Utilization of Dysphagia Services Among Older Adults Hospitalized With Pneumonia in a Large Sample of US Hospitals

Abstract

Background: Pneumonia is a major cause of morbidity and mortality among older adults, with increased risk for individuals with neurodegenerative conditions. Although dysphagia is a significant risk factor for pneumonia pathogenesis, there is a paucity of data on dysphagia management in patients hospitalized with pneumonia. Therefore, we examined dysphagia service utilization rates and associated clinical factors for older adults hospitalized with pneumonia.

Methods: We identified community-acquired and aspiration pneumonia (CAP and Asp-PNA) general care hospitalizations among older adults (age ≥ 60) between April 2022 and December 2023 using the Premier Healthcare Database. Factors that influenced utilization of three primary dysphagia services-clinical evaluations, instrumental evaluations (e.g., videofluoroscopy), and therapy-were examined in three generalized linear mixed models with a random effect for hospital and adjusted for patient demographics and hospital characteristics.

Results: Our sample included 195,782 older adults (51.7% female; 19.3% ND; 15.7% Asp-PNA) across 943 hospitals, and 23.6% received a clinical evaluation, 6.8% an instrumental evaluation, and 11.2% therapy. Generalized linear mixed models of clinical evaluations, instrumental evaluations, and therapy revealed significant associations of Asp-PNA, neurodegenerative disease (ND), and their interaction. The association between Asp-PNA and dysphagia services was greater in the non-ND group (clinical: OR = 9.57; instrumental: OR = 9.67; therapy: OR = 8.66) and attenuated in the ND group (clinical: OR = 5.49; instrumental: OR = 4.66; therapy: OR = 4.20). Similarly, the association between ND and dysphagia services was greater for those with CAP (clinical: OR = 2.85; instrumental: OR = 2.03; therapy: OR = 3.11) and dampened for Asp-PNA (clinical: OR = 1.64; instrumental: OR = 0.98; therapy: OR = 1.50).

Conclusions: Dysphagia services were provided to less than one quarter of older adults with pneumonia in our large U.S. cohort, although rates were higher among patients with Asp-PNA and neurodegenerative disease. Future research should focus on using dysphagia screening tools to promote appropriate referrals to dysphagia services for pneumonia patients.

Keywords: aspiration; dysphagia; pneumonia.