A high proportion of older adults hospitalised for pneumonia may have co-existing risk of aspiration due to dysphagia. The authors of this single-centre retrospective cohort study followed up patients over the age of 65 who were admitted to hospital with a diagnosis of aspiration pneumonia (defined as pneumonia in patients with known aspiration risk) and were discharged between April 2009 and September 2014. Of the 209 patients included, 58% were males, the median age was 85, 34% were discharged home rather than to a care facility and 33% had a performance status of four. The authors considered multiple prognostic factors including age, gender, BMI, performance status before admission, chronic conditions with a greater than 10% prevalence in the cohort (hypertension, stroke, dementia, diabetes, chronic heart failure and ischemic heart disease), CURB-65 score >2 (confusion, uraemia, respiratory rate, blood pressure and age >65 years), severity rating for community acquired pneumonia, serum albumin <3.0g/d and haematocrit <33% at admission. They also considered nutritional route at discharge (oral intake, tube feed or parenteral nutrition) and discharge location (home, care facility). Whilst all patients in the study were defined as having aspiration pneumonia, the median post-discharge survival times were 620 days for those on oral intake, 264 days for tube feeding and 34 days for those on parenteral nutrition. The overall post-discharge survival time was 369 days, with 77% of patients dying within the follow-up window. Non-oral feeding routes, male sex and low BMI were most strongly associated with mortality. The authors highlight the need for more research and for frank discussion with patients and caregivers about choice of feeding routes given the general prognosis following discharge.
Older patients hospitalised for pneumonia: what factors determine survival after discharge?
Reviewed by Roganie Govender
Extremely Poor Post‑discharge Prognosis in Aspiration Pneumonia and Its Prognostic Factors: A Retrospective Cohort Study.
CONTRIBUTOR
Roganie Govender
University College London, Head & Neck Academic Centre, UK.
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