves patient nutrition. 3.- To study the influence of this assessment on the morbi-mortality of patients. METHODS: A standardized swallow assessment plus pulsioxymetry (SSA) was prospectively performed by a nurse team in patients over 70 years that were hospitalized in the Internal Medicine Units of the “Príncipe de Asturias” University Hospital. These patients were considered by their doctors as able to perform a normal oral intake. In those patients with a positive SSA, a consultation to the Nutrition Unit was performed. These patients were compared with a similar group that was managed following the routine procedures of the hospital. In each patient, nutrition was evaluated by performing anthropometric and biochemical measurements, and the incidence of aspiration pneumonia and mortality was registered from the standard medical records. MAIN RESULTS: 1.- About 50 % of the hospitalized patients over 70 years that were considered able to perform a normal oral intake show some data of malnutrition. 2.- The nutrition status of these patients at admission was mainly determined by age and by the place of residence. 3.- In our patients, hospitalization for 7 days did not induce very significant changes in nutrition status. 4.- The prevalence of dysphagia in hospitalized patients without apparent disturbances of swallowing was about 18 %. 5.- In this population, aspiration pneumonia incidence was very low. 6.- The performance of the SSA by the nurse team did not modify either the rate of pneumonia development or the time of staging at the hospital, but improved the mortality and prevented the slight decrease that were observed in albumin concentration after 7 days in the hospital. CONCLUSSIONS: In hospitalized patients over 70 years without apparent changes in nutritional status or swallowing, a significant prevalence of malnutrition or dysphagia may be detected. The systematic evaluation of dysphagia by nurses may prevent some hospitalization-related complications.