Factors associated with aspiration pneumonia and preventive measures in hospitalized elderly: a systematic review of observational studies

Abstract

Purpose: to identify associated factors and preventive measures for aspiration pneumonia in hospitalized elderly patients. Methods: the PPOT (population, predictor, outcome, and type of study) was the strategy used to define the eligibility criteria: (1) Population: people over 60 years of age; (2) predictor: hospitalized patients (3) Outcomes: associated factors and measures to prevent aspiration pneumonia; (4) Type of study: Observational Studies (transversal and case-control). We performed the data collection in the PubMed, Lilacs, Scielo, Google Scholar, Science Direct, and Web of Science databases. Observational studies on factors associated with aspiration pneumonia and preventive measures in the elderly, without language restriction and available in full, were included. Data on authors/year/country, objective, methodology, sample, and results, were collected. The risk of bias was assessed, according to the JBI Critical Appraisal Checklist. Results: a case-control and two cross-sectional studies were analyzed. One paper presented a smaller sample with 86 patients, and another presented a larger sample comprising 443 patients. The median age was 77 years old. Conclusion: factors such as severe stroke, dysphagia, advanced age, male gender, coronary heart disease, lower Glasgow coma scale score, use of mechanical ventilation for more than 48 hours, and aspiration of colonized gastric juice were associated with aspiration pneumonia.

Identifying Risk Factors for Aspiration in Patients Hospitalized with Community-Acquired Pneumonia

“…Considering the increasing old population and the compromised immunity and physical degeneration in the elderly, the care for the elderly with comorbidities associated with AP should be strengthened. In accordance with previous studies [ 9 , 26 , 27 , 34 ], we found that males have a higher risk than females (OR, 1.4; 95% CI, 1.3–1.5), which suggests that we should pay special attention to males in clinical diagnosis and prevention of AP.…”

Factors associated with bronchopulmonary aspiration: a national-based study

“…Also, advanced age was a variable related to the outcome. The results corroborate those of previous research (6,25) , which showed that neurological dysfunction, decreased consciousness, gastroesophageal reflux, tube feeding and advanced age are potential risk factors for the occurrence of death (32) .…”

“…In this study, bronchopulmonary aspiration affected more people aged between 76 and 85 years. Although this event can occur in all age groups (18) , research has shown that aspiration is more frequent in the elderly, especially in those with dysphagia (18,(24)(25)(26) . Researchers also stated that exposure to risk factors, such as age and impaired oral hygiene, can contribute to morbidity and mortality from bronchopulmonary aspiration (18) , and these factors should be recognized, evaluated and monitored by health teams, especially in the most susceptible patients.…”

“…VAP is one of the consequences of bronchopulmonary aspiration and results in high in-hospital mortality rates (35)(36) . The VAP prevention bundle, which includes (i) elevated position at 30 and 45°, (ii) daily interruption of sedation and daily assessment of extubation conditions, (iv) peptic ulcer prophylaxis (stress ulcer) and (v) deep vein thrombosis prophylaxis (unless contraindicated) (37) , being an important strategy that, when used efficiently, positively impacts patient outcomes and quality of care (25) , because it allows nurses and other healthcare professionals to provide the best possible care, supported by evidence-based research and practices (32) .…”

Incidence and Predictors of Aspiration Pneumonia among Stroke Patients in Western Amhara Region, North-West Ethiopia: A Retrospective Follow up Study

“…Patients with multiple risks have increased rates of aspiration pneumonia, death, and other adverse outcomes. Frail elderly patients having both dysphagia and cerebrovascular diseases are more at risk of aspiration pneumonia than patients with only one of the diseases [41].…”