Using oral health assessment to predict aspiration pneumonia in older adults

Noguchi, Shingo; Yatera, Kazuhiro; Kato, Tatsuji; Chojin, Yasuo; Furuta, Norihiko; Akata, Kentaro; Kawanami, Toshinori; Yoshii, Chiharu; Mukae, Hiroshi

doi:10.1111/ger.12324

Cited by 19 publications

(12 citation statements)

References 29 publications

(61 reference statements)

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“…As validated tools for assessing oral health, the Revised Oral Assessment Guide (ROAG) [19] and OHAT [12] have often been used in recent studies. Poor oral health assessed as per the ROAG score demonstrated an existing association with aspiration pneumonia development [20]; however, the study did not examine the association of poor oral health with mortality. The current study was conducted with hospitalized patients.…”

Section: Discussionmentioning

confidence: 91%

Poor oral health and mortality in geriatric patients admitted to an acute hospital: an observational study

Maeda

2020

BMC Geriatr

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Background: Poor oral health at hospital admission is a potential higher mortality risk predictor. We aimed to determine in-hospital mortality by assessing poor oral health using a validated tool. Methods: A retrospective observational study was conducted in an acute care hospital, and 624 consecutive geriatric patients were included. Patients were divided into three groups according to oral health, stratified by the Oral Health Assessment Tool (OHAT) scores. Nutritional status, daily living activities, cognitive impairment, and comorbidities were collected as covariates. Univariate and multivariate analyses were performed to identify the relationship between oral health and survival. Results: The mean age was 83.8 ± 7.9 years, and 41% were males. Groups with an OHAT score equivalent to 0, 1-2, and ≥ 3 comprised 213, 206, and 205 patients, and 11 (5.2%), 13 (6.3%), and 37 (18.0%) of those patients died in the hospital, respectively. Patients in the OHAT score ≥ 3 group had higher mortality than those in the other groups (log-rank test: p = 0.012 for the OHAT = 0 group; p = 0.010 for the OHAT = 1-2 group after Bonferroni corrections). Patients in the OHAT score ≥ 3 group continued to have poor survival even after adjusting for confounders in the Cox's regression analysis (hazard ratio: 2.514, 95% confidence interval: 1.220-5.183, p = 0.012). Conclusion: In geriatric patients, poor oral health at hospital admission was an independent in-hospital mortality predictor. Future studies on oral care intervention stratified by oral health conditions are warranted.

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Section: Discussionmentioning

confidence: 91%

Poor oral health and mortality in geriatric patients admitted to an acute hospital: an observational study

Maeda

2020

BMC Geriatr

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“…Authors of a previous study concluded that the most common pathogens in ventilation and respiratory infections include Klebsiella pneumoniae, Escherichia coli and Staphylococcus (16). These are the main risk factors of VAP (17). The proliferation of oropharynx bacteria stimulated by the application of antibiotics is the primary cause of VAP, followed by the inhalation of secretions into the respiratory tract (18).…”

Section: Discussionmentioning

confidence: 99%

Laryngoscope‑assisted and cotton ball wiping methods in prevention of oral and pulmonary infection in patients receiving mechanical ventilation and the influence on hypersensitive C‑reactive protein and procalcitonin

Zhang

Xia

et al. 2019

Exp Ther Med

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Effects of laryngoscope-assisted and cotton ball wiping methods on the prevention of oral and pulmonary infection in patients receiving mechanical ventilation were compared to explore the influence of the two methods on high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT). In total, 152 patients who underwent mechanical ventilation in the ICU of Beijing Jishuitan Hospital from May 2005 to January 2018 were assigned and equally divided into two groups: 76 patients who had their oropharynxes scrubbed and rinsed by an electric toothbrush under direct vision by the use of a laryngoscope were selected as the laryngoscope group, and 76 patients who received the conventional cotton ball wiping method and the flushing method for oropharyngeal cleaning were assigned in the cotton ball group. Detection of serum hs-CRP and PCT levels in a 2-ml sample of fasting venous blood was performed on both groups of patients before hospitalization, and on the 5th and 10th day of hospitalization. The incidence rate of oral infection and ventilator-associated pneumonia, as well as the length of the cleaning time were recorded. The incidence rate of oral infection and ventilator-associated pneumonia in the laryngoscope group was statistically much lower than that in the cotton ball group (P<0.05). Before the experiment, there was no significant difference in the hs-CRP and PCT levels between the two groups (P>0.050), whereas the laryngoscope group had significantly lower hs-CRP and PCT levels at the 5th and 10th day of hospitalization than those in the cotton ball group (P<0.05). The hs-CRP and PCT levels at the three time-points in the same group were statistically different (P<0.05). In conclusion, oropharyngeal scrub and rinse by an electric toothbrush assisted by a laryngoscope, can not only better prevent oral infection and reduce the incidence of ventilator-associated pneumonia, but it also has shorter cleaning time and results in lower levels of inflammatory factors, which make this method beneficial in the clinic.

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“…A univariate analysis was carried out to determine variables that predict pneumonia‐related mortality during hospitalization. A stepwise multiple regression model was carried out using the variables found to be significant ( P < 0.15) in univariate analysis to identify independent predictors of pneumonia‐related mortality according to our previous report …”

Section: Methodsmentioning

confidence: 99%

Utility of the Quick Sequential Organ Failure Assessment in Japanese patients with nursing‐ and healthcare‐associated pneumonia

Noguchi

Yatera

Naito

et al. 2018

Geriatrics Gerontology Int

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Aim To clarify the utility of sepsis evaluation using the Quick Sequential Organ Failure Assessment (qSOFA) tool in addition to the Pneumonia Severity Index (PSI); age, dehydration, respiration, orientation and blood pressure (A‐DROP) index; and immunodeficiency, respiration, orientation, age and dehydration (I‐ROAD) scoring systems, and risk factor evaluation of potentially drug‐resistant (PDR) pathogens are suggested in the 2017 guidelines for pneumonia of the Japanese Respiratory Society in nursing‐ and healthcare‐associated pneumonia patients. Methods We included 289 hospitalized nursing‐ and healthcare‐associated pneumonia patients between April 2016 and March 2017, and investigated the ability of PSI, A‐DROP, I‐ROAD and qSOFA to predict pneumonia‐related mortality. We also evaluated the associations among the risk factors for PDR pathogens, the detection ratio of PDR pathogens and pneumonia‐related mortality. Results The mortality rate of pneumonia during hospitalization was 6.9% (20/289). The area under the curve for pneumonia‐related mortality predicted using PSI, A‐DROP, I‐ROAD and qSOFA was 0.697 (95% confidence interval [CI] 0.59–0.80), 0.63 (95% CI 0.51–0.76), 0.61 (95% CI 0.52–0.70) and 0.701 (95% CI 0.59–0.81), respectively. In addition, higher areas under the curve were observed for pneumonia‐related mortality predicted according to a combination of PSI and hypoalbuminemia (<2.5 g/dL) (0.75, 95% CI 0.64–0.86), and qSOFA and hypoalbuminemia (0.74, 95% CI 0.62–0.86) than for PSI and qSOFA alone. No significant associations were observed among the risk factors for PDR pathogens, the detection ratios of PDR pathogens and pneumonia‐related mortality. Conclusions qSOFA and the combination of qSOFA and hypoalbuminemia might be simple and useful evaluation tools for predicting pneumonia‐related mortality in nursing‐ and healthcare‐associated pneumonia patients. Geriatr Gerontol Int 2019; 19: 177–183.

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Using oral health assessment to predict aspiration pneumonia in older adults

Abstract: In clinical practice, oral health assessment using ROAG can help predict aspiration risk in older adults with pneumonia.

Cited by 19 publications

References 29 publications

Poor oral health and mortality in geriatric patients admitted to an acute hospital: an observational study

Poor oral health and mortality in geriatric patients admitted to an acute hospital: an observational study

Laryngoscope‑assisted and cotton ball wiping methods in prevention of oral and pulmonary infection in patients receiving mechanical ventilation and the influence on hypersensitive C‑reactive protein and procalcitonin

Utility of the Quick Sequential Organ Failure Assessment in Japanese patients with nursing‐ and healthcare‐associated pneumonia

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