Cross-Sectional Study On Aspiration Risk Factors In Elderly In Urban Area Of Xi’an City

Objective:The objectives of thesis are to analyze the incidence of aspiration in the elderly in urban area of Xi’an city through the cross-sectional study on their aspiration conditions; to explore the risk factors causing aspiration in the elderly in the city; to provide a scientific basis for the establishment of aspiration prevention, diagnosis and treatment guidelines for Chinese elderly and to provide regional information of Xi’an urban for the aspiration epidemiological database of Chinese elderly. Methods 1. Cross-sectional StudyIn Xi’an city, 900 cases of elderly aged ≥60 years were randomly selected from 2 hospitals, 4 nursing homes and 4 communities under the jurisdiction of 6 administrative urban districts using random cluster sampling method from September to November, 2013; then a questionnaire survey was performed among them using Questionnaire for Aspiration Risk Factors in Elderly Population, which was prepared by the Special Research Group, Ministry of Health. The survey contents included general demographic characteristics(gender, age, education level, occupation, history of contact with a particular substance, living type), disease history, medication history, standardized swallowing assessment(SSA), activities of daily living(ADL), etc. A database was built based on the collected data using software Epi Date 3.1; in the process, the data was inputted and checked by two individuals in two times independently. Through statistical software SPSS 19.0, the data was analyzed using descriptive analysis, equilibrium test, chi-square test, t test, variance analysis and other methods. Descriptive analysis on the general demographic and sociological characteristics was first performed among the elderly in urban area of Xi’an city; the awareness of these elderly and their carers about aspiration was then investigated; the SSA and ADL scores of these elderly from those hospitals, nursing homes and communities were compare; this paper finally analyzed the overall incidence of aspiration in these elderly and respective incidence of aspiration in the three centers of hospitals, communities and nursing homes. 2. Case-control StudyThe elderly(388 cases), who had been definitively diagnosed as aspiration in the cross-sectional study, were defined as the case group. Those 408 cases without aspiration were defined as the control group. Univariate analysis and unconditional logistic regression multivariate analysis were conducted using the statistical software of SPSS 19.0 to explore the risk factors leading to aspiration of the elderly. Results: 1. Equilibrium TestThis study covered 900 cases of elderly aged ≥60 in Xi’an. Eight hundred and sixty-one questionnaires were returned with a return rate of 95.67%. Of them, the valid questionnaires were 796, with an efficient return rate of 92.45%. Three hundred and three valid questionnaires were returned from the hospitals, accounting for 38.07%; 288 were returned from the nursing homes, accounting for 36.18%; 205 were returned from the communities, accounting for 25.75%. The equilibrium test on the gender and age of patients from the three centers of hospitals, communities and nursing homes showed that the differences in the gender and age among these three centers were not statistically significant(P>0.05), suggesting that a good equilibrium among different centers. 2. General Demographic DataThese subjected included by this study covered 515 males(64.70%) and 281 females(35.30%), with an age of 68.13±5.07; their education level was dominated by primary school or lower, and such patients were 326 cases(40.95%); most o f them(528 cases, accounting for 66.33%) were living with their families; their occupational distribution was relatively uniform, including workers, farmers, civil servants/administrative cadres, soldiers, and other professions with about 20% for each; 160 cases(20.10%) were reported with the history of contact with special substances. 3. Awareness of These Elderly and Their Carers about Aspiration in Urban Area of Xi’an cityThe overall awareness rate of these elderly and their carers about aspiration w as 22.11%. Of them, the awareness rate of subjects themselves about aspiration was 10.08%, while the awareness rate of their carers was 33.40%. 4. SSA and ADL Scores of These Elderly from Those Hospitals, Nursing Homes and Communities in Urban Area of Xi’an cityThe elderly from hospital had the worst swallowing function and the worst daily living ability in the three groups. The elderly from communities had the best swallowing function and the best daily living ability in groups. 5. Overall Incidence of Aspiration in These Elderly and Respective Incidence of Aspiration in the Three Centers in Urban Area of Xi’an cityAmong these 796 cases of elderly, 388 cases were diagnosed as aspiration, with an overall incidence rate of 48.70%. The incidence rate for the elderly from the hospitals was 62.71%, while 52.20% and 31.60% for those from nursing homes and communities, respectively. The incidence rate of those from the hospitals was significantly higher tha n that of the other two centers. 6. Case-control Study on Aspiration Risk Factors in the Elderly in Urban Area of Xi’an city 6.1 Univariate Analysis of the Aspiration Group and the Control GroupThe average age of the aspiration group was higher than that of the control group; ADL scores of the aspiration group was lower than that of the control group(P<0.05).Comparison of the disease situation between the two groups showed that the incidence rates of cerebrovascular disease, lung disease, diabetes, Alzheimer’s disease and Parkinson’s disease in the aspiration group were higher than those in the control group(P <0.05).Tests on the difference in drug use of these two groups showed that the incidence rate of aspiration in the elderly using sedative-hypnotic drugs was significantly higher tha n those elderly, who did not use these drugs(P <0.05). 6.2 Multivariate Analysis of the Aspiration Group and the Control GroupThe multivariate analysis on various assigned variables showed that under the test level of α=0.05,the impacts of age(elderly),gender(male),swallowing difficulty, concomitant diseases(cerebrovascular disease,lung disease,senile dementia,Parkinson’s disease,diabetes) and the use of sedative-hypnotic drugs on aspiration were statistically significant. Conclusion:1.The overall awareness rate of these elderly and their carers about aspiration in urban area of Xi’an city was 22.11%.Of them, the awareness rate of subjects themselves about aspiration was 10.08%, while the awareness rate of their carers was 33.40%. 2. The overall aspiration rate of elderly in urban area of Xi’an city reached 48.70%.The incidence rate of elderly aspiration was 62.71%, 52.20% and 31.60% respectively from hospitals, nursing homes and communities.3. The elderly from hospital in urban area of Xi’an city had the worst swallowing function and the worst daily living ability in the three groups. The elderly fro m communities had the best swallowing function and the best daily living ability in groups. The elderly with aspiration had a worse daily living ability than normal elderly.4. The main risk factors causing aspiration in the elderly in urban area of Xi’an city include age(elderly), gender(male), swallowing difficulty, concomitant diseases(cerebrovascular disease, lung disease, senile dementia, Parkinson’s dis ease, diabetes) and the use of sedatives and sleeping tablets.