Collaboration Between Acute Care Hospitals and Nursing Homes for Dysphagia Management: A Comparative Study of...

Objective Although acute care hospitals address pneumonia through antibiotic therapy and provide in-hospital swallowing rehabilitation conducted by speech-language pathologists, post-discharge follow-up is often insufficient. In particular, limited attention is given to monitoring the recurrence of pneumonia and the status of oral intake once residents return to their nursing homes. The aim of this study was to determine the benefits of collaboration between acute care hospitals and nursing homes for dysphagia and whether swallowing tests are a predictor of the development of pneumonia. Methods We included 48 residents (17 males and 31 females) from affiliated nursing homes who underwent swallowing function assessments at our hospital between April 2018 and September 2024. The mean age of the participants was 88 (72-107) years. The participants were divided into two groups based on the presence or absence of hospitalization for pneumonia. Swallowing function was assessed using videofluoroscopic swallowing studies (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES). The Mann-Whitney U test was used to compare the two groups. Statistical analyses were performed using SPSS version 29.0 (IBM Corp., Armonk, NY). Results The primary presenting complaint leading to consultation was coughing during meals, observed in eight (25.8%) non-hospitalized and nine (52.9%) hospitalized patients. No statistically significant differences were observed in oral hygiene status, as measured by the Oral Health Assessment Tool (OHAT) score, between the two groups. However, the Hyodo score obtained from FEES was significantly higher in the hospitalized group compared to the non-hospitalized group (P = 0.004). Similarly, the score on the Penetration-Aspiration Scale (PAS) from VFSS was significantly higher in the hospitalized group (P = 0.002). Conclusion Interinstitutional collaboration between acute care hospitals and nursing homes in the assessment of swallowing function provides significant benefits for both settings. In addition, in elderly care facilities with well-established oral care practices, optimized mealtime environments, and standardized feeding assistance protocols, instrumental swallowing function assessments demonstrate significant prognostic utility for predicting pneumonia onset.