Assessment of Swallowing Function and Dysphagia: Is the Assessment of Swallowing Function Necessary for the Diagnosis of Aspiration Pneumonia?

Microaspiration during the night, i.e., silent aspiration, is a major mechanism of aspiration pneumonia (AP) in elderly patients. Thus, swallowing abnormalities such as dysphagia are major risk factors for the development of AP. Dysphagia is an important upper airway disorder causing respiratory tract illnesses. We must always be aware of the possibility that severe dysphagia patients may develop a variety of pulmonary diseases. To assess AP risks and conduct therapeutic strategy for AP, assessment of swallowing function is necessary in many clinical settings. Methods for assessing dysphagia range from bedside assessments by speech therapists to videofluoroscopic examinations of swallowing by physicians. Videofluoroscopic and/or videoendoscopic swallowing studies may be used to determine the nature and extent of swallow disorders. In frail elderly patients who require a comprehensive nursing care, videofluoroscopic examination of swallowing is not recommended. Bedside swallowing function assessments including simple swallowing provocation tests and oximeter monitoring are safely performed.