Abstract
Background
In end-of-life care of elderly, the decision of care plan including gastrostomy is difficult frequently because of insufficient knowledge relating the life prognosis of elderly. It is important the families to decide correctly the life prognosis of elderly with geriatric diseases. Our purpose is to examine the significant factors for predicting life prognosis of elderly in end-of-life care.
Methods
A total of 320 elderly patients was enrolled (male/female 151/169; averaged age: male 84.7 ± 5.9 year, female 86.8 ± 6.3 year) and retrospective analyses were performed. The elderly patients were classified as either: (1) with or without past illness of aspiration pneumonia; (2) with or without incidence of cerebrovascular disorder; (3) impaired or normal cognitive function; (4) impaired or normal swallowing function, and performed Kaplan–Meier survival analysis. Swallowing function was examined using video endoscopic (VE) evaluation method. The Kaplan–Meier analysis of the number of days from implementation of VE test (day 0) to death was evaluated with the log-rank Mantel–Cox test. The maximum follow-up time recorded was 180 days.
Results
There were no significant differences in number of days when divided with or without past illness of aspiration pneumonia, cerebrovascular disorder and impaired cognitive function. The survival probabilities of elderly with impaired swallowing function were significant lower than in elderly with the normal function.
Conclusions
For judgement of life prognosis, the condition of being frail such as impaired swallowing function might be a useful factor, and the viewpoint would contribute to decide the treatment plan for the good end-of-life care of elderly.
Similar content being viewed by others
References
Kawasaki A, Matsushima M, Miura Y et al (2015) Recognition of and intent to use gastrostomy or ventilator treatments in older patients with advanced dementia: differences between laypeople and healthcare professionals in Japan. Geriatr Gerontol Int 15:318–325. doi:10.1111/ggi.12276
Jaul E, Zabari Y, Brodsky J (2014) Spiritual background and its association with the medical decision of, DNR at terminal life stages. Arch Gerontol Geriatr 58:25–29. doi:10.1016/j.archger.2013.08.004
Gillick MR (2000) Rethinking the role of tube feeding in patients with advanced dementia. New Engl. J Med 342:206–210
Lunney JR, Lynn J, Foley DJ et al (2003) Patterns of functional decline at the end of life. JAMA 289:2387–2392
Kohno S, Imamura Y, Shindo Y et al. (2013) Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP). Respir Investig 51:103–126. doi:10.1016/j.resinv.2012.11.001
Hughes CP, Berg L, Danziger WL, et al (1982) A new clinical scale for the staging of dementia. Br J Psych 140:566–572
Hayashi T, Nomura H, Ina K et al (2011) Place of death for the elderly in need of end-of-life home care: a study in Japan. Arch Gerontol Geriatr 53:242–244. doi:10.1016/j.archger.2010.12.005
Takahashi N, Kikutani T, Tamura F et al (2012) Videoendoscopic assessment of swallowing function to predict the future incidence of pneumonia of the elderly. J Oral Rehabil 39:429–437. doi:10.1111/j.1365-2842.2011.02286.x
Brown CJ, Flood KL (2013) Mobility limitation in the older patient: a clinical review. JAMA 310:1168–1177
Acknowledgements
The author thanks the medical staff of Tottori Municipal Hospital for their assistance.
Author contributions
All authors contributed to the study’s conception. KN supervised the study data collection/analysis and drafted the manuscript. YN contributed to the critical reading of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
We have no support or funding to report.
Conflict of interest
We have no conflict of interest in the present study.
Ethical approval
This study was approved by the ethics committee of Tottori Municipal Hospital (No. 1153).
Informed consent
Written informed consent was not obtained because guidelines for epidemiological research established by the Japanese Ministry of Health, Labour and Welfare do not require written informed consent for retrospective studies.
Rights and permissions
About this article
Cite this article
Naruishi, K., Nishikawa, Y. Swallowing impairment is a significant factor for predicting life prognosis of elderly at the end of life. Aging Clin Exp Res 30, 77–80 (2018). https://doi.org/10.1007/s40520-017-0756-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-017-0756-1