Prevention of Aspiration: Oral Care, Antibiotics, Others

Abstract

Patients with aspiration pneumonia often develop this lung infection due to poor oral health or because the contents of the digestive tract or upper airway enter the lower airway traversing the larynx through different mechanisms. Prevention of this condition is directed at the mechanism by which it occurs. The elderly are the most likely to suffer from aspiration pneumonia, occasionally due to issues related to poor dental health, but more frequently due to abnormal swallowing, which may appear after a stroke, a functional impairment related to aging, or may be part of a specific disease such as Parkinson's disease or some other nervous system condition. People with dysphagia complicated by pneumonia have limited feeding and become debilitated, and aspiration pneumonia in these individuals has a high mortality rate at 90 days. Dietary modifications, assistance with feeding, use of postures that facilitate a normal deglutition, rehabilitation, and use of medications to improve swallowing defects are the tools of medicine to overcome the obstacles to swallowing normally and prevent the development of aspiration pneumonia and its consequences.

Keywords

swallowing defect - monitoring of impaired consciousness - care for the elderly - correction of defective swallowing - dysphagia rehabilitation

Publication History

Article published online:
29 November 2024

• References

• 1 Almirall J, Rofes L, Serra-Prat M. et al. Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly. Eur Respir J 2013; 41 (04) 923-928
• 2 Simmons SR, Bhalla M, Herring SE, Tchalla EYI, Bou Ghanem EN. Older but not wiser: the age-driven changes in neutrophil responses during pulmonary infections. Infect Immun 2021; 89 (04) e00653 –e20
• 3 Niederman MS, Cilloniz C. Aspiration pneumonia. Rev Esp Quimioter 2022; 35 (Suppl 1, Suppl 1): 73-77
• 4 Fernández-Sabé N, Carratalà J, Rosón B. et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine (Baltimore) 2003; 82 (03) 159-169
• 5 Mylotte JM. Nursing home-acquired pneumonia. Clin Infect Dis 2002; 35 (10) 1205-1211
• 6 Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 2010; 39 (01) 39-45
• 7 Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001; 344 (09) 665-671
• 8 Lanspa MJ, Jones BE, Brown SM, Dean NC. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med 2013; 8 (02) 83-90
• 9 Shiraishi A, Yoshimura Y, Wakabayashi H, Tsuji Y. Poor oral status is associated with rehabilitation outcome in older people. Geriatr Gerontol Int 2017; 17 (04) 598-604
• 10 Scannapieco FA, Amin S, Salme M, Tezal M. Factors associated with utilization of dental services in a long-term care facility: a descriptive cross-sectional study. Spec Care Dentist 2017; 37 (02) 78-84
• 11 Andersson P, Hallberg IR, Renvert S. Inter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward. Spec Care Dentist 2002; 22 (05) 181-186
• 12 Noguchi S, Yatera K, Kato T. et al. Using oral health assessment to predict aspiration pneumonia in older adults. Gerodontology 2018; 35 (02) 110-116
• 13 Scannapieco FA. Poor oral health in the etiology and prevention of aspiration pneumonia. Dent Clin North Am 2021; 65 (02) 307-321
• 14 Yoneyama T, Yoshida M, Ohrui T. et al; Oral Care Working Group. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002; 50 (03) 430-433
• 15 Juthani-Mehta M, Van Ness PH, McGloin J. et al. A cluster-randomized controlled trial of a multicomponent intervention protocol for pneumonia prevention among nursing home elders. Clin Infect Dis 2015; 60 (06) 849-857
• 16 Kawashima K, Motohashi Y, Fujishima I. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Dysphagia 2004; 19 (04) 266-271
• 17 Steele CM, Greenwood C, Ens I, Robertson C, Seidman-Carlson R. Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia 1997; 12 (01) 43-50 , discussion 51
• 18 Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol 2007; 116 (11) 858-865
• 19 Dennis MS, Lewis SC, Warlow C. FOOD Trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet 2005; 365 (9461) 764-772
• 20 Hamdy S, Aziz Q, Rothwell JC. et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology 1998; 115 (05) 1104-1112
• 21 Serra-Prat M, Hinojosa G, López D. et al. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J Am Geriatr Soc 2011; 59 (01) 186-187
• 22 Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care 2019; 23 (01) 103-107
• 23 Macht M, Wimbish T, Bodine C, Moss M. ICU-acquired swallowing disorders. Crit Care Med 2013; 41 (10) 2396-2405
• 24 Schefold JC, Berger D, Zürcher P. et al. Dysphagia in mechanically ventilated ICU patients (DYnAMICS): a prospective observational trial. Crit Care Med 2017; 45 (12) 2061-2069
• 25 Barczi SR, Sullivan PA, Robbins J. How should dysphagia care of older adults differ? Establishing optimal practice patterns. Semin Speech Lang 2000; 21 (04) 347-361
• 26 Ebihara T. Comprehensive approaches to aspiration pneumonia and dysphagia in the elderly on the disease time-axis. J Clin Med 2022; 11 (18) 5323
• 27 Luk JK, Chan DK. Preventing aspiration pneumonia in older people: do we have the ‘know-how’?. Hong Kong Med J 2014; 20 (05) 421-427
• 28 Writh R, Dziewas R, Beck A. et al. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging 2016; 11: 198-208
• 29 Perry A, Lee SH, Cotton S, Kennedy C. Therapeutic exercises for affecting post-treatment swallowing in people treated for advanced-stage head and neck cancers. Cochrane Database Syst Rev 2016; 2016 (08) CD011112
• 30 Wilkinson TJ, Thomas K, MacGregor S, Tillard G, Wyles C, Sainsbury R. Tolerance of early diet textures as indicators of recovery from dysphagia after stroke. Dysphagia 2002; Summer; 17 (03) 227-232
• 31 Chen S, Kent B, Cui Y. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review. BMC Geriatr 2021; 21 (01) 429
• 32 Painter V, Le Couteur DG, Waite LM. Texture-modified food and fluids in dementia and residential aged care facilities. Clin Interv Aging 2017; 12: 1193-1203
• 33 Mesioye A, Smith J, Zilberstein M. et al. Dysphagia rounds: interdisciplinary collaboration to improve swallowing safety in a VA community living center. J Am Geriatr Soc 2018; 66: S192
• 34 Watando A, Ebihara S, Ebihara T. et al. Effect of temperature on swallowing reflex in elderly patients with aspiration pneumonia. J Am Geriatr Soc 2004; 52 (12) 2143-2144
• 35 Ebihara T, Sekizawa K, Nakazawa H, Sasaki H. Capsaicin and swallowing reflex. Lancet 1993; 341 (8842) 432
• 36 Ebihara T, Ebihara S, Watando A. et al. Effects of menthol on the triggering of the swallowing reflex in elderly patients with dysphagia. Br J Clin Pharmacol 2006; 62 (03) 369-371
• 37 Okamura N, Maruyama M, Ebihara T. et al. Aspiration pneumonia and insular hypoperfusion in patients with cerebrovascular disease. J Am Geriatr Soc 2004; 52 (04) 645-646
• 38 Ebihara T, Yamasaki M, Kozaki K, Ebihara S. Medical aromatherapy in geriatric syndrome. Geriatr Gerontol Int 2021; 21 (05) 377-385
• 39 Sun S-F, Hsu C-W, Lin H-S. et al. Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and traditional swallowing rehabilitation in the treatment of stroke-related dysphagia. Dysphagia 2013; 28 (04) 557-566
• 40 Park J-W, Kim Y, Oh J-C, Lee HJ. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia 2012; 27 (04) 521-527
• 41 Gokula M, Rubeen S, Thotakura S. Does amantadine help elderly residents with symptomless dysphagia?. Ann Longterm Care 2011; 19 (05) 37-40
• 42 Shinohara Y. Antiplatelet cilostazol is effective in the prevention of pneumonia in ischemic stroke patients in the chronic stage. Cerebrovasc Dis 2006; 22 (01) 57-60
• 43 Tomaki M, Ichinose M, Miura M. et al. Angiotensin converting enzyme (ACE) inhibitor-induced cough and substance P. Thorax 1996; 51 (02) 199-201
• 44 Yavagal DR, Karnad DR, Oak JL. Metoclopramide for preventing pneumonia in critically ill patients receiving enteral tube feeding: a randomized controlled trial. Crit Care Med 2000; 28 (05) 1408-1411
• 45 Teismann IK, Steinsträter O, Warnecke T. et al. Tactile thermal oral stimulation increases the cortical representation of swallowing. BMC Neurosci 2009; 10: 71
• 46 Knol W, van Marum RJ, Jansen PA, Souverein PC, Schobben AF, Egberts AC. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc 2008; 56 (04) 661-666
• 47 Baijens LW, Clavé P, Cras P. et al. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016; 11: 1403-1428
• 48 Lin LC, Wu SC, Chen HS, Wang TG, Chen MY. Prevalence of impaired swallowing in institutionalized older people in taiwan. J Am Geriatr Soc 2002; 50 (06) 1118-1123
• 49 Vergis EN, Brennen C, Wagener M, Muder RR. Pneumonia in long-term care: a prospective case-control study of risk factors and impact on survival. Arch Intern Med 2001; 161 (19) 2378-2381
• 50 Gomes GF, Pisani JC, Macedo ED, Campos AC. The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia. Curr Opin Clin Nutr Metab Care 2003; 6 (03) 327-333
• 51 MacLeod JB, Lefton J, Houghton D. et al. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma 2007; 63 (01) 57-61
• 52 Lee JS, Kwok T, Chui PY. et al. Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial. Clin Nutr 2010; 29 (04) 453-458
• 53 Eilers J. et al. Development, testing, and application of the oral assessment guide. Oncology Nursing Forum 1988; 15: 325-330