Screening for silent penetration and/or aspiration in older adults: assessment of different cough reflex test modalities

Objectives Reduced laryngeal sensitivity increases the risk of silent penetration and/or aspiration (SPA) and reduces the effectiveness of dysphagia screening tests. The aim of this study was to evaluate the diagnostic value of several Cough Reflex test (CRT) modalities for screening SPA in patients over 75 years of age.Methods This prospective study included 37 patients over the age of 75 who were hospitalised for acute conditions. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was used to compare the presence of SPA with the results of CRT obtained using citric acid at concentrations of 0.1 mol/L, 0.2 mol/L and 0.4 mol/L. During CRT, the presence of C2 (2 or more coughs) and C5 (5 or more coughs) were noted.Results and discussion Only the 0.1 mol/L concentration proved to be discriminatory: absence of C2 distinguished patients with SPA from healthy individuals (p = 0.009; Se: 81.25%; Sp: 71.43%). Absence of C5 discriminated patients with SPA from those with detected penetrations and/or aspirations (DPA) (i.e. aspiration triggering cough) (p = 0.026; Se: 81.25%; Sp: 71.43%). This test does not require specific expertise in dysphagia management, is non-invasive and is sensitive for detecting SPA.Conclusion The CRT using citric acid at 0.1 mol/L is a clinically valuable, non-invasive and sensitive tool for detecting SPA in an acute-care geriatric population.