Interventions to Prevent Aspiration Pneumonia in Older Adults: A Systematic Review

Abstract

A systematic review was conducted to assess the effectiveness of the following interventions for prevention of aspiration pneumonia (AP) in older adults: compensatory strategy/positioning changes, dietary interventions, pharmacologic therapies, oral hygiene, and tube feeding. Data sources included a key word search of the MEDLINE, EMBASE, Cochrane Library, CINAHL, and HealthSTAR databases and hand searches of six journals. Reference lists of relevant primary and review articles were searched. Studies included were randomized, controlled trials (RCTs) enrolling adults aged 65 and older at risk of and assessed for AP. Two investigators extracted data on population, intervention, outcomes, and methodological quality. Of the 17 identified RCTs, eight met the selection criteria, two addressed dietary management or compensatory swallowing, two assessed pharmacological therapies, one assessed oral hygiene, and three assessed tube feeding. None of the eight trials reported use of blinding, and allocation concealment was unclear in five. Use of amantadine prevented pneumonia in one trial of nursing home residents. The antithrombotic agent cilostazol prevented AP in another trial but resulted in excessive bleeding. Insufficient data exist to determine the effectiveness of positioning strategies, modified diets, oral hygiene, feeding tube placement, or delivery of food in preventing AP. Considering how common the problem of AP is in older adults, larger, high-quality RCTs on the effectiveness of preventive interventions are warranted.

Hydrophilic nano-silica coating agents with platinum and diamond nanoparticles for denture base materials

“…Oral microorganisms have been implicated in bacterial endocarditis, aspiration pneumonia, and other systemic diseases 1,2) . Especially, the morbidity caused by aspiration pneumonia has been recognized as a major geriatric health problem.…”

Complications of Oropharyngeal Dysphagia: Malnutrition and Aspiration Pneumonia

“…They increase in direct relation with age and underlying diseases. The risk of aspiration pneumonia is higher in older patients because of the high incidence of dysphagia (Loeb et al 2003). In elderly nursing home residents with oropharyngeal dysphagia, aspiration pneumonia occurs in 43-50% during the first year, with a mortality of up to 45% (Cook and Kahrilas 1999).…”

“…In addition, there are a limited number of studies addressing these-unresolvedquestions. A recent review found that there are insufficient data to determine the effectiveness of treatments for dysphagia prevention in older adults (Loeb et al 2003). In contrast, other authors found that treatment of dysphagia is cost-effective and the use of dysphagia-preventive programs is correlated with a reduction in aspiration pneumonia rates (Logemann 1995).…”

“…Use of neuroleptics is also associated with a 60% greater risk of pneumonia (Knol et al 2008). Studies using pharmacological stimulant agents have also shown some promising positive effects (Loeb et al 2003). Several types of pharmacological and mechanical stimulation increase the concentration of substance P (SP) in saliva and improve the swallowing reflex and cough-reflex sensitivity.…”

Pneumonia in the Nursing Home

“…59 Japanese investigators randomized 184 nursing home residents to intense oral care versus 182 controls. 60 Care consisted of brushing and/or wiping mucosal surfaces after each meal, sometimes with povidone iodine, as well as weekly cleaning by a hygienist.…”