Association Between the Swallowing Reflex and the Development of Aspiration Pneumonia in Patients with Dysphagia Admitted to Long-term Care Wards -A Prospective Cohort Study of 60 Days-

Objective To investigate the association between the simple swallowing provocation test (SSPT) and development of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. Design The study design was a prospective cohort study. Subjects were followed for 60 days from admission. Setting LTC wards. Participants Study subjects were patients with dysphagia aged 65 years or older who were admitted to LTC wards between August 2018 and August 2019. In total, 39 subjects were included in the analysis (20 males, 19 females; mean age 83.8 ± 8.5 years). Subjects were divided into two groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow coma scale, body mass index, geriatric nutritional risk index, the mann assessment of swallowing ability, food intake level scale, functional independence measure, and oral health assessment tool. Interventions Not applicable. Main Outcome Measure The outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 ml. Results The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The phi coefficient was −0.43, the risk ratio was 2.29, and the 95% confidence interval (95%CI) was 1.14 to 4.58. The predictive factor for aspiration pneumonia was SSPT: 0.4 ml (95% CI: 1.57–26.03). Conclusions Our findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was conducted with the approval of the Naruto Yamakami Hospital Ethics Committee (1-1-01). All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data that support the findings of this study are available from the corresponding author, Omura, T., upon reasonable request. * SSPT : the simple swallowing provocation test LTC : long-term care ADL : activities of daily living NHCAP : nursing and healthcare-associated pneumonia MASA : the mann assessment of swallowing ability GCS : glasgow coma scale FILS : food intake level scale BMI : body mass index GNRI : geriatric nutritional risk index FIM : functional independence measure OHAT : oral health assessment tool CI : confidence interval