Eur Respir J. 2012 Jul 26.
To explore whether oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly and to assess the physiology of deglutition of patients with pneumonia. Case-control study: 36 elderly patients (>70 years) hospitalised with pneumonia were matched by age and sex with two independently-living controls. All subjects were given the volume-viscosity swallow test to identify signs of oropharyngeal dysphagia. Pathophysiological study: All cases and 10 healthy elderly were examined with video fluoroscopy. Case-control study: Prevalence of oropharyngeal dysphagia was 91.7% in cases and 40.3% in controls (p<0.001). Adjusting for functionality and co-morbidities, dysphagia showed an independent effect on pneumonia (OR=11.9, 95%CI:3.03–46.9). Pathophysiological study: Among cases, 16.7% showed safe swallow, 30.6% high penetrations, 36.1% severe penetrations and 16.7% silent aspirations during videofluoroscopy, while in the healthy elderly these percentages were 80.0%, 20.0%, 0% and 0%, respectively (p<0.001). A delay in the laryngeal vestibule closure (0.414±0.029 s vs 0.200±0.059 s, p<0.01) was the main mechanism of impaired airway protection. In elderly subjects, oropharyngeal dysphagia is strongly associated with community-acquired pneumonia independently of functionality and co-morbidities. Elderly patients with pneumonia presented a severe impairment of swallow and airway protection mechanisms. We recommend universal screening of dysphagia in older persons with pneumonia.