Aspiration pneumonia is a common complication among persons that are on long term care but may also occur in any other person. The condition is encountered when an individual inhales food contents either from the oropharynx or from the stomach. These contents end up in the lower respiratory tract. The incidence of the condition is at least three times as common in persons on long term care as it is in the general population. There a number of things one can do in aspiration pneumonia prevention.
There are a number of factors that predispose to this type of pneumonia among the patients that are on long term care. These include dysphagia (difficulty in swallowing), poor oral hygiene and certain medications. Prevention focuses on dealing with each of these risk factors. Other than aspiration pneumonia, other syndromes that may result from this event include pneumonitis, obstruction and abscess formation. Pneumonia sets in when the contents that have been aspirated contain bacteria.
It is estimated that close to 15% of adults have problems of swallowing, a known risk factor for aspiration. The problem appears to worsen with advancing age and increases 50% in patients aged 80 to 89 years. The physical and physiological changes that occur within the head and neck region as we age are responsible for this. Other conditions that may also contribute to the difficulty in swallowing include stroke, cerebral palsy, dementia and traumatic brain injury among others.
Dysphagia can be managed in a number of ways. One of them is to engage therapists that specialize in posture changes and swallowing. The therapists will teach the patients some maneuvers that can help minimize the risk. Another intervention which can be undertaken is the modification of diet. Diet that has a honey-like viscosity is less likely to be aspirated as compared to thin liquids. Starch based commercial thickeners are usually added to the diet to achieve this viscosity. Tube feeding is a last resort option.
A majority of long term care patients have been shown to have poor oral hygiene. In one study involving 260 patients, it was established that 70% of them had not been by a dentist in 5 years. Many of these patients may not be able to clean their own teeth which worsens the problem further. Providing assistance on teeth cleaning on a regular basis is one of the interventions that may be undertaken to reduce the incidence of aspiration.
The contribution that is made by drugs as a risk factors is related to two main effects. One of the effects is that they increase the secretions and the other is that they inhibit the swallowing function. It is important that all the drugs being administered are evaluated to determine which among them will have these effects. Drugs that increase the risk of aspiration include proton pump inhibitors, antiemetics, muscle relaxants and sedatives.
Drugs may also be used to reduce the risk of aspiration. This is achieved by either reducing the secretions or enhancing the swallowing ability. Levodopa is one of the drugs that are most important in this area. It works by increasing the levels of a chemical known as dopamine that is needed to maintain the tone of neck muscles used in swallowing. Angiotensin converting enzyme inhibitors are other useful drugs.
Aspiration pneumonia is a major cause of morbidity among patients in long term care. Although it can be treated by use of antibiotics, the general recommendation is that greater emphasis should be placed on prevention. This should be done by a multidisciplinary team that includes a physician, nurses, swallowing therapists and physiotherapists.
There are a number of factors that predispose to this type of pneumonia among the patients that are on long term care. These include dysphagia (difficulty in swallowing), poor oral hygiene and certain medications. Prevention focuses on dealing with each of these risk factors. Other than aspiration pneumonia, other syndromes that may result from this event include pneumonitis, obstruction and abscess formation. Pneumonia sets in when the contents that have been aspirated contain bacteria.
It is estimated that close to 15% of adults have problems of swallowing, a known risk factor for aspiration. The problem appears to worsen with advancing age and increases 50% in patients aged 80 to 89 years. The physical and physiological changes that occur within the head and neck region as we age are responsible for this. Other conditions that may also contribute to the difficulty in swallowing include stroke, cerebral palsy, dementia and traumatic brain injury among others.
Dysphagia can be managed in a number of ways. One of them is to engage therapists that specialize in posture changes and swallowing. The therapists will teach the patients some maneuvers that can help minimize the risk. Another intervention which can be undertaken is the modification of diet. Diet that has a honey-like viscosity is less likely to be aspirated as compared to thin liquids. Starch based commercial thickeners are usually added to the diet to achieve this viscosity. Tube feeding is a last resort option.
A majority of long term care patients have been shown to have poor oral hygiene. In one study involving 260 patients, it was established that 70% of them had not been by a dentist in 5 years. Many of these patients may not be able to clean their own teeth which worsens the problem further. Providing assistance on teeth cleaning on a regular basis is one of the interventions that may be undertaken to reduce the incidence of aspiration.
The contribution that is made by drugs as a risk factors is related to two main effects. One of the effects is that they increase the secretions and the other is that they inhibit the swallowing function. It is important that all the drugs being administered are evaluated to determine which among them will have these effects. Drugs that increase the risk of aspiration include proton pump inhibitors, antiemetics, muscle relaxants and sedatives.
Drugs may also be used to reduce the risk of aspiration. This is achieved by either reducing the secretions or enhancing the swallowing ability. Levodopa is one of the drugs that are most important in this area. It works by increasing the levels of a chemical known as dopamine that is needed to maintain the tone of neck muscles used in swallowing. Angiotensin converting enzyme inhibitors are other useful drugs.
Aspiration pneumonia is a major cause of morbidity among patients in long term care. Although it can be treated by use of antibiotics, the general recommendation is that greater emphasis should be placed on prevention. This should be done by a multidisciplinary team that includes a physician, nurses, swallowing therapists and physiotherapists.
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