56MANAGEMENT AND OUTCOMES IN FRAIL, ELDERLY PATIENTS ADMITTED WITH ASPIRATION PNEUMONIA

Abstract

Introduction: Dysphagia affects 50-75% of nursing home residents and aspiration pneumonia accounts for 13-48% of infections in this population. Artificial feeding via percutaneous endoscopic gastrostomy (PEG) has poor outcomes in dementia and the frail elderly. Unfortunately such patients are frequently kept nil by mouth (NBM) in hospital pending swallow assessment, which contributes to poor nutrition, dehydration and increased risk of delirium. We aimed to study the factors for aspiration related to dysphagia, its management and outcome in care of the elderly wards. Methods: We identified 42 patients with aspiration pneumonia, excluding those with acute stroke and oropharyngeal malignancy. Results: Mean age was 83.9 years; 69% were male. 48% had dementia, which was the likely contributing factor to swallowing problems in addition to general frailty; 71% were kept NBM on admission. 26% were previously known to Salt Language Therapists, 24% were already on altered consistency food s. 14% were risk feeding in the community, yet only 1 of them was allowed to continue to do so when admitted. Nine patients (four with dementia) had nasogastric tube inserted, but only three were successfully fed. Mean time without any nutrition was 2.5 days. One patient had PEG inserted but died a few days later. 67% either died, were discharged with fast-track or “risk feeding”. Three month mortality was 62%. There was no significant difference in mortality between those patients who were allowed oral intake on admission and those kept NBM until assessment (63.3% vs 60.7%). Conclusion: Aspiration pneumonia is common in the frail, elderly population and in the majority it appears to be a terminal event. Depriving patients of food on admission to hospital is unlikely to be in their best interests, except in very few specific cases. We should also be considering advanced care planning in these patients.