Risk Factors for Aspiration Pneumonia in Older Adults

Manabe, Toshie; Teramoto, Shinji; Tamiya, Nanako; Okochi, Jiro; Hizawa, Nobuyuki

doi:10.1371/journal.pone.0140060

Cited by 164 publications

(157 citation statements)

References 30 publications

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“…They frequently coexist [3]; pneumonia is the most common cause of death in patients with dementia [4,5], and dementia is a well-recognized risk factor for community acquired pneumonia [6] and aspiration pneumonia [7] in the elderly. Pneumonia is also reportedly associated with poor long-term prognosis in patients with dementia [8,9].…”

Section: Introductionmentioning

confidence: 99%

Association between dementia and discharge status in patients hospitalized with pneumonia

Yasunaga

Sasabuchi

et al. 2017

BMC Pulm Med

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Background: Pneumonia is the most common cause of death in patients with dementia, but the outcomes of patients with dementia hospitalized with pneumonia are poorly understood. We sought to illuminate the association between dementia and in-hospital mortality and discharge status in patients hospitalized with pneumonia. Methods: We used the Diagnosis Procedure Combination database, a national inpatient database in Japan, to identify retrospectively patients aged ≥60 years admitted to hospital with pneumonia during the study period of May 1, 2010 to March 31, 2014. We recorded their sex, age, body mass index, severity of pneumonia and comorbidities (including dementia). The outcomes were in-hospital mortality and discharge home. Multivariable Cox regression analysis was performed to analyze factors influencing discharge home. Results: We identified 470,829 patients hospitalized with pneumonia; 45,031 were recorded as having dementia (9.6%). In-hospital mortality was 13.1% and 13.4% in patients with and without dementia, respectively (P = 0.63). The proportions of patients discharged home were 52.9% and 71.3% in patients with and without dementia, respectively (P < 0.001). The adjusted hazard ratio for discharge home for patients with dementia was 0.68 (95% confidence interval, 0.67-0.69; P < 0.001). Conclusions: In-hospital mortality from pneumonia did not differ significantly between patients with and without dementia; however, those with dementia were less likely to be discharged home.

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Section: Introductionmentioning

confidence: 99%

Association between dementia and discharge status in patients hospitalized with pneumonia

Yasunaga

Sasabuchi

et al. 2017

BMC Pulm Med

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“…Dementia and Parkinson's disease are also risk factors for aspiration pneumonia because of their neuromuscular sequelae. 65 Other neurologic disorders, such as myasthenia gravis, multiple sclerosis, and amyotrophic lateral sclerosis, predispose to aspiration and subsequently aspiration pneumonitis because of a significant reduction in respiratory muscle compliance and overall mobility. Dehydration is an indicator of poor oral intake and impaired feeding mechanisms, which may predispose this population to aspiration.…”

Section: Identification Of Patients In Respiratory Compromise Due Tomentioning

confidence: 99%

“…Dehydration is an indicator of poor oral intake and impaired feeding mechanisms, which may predispose this population to aspiration. 65 In addition to focal neurologic and neuromuscular dysfunctions, alterations in consciousness from medication use and drug abuse increase the risk of aspiration. For example, escalating doses of antipsychotic medications increase the risk of swallowing difficulty.…”

Section: Identification Of Patients In Respiratory Compromise Due Tomentioning

confidence: 99%

Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients

et al. 2017

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Acute respiratory compromise describes a deterioration in respiratory function with a high likelihood of rapid progression to respiratory failure and death. Identifying patients at risk for respiratory compromise coupled with monitoring of patients who have developed respiratory compromise might allow earlier interventions to prevent or mitigate further decompensation. The National Association for the Medical Direction of Respiratory Care (NAMDRC) organized a workshop meeting with representation from many national societies to address the unmet needs of respiratory compromise from a clinical practice perspective. Respiratory compromise may arise de novo or may complicate preexisting lung disease. The group identified distinct subsets of respiratory compromise that present similar opportunities for early detection and useful intervention to prevent respiratory failure. The subtypes were characterized by the pathophysiological mechanisms they had in common: impaired control of breathing, impaired airway protection, parenchymal lung disease, increased airway resistance, hydrostatic pulmonary edema, and right-ventricular failure. Classification of acutely ill respiratory patients into one or more of these categories may help in selecting the screening and monitoring strategies that are most appropriate for the patient's particular pathophysiology. Standardized screening and monitoring practices for patients with similar mechanisms of deterioration may enhance the ability to predict respiratory failure early and prevent its occurrence.

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“…Most patients with AP, particularly the elderly, have dysphagia and difficulty with oral intake5 and malnutrition 6. Indeed, AP is frequently fatal in such patients.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitative management for aspiration pneumonia in elderly patients

Momosaki

2017

J of Gen and Family Med

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Aspiration pneumonia is a common disease that frequently occurs in elderly patients. Most patients with aspiration pneumonia have swallowing disability and develop hospital‐acquired disability. Frequently, patients have difficulty returning home, and they often require long‐term hospitalization. Recently, the effectiveness of rehabilitative management including physical, pulmonary, and dysphagia rehabilitation for aspiration pneumonia was reported. Several studies showed that early rehabilitation was associated with reduced mortality and early hospital discharge after aspiration pneumonia. Unnecessary “nil by mouth” directives associated with aspiration pneumonia at hospital admission resulted in adverse effects, including decline in swallowing ability and prolonged treatment duration. Rehabilitative management combined with appropriate nutrition is recommended to improve clinical outcomes, including physical and swallowing function in geriatric patients with aspiration pneumonia.

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Risk Factors for Aspiration Pneumonia in Older Adults

Cited by 164 publications

References 30 publications

Association between dementia and discharge status in patients hospitalized with pneumonia

Association between dementia and discharge status in patients hospitalized with pneumonia

Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients

Rehabilitative management for aspiration pneumonia in elderly patients

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