Pulmonary consequences of aspiration

Terry, Peter B.; Fuller, S. D.

doi:10.1007/bf02407220

Cited by 35 publications

(21 citation statements)

References 12 publications

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“…The prevalence of swallowing problems in elderly adults lies between 12 and 60% [22]. Swallowing problems are known to be associated with increased morbiditiy and mortality [23,24]. However, this problem as a risk factor for early emergency readmission in elderly adults has not been reported previously.…”

Section: Discussionmentioning

confidence: 90%

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Risk Factors for Early Emergency Hospital Readmission in Elderly Medical Patients

Chu

Pei²

1999

Gerontology

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Background: Early emergency readmissions is a common and important problem in the elderly patient. Identification of the risk factors for early emergency readmissions is needed to prevent this occurring. Objective: The aim of this study was to study the risk factors for early emergency readmission in the elderly medical patient. Methods: A case-control study (sex- and age-matched) was conducted from March to December 1996. 380 elderly (age 65 years or over) medical patients with emergency hospital readmission (within 28 days) and 380 matched controls were recruited from an acute university general hospital in Hong Kong. Potential risk factors which included demographic, socio-economic, principal medical diseases, comorbid diseases, dysphagia, physical functional status and mental status were studied. Results: In bivariate analyses for the risk factors of early emergency readmission, institutional carer, previous visiting nurse service, adverse drug reaction, chronic obstructive pulmonary disease, end-stage renal failure, mobility being chair- or bed-bound, dysphagia, use of a nasogastric tube feeding, urinary incontinence and bowel incontinence were significant. Readmission cases had higher mean number of comorbid diseases, lower mean Barthel Index, higher mean number of impairments in Activities of Daily Living (ADL) tasks and lower mean Abbreviated Mental Test score than controls. In multivariate logistic regression model, the number of ADL impairments (OR = 1.13, 95% CI = 1.08–1.19), no income (OR = 2.28, 95% CI = 1.19–4.37), adverse drug reaction (OR = 4.19, 95% CI = 1.56–11.2), advanced malignancy (OR = 2.45, 95% CI = 1.37–4.37), congestive heart failure (OR = 1.63, 95% CI = 1.05–2.53), chronic obstructive airways disease (OR = 2.1, 95% CI = 1.47–3.02), end-stage renal failure (OR = 5.48, 95% CI = 1.69–17.75), dysphagia (OR = 3.9, 95% CI = 1.5–10.11) and the number of comorbid diseases (OR = 1.3, 95% CI = 1.13–1.49) were significant risk factors for early emergency readmissions. Living in a private old aged home was associated with a lower risk of readmissions (OR = 0.53, 95% CI = 0.36–0.93). Conclusions: Definite medical, functional and socio-economic factors were found to be risk factors for early emergency readmissions in the elderly medical patient. A multiple risk factors intervention approach should be considered in designing future prevention strategies.

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Section: Discussionmentioning

confidence: 90%

“…We believe this is an important finding. Hence, identifying the elderly patients with dysphagia and giving appropriate management can help to decrease the risk of aspiration complications [23,24] which are a potentially preventable cause of early emergency readmission.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Early Emergency Hospital Readmission in Elderly Medical Patients

Chu

Pei²

1999

Gerontology

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“…This was observed only once in the 42 years of the investigation period in a 40-year-old alcoholic man. The emergency team succeeded in extracting the bolus but the patient never regained consciousness and died of aspiration pneumonia 5 days after the bolus event [48].…”

Section: Discussionmentioning

confidence: 99%

Laryngologic aspects of bolus asphyxiation-bolus death

et al. 1992

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Among 12,982 forensic autopsies, 78 cases of café coronary due to bolus impaction in the larynx (bolus death) were observed from 1947 to 1988. In all cases bolus material occluded the entry to the larynx; only once was a singular occlusion of the glottis observed. The bolus frequently extended into the mouth, trachea, and bronchial tree or esophagus. In all cases small amounts of aspirated material were observed in the deeper parts of the bronchial tree. The most commonly observed bolus was not masticated meat or a meat product. In adults and the elderly the bolus was often too large to pass the physiological narrowings of the hypopharynx. It was commonly lodged above the arytenoid cartilages. Forty-five of the bolus events were observed by bystanders. In 43 of the victims vital reactions were observed by bystanders or at the autopsy. This justifies the hope that many lives could have been saved had the right diagnosis and immediate therapy been initiated. The first step should be manual extraction or use of the Heimlich maneuver; in cases of failure of both attempts, immediate tracheotomy followed by hospitalization and bronchial lavage are indicated.

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“…Age-related decline in the cough reflex [35] and possible deterioration of pulmonary host defenses allow the development of pneumonia when these virulent bacteria are aspirated into the lungs in sufficient nmnbers [36]. In the elderly with gingival inflammation or dentures, anaerobic bacteria may colonize oropharyngeal secretions [37] and also cause aspiration pneumonia.…”

Section: Consequences Of Aspirationmentioning

confidence: 99%

Aspiration and the elderly

Knebl²,

et al. 1990

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Aspiration is prevalent in the elderly but its association with impairment of oral intake and gastroesophageal reflux is often misunderstood. This paper describes the causes, pathophysiology, and consequences of aspiration and their unique features in aged persons. It also explains how videofluoroscopic evaluation can assess current function while limiting factors that result in misinformation. The management of aspiration is discussed, emphasizing the importance and difficulties in maintaining functional well-being and possible complications of therapy.

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Pulmonary consequences of aspiration

Cited by 35 publications

References 12 publications

Risk Factors for Early Emergency Hospital Readmission in Elderly Medical Patients

Risk Factors for Early Emergency Hospital Readmission in Elderly Medical Patients

Laryngologic aspects of bolus asphyxiation-bolus death

Aspiration and the elderly

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