Preventing Aspiration Pneumonia Among the Elderly: A Review Focused on the Impact of the Consistency of Food Substances

Abstract

Aspiration pneumonia is the leading cause of death among the elderly. Modified-texture foods, i.e., foods with altered consistency, are recommended in order to maintain both normal swallowing and adequate nutrition, which is also expected to reduce aspiration pneumonia, when elderly people are suspected to suffer from disorders of eating and/or swallowing. However, it is reported that overly-restrictive diets have been provided to most residents given modified-texture diets. Furthermore, there is scant empirical evidence of the medical effectiveness of food texture-modification. Little attention has been paid to the effect of the consistency of food substances, as well as the ability of mastication, on general health. Our cross-sectional studies showed that eaters of regular foods have lower incidences of pneumonia and fever, while those eating modified-texture, i.e., softer and finer, foods have higher incidences of pneumonia and fever. In this review, the effects of interventions for prevention of aspiration pneumonia were overviewed then the impact of the consistency of food substances on the health of the elderly and the direction of further research was discussed.

Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia

“…Tube feeding is associated with a higher risk of aspiration pneumonia compared to oral feeding (32,49), and our study showed similar results (adjusted HR 2.57, 95% CI: 1.61-4.12, P < 0.001) under multivariate analysis. Although PEG has not shown more favorable outcomes compared to NGT in meta-analyses (15,22), subgroup analysis in this study demonstrates that the risk of pneumonia was significantly reduced in PEG compared to NGT in older patients with oropharyngeal dysphagia (adjusted HR 0.26, 95% CI: 0.11-0.63, P = 0.003), but not in patients without oropharyngeal dysphagia (adjusted HR 1.57, 95% CI: 0.71-3.45, P = 0.261).…”

Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?

“… Although the risk of aspiration in instrumental studies is reduced with liquids with increasing degrees of thickness, higher viscosity liquids also result in increased pharyngeal residue after swallowing with the potential for increased aspiration risk [ 28 ]. The same may be true for some modified texture foods [ 25 ]. …”