An examination of factors related to aspiration and silent aspiration in older adults requiring long‐term care in rural Japan

Abstract

Swallowing disorders are a growing problem among the elderly in long-term care (LTC), and they can cause aspiration pneumonia. In order to detect swallowing disorders early, simple tools are needed to assess aspiration and silent aspiration (SA). To compile a sample of elderly people requiring LTC, and categorise them as having suspected aspiration and/or SA using simple screening tools. In addition, oral ability, severity of dementia, vital functions and nutritional status were compared in these groups. A total of 393 elderly people in LTC (89 men and 304 women; age ranging from 65 to 100 years) were included in the study. The modified water swallow test, cervical auscultation and cough test were used to assess swallowing function. The participants were categorised as having suspected aspiration and/or SA, and the following assessments were performed: (i) oral ability (lips function, tongue function, rinsing and gargling ability), (ii) dementia severity, (iii) vital functions and (iv) nutritional status. Suspected aspiration was apparent in 50.5% of patients, of which 24.0% had suspected SA. Those with suspected aspiration showed worsened oral ability, dementia severity, vital functions and nutritional status. Similarly, those with suspected SA showed worsened dementia severity, vital functions and nutritional status. Logistic regression analysis revealed that lip closure, lingual movement and rinsing ability were significantly associated with suspected aspiration. Dementia severity was the best predictor of suspected SA. Simple screening tools can be used to identify suspected aspiration and SA, which may facilitate early detection of aspiration pneumonia or swallowing disorder risk.

Using oral health assessment to predict aspiration pneumonia in older adults

“…Oral hygiene has been well studied; tooth decay and plaque are known to be associated with aspiration pneumonia . While few studies have examined the relationship between aspiration pneumonia and oral health status, Sellars et al reported that the OAG scores were significantly higher in poststroke adults with pneumonia, in whom aspiration is the underlying aetiology in 40%‐50% of cases, compared to those without pneumonia . Furthermore, Sakai et al reported that oral dysfunction was associated with aspiration; Shiraishi et al also reported that poor oral health on assessment using the ROAG score was associated with impaired activities of daily living, lower muscle mass and malnutrition, which are considered risk factors for aspiration pneumonia .…”

“…However, these diagnostic techniques may not be feasible in many older adults with pneumonia, due to poor general condition or unavailability of equipment. The bedside water swallow test is known to be an effective screening tool, but similar, simple screening tools are required to identify aspiration, given an ageing population at increased risk …”

“…Oral health has recently received attention for its utility in predicting swallowing dysfunction, as both the oral and pharyngeal phases may be affected in swallowing disorders . The influence of oral health on the risk of aspiration pneumonia is currently unknown, although there are many reports on the importance of oral care and hygiene .…”

Effects of oral care with tongue cleaning on coughing ability in geriatric care facilities: a randomised controlled trial

“…VE and VF have been considered as the gold standards for evaluating eating and swallowing functions (11,23). VE and VF have been considered as the gold standards for evaluating eating and swallowing functions (11,23).…”

Decreased cognitive function is associated with dysphagia risk in nursing home older residents

“…A decrement in cognitive function can influence the cognition or intake of food during swallowing, which can in turn be an aggravating factor of dysphagia. A cross‐sectional study of Japanese older adults requiring long‐term care reported a negative association between the severity of dementia and swallowing function . Further, in older nursing home residents, history of dementia is reported to be a significant predictor of dysphagia .…”