Age and Ageing Advance Access originally published online on June 13, 2006
Age and Ageing 2006 35(5):544; doi:10.1093/ageing/afl051
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Reply
SIR—We thank both Dr Sutton and Dr O’Shea for the interesting further analysis of data from our paper. They have, however, further analysed patients according to their swallowing status, which we believe to be unscientific.We have specifically not attempted to correlate swallowing status with clinical outcomes in this study for the following two reasons:
- The swallowing status was defined at presentation to ensure that an abnormal swallow was equally prevalent in the placebo and the active group and to determine the duration of gel administration. The intention was not to correlate swallowing status and outcome as this has already previously been described by this group [1].
- As is known both clinically and in the research setting, a clinically safe swallow does not exclude aspiration as published in the same edition of Age and Ageing [2].
All patients in our study and for whom the initial swallow was abnormal had a daily nurse led assessment before a decision about oral intake. It is well known that swallowing ability may fluctuate from day to day and from time of the day, with worsening swallow associated with tiredness. Therefore, although we have this data, we do not believe that it is justified to move people from an abnormal to a normal swallow group.
We thus believe that combining groups with both normal and abnormal swallowing is more the situation seen in clinical practice and removes the potential inaccurate labelling of swallowing status, which is so well known.
We agree with the authors that further work is required in this area but hope that we may have opened this area of research up to others for the future benefits of patients both with and without abnormal swallow post-stroke.
Institute of Health Sciences, University of Reading, Building 22, London Road, Reading RG1 5AQ, UK Tel: (+44) 118 3786853 Fax: (+44) 118 3786862 Email: m.a.gosney{at}reading.ac.uk
References
- Millns B, Gosney M, Jack C, Martin MV, Wright AE. Acute stroke predisposes to oral Gram negative bacilli – a cause of aspiration pneumonia? Gerontology 2003; 49: 173–6.[CrossRef][Web of Science][Medline]
- Clayton J, Jack CIA, Ryall C, Tran J, Hilal E, Gosney M. Tracheal pH monitoring and aspiration in acute stroke. Age Ageing 2006; 35: 47–53.
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