[Dysphagia] Dehydration and falls 2

[lobsterpam at aol.com (lobsterpam at aol.com)]

I'm not ready tho throw out the baby however as 
less thick alternatives can reduce aspiration as clearly seen on videos and 
reduce pneumonias as clearly seen during the few cases that pt.s who are doing 
fine on nectar get pneumonia when upgraded to thin without a repeat video. 


 
We need to be careful about drawing conclusions from incomplete data. I'm not sure anything can be "clearly seen" from a "few cases." There are just as many cases that would show the opposite. What about all the videos we've done where the person has no respiratory sx, but a video is done and they're aspirating thins - and have been for ages? Or the ones who are placed on thickened liquids or tubes, steal water, and still do fine? And the ones who get pneumonia repeatedly when they are made NPO?

No one is suggesting that aspiration is a GOOD thing, but the development of pneumonis is a far more complicated relationship than just aspirating thin liquids.? 

Feinberg, M., Knebl, J., and Tully, J. (1996) Prandial Aspiration and Pneumonia in an Elderly Population Followed? Over 3 Years. Dysphagia 11:104-10
Abstract.? The purpose of our study was to prospectively? determine pneumonia frequency and correlate it with? prandial liquid aspiration and feeding status in frail elderly nursing home residents. Initially, 152 patients had? video swallowing examinations (81? oropharyngeal dys-? phagia,? 19 thoracic dysphagia, 52 without dysphagia).? Those diagnosed with oropharyngeal impairment were? subsequently managed with swallowing therapy or artifi-? cial feeding modalities. Patients were followed for 3 years? (unless they expired earlier) and clinical courses were? categorized according to the degree of prandial aspiration? and feeding (PAF) status. Subjects with new lung infil-? trates persisting for at least 5 days with appropriate clini-? cal findings were diagnosed as having pneumonia and? were classified according to the PAF status months in? which these findings occurred. Fifty-six pneumonias were? diagnosed during 4,280 months with the following fre-? quencies: no aspiration months 0.6%; minor aspiration? months 0.9%; major aspiration/oral feeding months 1.3%;? major? aspiration/artificial? feeding? months? 4.4%,? p? <? 0.001. Our results indicate that there is not a simple and? obvious relation between prandial liquid aspiration and? pneumonia. Artificial feeding does not seem to be a satis-? factory solution for preventing pneumonia in elderly prandial aspirators. 

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