Introduction Elderly patients are recognised to be at increased risk of oropharyngeal dysphagia (OPD), the causes of which are likely to be multifactorial.1,2 The study aim is to identify if sepsis is an additional risk factor for OPD in the elderly (age ≥ 65).
Methods A hospital electronic database was searched for all elderly patients (≥65 years) referred for assessment for suspected dysphagia between May 2013 and January 2014. Exclusion criteria were age < 65 years and/or concurrent OPD due to: acute intracranial event, space occupying lesion or trauma. Data were collected on age; sex; co-morbidities; delirium; existing OPD; body mass index (BMI) on admission + discharge; sepsis; type of sepsis; microbiology confirming sepsis; diagnosis of sepsis made before OPD; recovery of OPD with resolution of sepsis; mortality; aspiration subsequent to sepsis and OPD and medication potentially contributing to OPD (e.g. benzodiazepines and opiates). Sepsis was defined as evidence of a systemic inflammatory response syndrome with a clinical suspicion of infection.
Results Three hundred of 1470 patients referred for dysphagia assessment during the study period met the inclusion criteria. The prevalence of sepsis induced OPD was 17% (50 patients). The mean age was 82 years while the median was 80. The interquartile age range was 12.5 years. 60% were male and 40% female. Admission BMIs ranged from 15.8 to 34.3 with a median of 21.2.Common co-morbidities included: dementia, chronic obstructive pulmonary disease, ischaemic heart disease, diabetes and chronic kidney disease. Within this group, the vast majority (76%) failed to recover swallowing, 14% had complications of aspiration and 36% died. Types of sepsis included: chest (48%); mixed (26%); urological (18%); biliary (4%); cellulitis (2%); intra-abdominal (2%); gastroenteritis (2%) and unknown (2%). Confirmatory microbiology was found in only 38%. Other factors contributing to the risk for dysphagia included delirium (18%) or new onset confusion (26%), reduced conscious level (26%) and intake of medication potentially contributing to OPD (38%). However 14% of patients had sepsis induced dysphagia without any clear or established risk factors.
Conclusion The prevalence of sepsis induced dysphagia is significant (17%) and should be taken into account in any new onset aspiration event in older hospitalised patients. Additional risk factors include neuroleptic medication, reduced conscious levels and associated confusion. Sepsis should be recognised as a major factor in the decompensation of swallowing and OPD in the elderly which rarely recovers, has increased mortality and might be considered a geriatric syndrome for which clinicians should be vigilant.
References 1 Shaw DW, Cook IJ, Gabb M, Holloway RH, Simula ME, et al. Influence of normal ageing on oral-pharyngeal and upper esophageal sphincter function during swallowing. Am J Physiol. 1995;268(3 Pt 1):G389–96.
2 Rofes L, Arreola V, Almirall J, Cabre M, Campins L, Garcia-Peris P, et al. Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterology Research and Practice. 2011;2011:13.
Disclosure of Interest None Declared
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