The Prevalence of Aspiration Pneumonia in Rest Home Residents with Reduced Cough Reflex Sensitivity

Abstract

The aim of this study was to determine whether there was an association between a failed test of cough reflex sensitivity and history of chest infection in a general population of rest home residents. One hundred rest home residents from four different levels of care (rest home, hospital, dementia and psycho-geriatric) were recruited and their cough reflex assessed using a solution of 0.6 Mol/L citric acid nebulised and presented via a facemask.Participant’s records were then checked to see if there were any documented episodes of chest infection in the 6 month period prior to cough reflex testing.The results showed that out of 100 participants, 4 failed the cough reflex test. Of the 4 that failed the test, 3 had no documented episodes of chest infections recorded in the 6 month period prior to cough reflex testing. Data was not available for one participant who was deceased by the time of collection of the second data set. As such, there was no direct association demonstrated between a failed cough reflex test and development of chest infection or aspiration pneumonia. The results of the study are unexpected in two ways. Firstly, the relatively low number of participants who failed the cough reflex test is surprising as 72% of the participants for whom a full data set was obtained had neurological conditions that are known predisposing factors for reduced cough reflex sensitivity. Secondly, the finding of no association between a failed cough reflex test and history of recorded chest infection is not consistent with other studies. There is however an established body of research that indicates the causes of aspiration pneumonia are multifactorial and not solely dependent upon aspiration. The characteristics of participants and the implications of the findings are described. The potential use of cough reflex testing as a tool to screen against the risks of silent aspiration in relation to assessment of oro-pharyngeal dysphagia in this frail, elderly population is discussed.