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

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.