Signs for identifying risk factors for aspiration pneumonia in elderly people needing nursing care

Main Article Content

Hiroki Shindo Takeshi Kikutani Mitsuyoshi Yoshida Yuri Yajima Fumiyo Tamura

Abstract

Signs for identifying risk factors for aspiration pneumonia in elderly people needing nursing care

Abstract

Aim: To identify signs predictive of pneumonia development that can be recognized at nursing homes where limited medical staff and equipment are available.

Methods: Subjects were 761 elderly individuals needing nursing care (172 men 594 women; mean age, 86.8±7.2 years), from 42 nursing homes across Japan who could eat orally and had not received antibiotic treatment during the previous three months. Dental hygienists examined each subject for wet hoarseness during and after eating a meal as a sign of impaired swallowing function, prolongation of mealtime length, refusal of oral care, dry mouth and halitosis. Data on the subjects’ activities of daily living, body mass index (BMI) calculated from body height and weight as a measure of nutritional status, and underlying diseases were transcribed from the medical records kept at each nursing home.

Results: During the study period, pneumonia occurred in 116 subjects (44 men, 72 women). Significant associations with pneumonia development were identified for nutritional status (P = 0.007) and swallowing function (P = 0.002). Analysis including comorbid conditions further identified heart disease (P = 0.03).

Conclusion: In this study, decreased BMI and wet hoarseness during and after eating a meal were identified as signs of pneumonia risk at nursing homes.

Article Details

How to Cite
SHINDO, Hiroki et al. Signs for identifying risk factors for aspiration pneumonia in elderly people needing nursing care. Medical Research Archives, [S.l.], v. 4, n. 7, nov. 2016. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/754>. Date accessed: 29 mar. 2024.
Keywords
aspiration pneumonia, nutritional status, swallowing function, oral care, nursing home, caregiver
Section
Research Articles

References

Antonelli Incalzi R, Landi F, Cipriani L, Bruno E, Pagano F, Gemma A, Capparella O, Carbonin PU. Nutritional assessment:a primary component of multidimensional geriatric assessment in the acute care setting. J Am Geriatr Soc. 1996; 44(2):166-174. [PubMed: 8576507]
DiBardino DM, Wunderink RG. Aspiration pneumonia: A review of modern trends. J Crit Care. 2015; Feb;30(1):40-48. doi:10.1016/j.jcrc.2014.07.011. Epub 2014 Jul 22. Review. [PubMed: 25129577]
El-Solh AA, Pietrantoni C, Bhat A, Okada M, Zambon J, Aquilina A, Berbary E. Colonization of dental plaques a reservoir of respiratory pathogens for hospital acquired pneumonia in institutionalized elders. Chest 2004; 126(5):1575-1582. [PubMed: 15539730]
Furuta M, Komiya-Nonaka M, Akifusa S, Shimazaki Y, Adachi M, Kinoshita T, Kikutani T, Yamashita Y. Interrelationship of oral health status, swallowing function, nutritional status, and cognitive ability with activities of daily living in Japanese elderly people receiving home care services due to physical disabilities. Community Dent Oral Epidemiology 2013; 41(2):173-181. [PubMed: 22934613]
Jones B, Ravich WJ, Donner MW, Kramer SS, Hendrix TR. Pharyngoesophageal interrelationships:observations and working concepts. Gastroenterol Radiol. 1985; 10(3):225-233. [PubMed: 4029538]
Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly. The Mini Nutrition assessment as part of the geriatric evaluation. Nutr Rev. 1996; 54(1):S59-S65. [PubMed: 8919685]
Henry RG. Functionally dependent veterans. Issues related to providing and improving their oral health care. Med Care. 1995; Nov;33(11 Suppl):NS143-163. Review. [PubMed: 7475426]
Jones B, Ravich WJ, Donner MW, Kramer SS, Hendrix TR. Pharyngoesophageal interrelationships:observations and working concepts. Gastroenterol Radiol. 1985; 10(3):225-233. [PubMed: 4029538]
Kakinoki Y, Nishihara T, Arita M, Shibuya K, Ishikawa M. Usefulness of new wetness tester for diagnosis of dry mouth in disabled patients. Gerodontology 2004; Dec; 21(4):229-231. [PubMed: 15603283]
Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H. High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med. 1994; Jul;150(1):251-253. [PubMed: 8025758]
Kleinberg I, Codipilly M. The biological basis of oral malodor formation. Bad breath: research perspectives, ed. Rosenberg, M., P. 13-39, Ramot Publishing -Tel Aviv University, Tel Aviv, 1995.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003; Aug; 22(4):415-421. [PubMed: 12880610]
Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, Loesche WJ. Predictors of aspiration pneumonia:how important is dysphagia? Dysphagia 1998; 13(2):69-81. [PubMed: 9513300]
Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia 2002; Fall;17(4):298-307. [PubMed: 12355145]
Ministry of Health, Labour and Welfare of Japan, 2011. Activity of Daily Living Independence of Demented Elderly. Available at:http://www.mhlw.go.jp:80/ topics/kaigo/kentou/15kourei/sankou4.html (accessed on May 29, 2011, in Japanese).
Miyazaki H, Sakao S, Katoh Y, Takehara T. Correlation between volatile sulphur compounds and certain oral health measurements in the general population. J Periodontol. 1995; 66(8):679-684. [PubMed: 7473010]
Persson, S, Edlund, MB, Claesson, R. Carlsson J. The formation of hydrogen sulfide and methyl mercaptan by oral bacteria. Oral Microbiol. Immun 1990; 5(4):195-201. [PubMed: 2082242]
Quagliarello V, Ginter S, Han L, Van Ness P, Allore H, Tinetti M. Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis. 2005; Jan 1;40(1):1-6. Epub 2004 Dec 1. [PubMed: 15614684]
Robbins J, Levine R, Wood J, Roecker EB, Luschei E. Age effects on lingual pressure generation as a risk factor for dysphagia. J Gerontol A Biol Sci Med Sci. 1995; 50(5):M257-M262. [PubMed: 7671027]
Sivit CJ, Curtis DJ, Crain M, Cruess DF, Winters C. Pharyngeal swallow in gastroesophageal reflux disease. Dysphagia 1988; 2(3):151-155. [PubMed: 3251690]
Takahashi K, Groher ME, Michi K. Methodology for detecting swallowing sounds. Dysphagia 1994; 9(1):54-62. [PubMed: 8131426]
Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T; Japanese Study Group on Aspiration Pulmonary Disease. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc. 2008; 56(3): 577-579. [PubMed: 18315680]
Teramoto S. Novel preventive and therapuetic strategy for post-stoke pneumonia. Expert Review Neurother. 2009; 9(8):1187-1200. [PubMed: 1963607]
Van der Putten GJ, De baat CD, De Vischere L, Schols J. Poor oral health, a potential new geriatric syndrome. Gerodontology 2014; Feb;31 Suppl 1:17-24. doi:10.1111/ger.12086. [PubMed: 24446975]
Volicer L, Bass EA, Luther SL. Agitation and resistiveness to care are two separate behavioral syndromes of dementia. J Am Med Dir Assoc. 2007; Oct; 8(8):527-532. [PubMed: 17931577]
Waito A, Bailey GL, Molfenter SM, Zoratto DC, Steele CM. Voice-quality abnormalities as a sign of dysphagia:validation against acoustic and videofluoroscopic data. Dysphagia 2011; Jun; 26(2):125-134. doi:10.1007/s00455-010-9282-4. Epub 2010 May 8. [PubMed: 20454806]
Warms T, Richards J. "Wet Voice" as a predictor of penetration and aspiration in oropharyngeal dysphagia. Dysphagia 2000; Spring;15(2):84-88. [PubMed: 10758190]
Witter DJ, Cramwinckel AB, van Rossum GM, Kayser AF. Shortened dental arches and masticatory ability. J Dent. 1990; 18(4):185-189. [PubMed: 2212200]