2021 Volume 25 Issue 2 Pages 90-101
This study focused on the decline of swallowing function, which is considered to be the main cause of aspiration pneumonia. The aim of the present study was to design a clinical pathway based on swallowing functional assessment and to consider its effect in patients admitted with aspiration pneumonia.
The swallowing functional assessment for patients with aspiration pneumonia was undertaken using the basic information of the patient as well as the following four aspects and sub-items: general condition, food intake condition, swallowing function and oral condition. This functional evaluation was conducted at three points: (1) at the beginning of the intervention by a speech therapist, (2) at the end of pneumonia treatment, and (3) at the end of the intervention with stable swallowing function. 102 aspiration pneumonia patients (51 males, median age 90 years) were included and compared between the oral-intake group and the dead or non-oral-intake group. Moreover, the clinical pathway was developed in accordance with pneumonia treatment and then applied to the other 51 patients (24 males, median age 91 years) and its effect was examined.
At the end of pneumonia treatment, there were significant differences between the two groups in age, BMI, Barthel Index, consciousness level, response to verbal command, expectoration of sputum, pharyngeal suction, amount of oral intake, gargle function and oral care independence. Furthermore, multiple logistic regression analysis including these items as the independent variables and setting the oral intake discharge as the objective variable showed that both response to verbal command and amount of oral intake were significant factors. A comparison of the total length of hospital stay from admission to discharge did not show a significant difference between before and after introducing the clinical pathway of swallowing functional assessment. The term from the end of pneumonia treatment to the end of the intervention was significantly shorter after introducing the clinical pathway, especially in the oral intake group, suggesting that swallowing functional assessment and support for patients in the clinical pathway were effective.
The clinical intervention based on swallowing functional assessment for aspiration pneumonia patients was shown to be possibly effective in terms of support for oral intake after discharge.
