The oral cavity is an environment that consists of numerous species of microorganisms (both bacterial and fungal) together with their biofilms and cytokines (chemicals). Most of these organisms are beneficial and are thus termed normal flora. In cases of poor hygiene, the oral cavity is invaded by disease causing organisms which increase the risk of aspirating in bedridden individuals. In this article we discuss the relationship between oral care and aspiration pneumonia.
It has been established that the risk for aspiration among patients on long term care is markedly increased if there is a concomitant disease in the cavity. Examples of these diseases and medical conditions include periodontal diseases and dental caries. Other conditions that may worsen the situation include the existence of swallowing difficulties, inability to feed and poor motor coordination. The elderly are at a higher risk of suffering from this conditions than the general population.
Findings from various studies show that approximately 15% of adults within the general population have difficulties in swallowing. This problem appears to worsen with advancing age such that among those aged above 80 years, the proportion approaches 50%. It is thought that these challenges arise due to the changes occurring in the oropharynx as one advances in age. Other factors that may increase the risk include cerebral palsy, stroke and dementia among others.
One of the interventions that have been shown to lower the risk of aspirating is a change in feeding posture. The position that is chosen should be less than 90 degrees from the horizontal plane. There is a need for the caregiver and the patient to be taken through maneuvers that can be adopted to reduce this risk as much as possible. Several sessions of training are typically needed.
The numerous medications that are prescribed for this group of patients may in some cases inhibit the swallowing reflex. For this reason all drugs need to be carefully considered with regard to their effect on swallowing. Other interventions that may be undertaken include dietary modification, administration of medications to reduce gastric acid secretion (proton pump inhibitors) and to minimize the secretions by giving drugs such as angiotensin converting enzymes.
Most of the elderly patients undergoing long term care also suffer a suppression in their oral functions. This is mainly due to their depressed level of consciousness. The cavity is initially abnormally dry resulting in reflex production of mucosal secretions and saliva. The secretions get mixed up with solid residuals that have not been cleared and form a sticky paste which adheres on mucosal surfaces and the teeth.
With self-cleaning mechanisms of the oral cavity suppressed, there is a need to artificially remove this sticky paste from the cavity. If this is not done, the area will be colonized by harmful bacteria that can easily cause upper respiratory tract infections and aspiration pneumonia. Gram negative bacteria are the most commonly isolated organisms in such settings. Even if overt aspiration does not occur, silent aspiration of microorganisms may cause pneumonia.
Good oral hygiene among elderly patients on long term nursing care is an important step in not only lowering the risk of aspiration but also preventing local and systemic complications. Some of these complications include abscess formation infective endocarditis. The poor hygiene in this group of patients is due to a number of factors. Eliminating as many of them as possible significantly reduces the possible risks.
It has been established that the risk for aspiration among patients on long term care is markedly increased if there is a concomitant disease in the cavity. Examples of these diseases and medical conditions include periodontal diseases and dental caries. Other conditions that may worsen the situation include the existence of swallowing difficulties, inability to feed and poor motor coordination. The elderly are at a higher risk of suffering from this conditions than the general population.
Findings from various studies show that approximately 15% of adults within the general population have difficulties in swallowing. This problem appears to worsen with advancing age such that among those aged above 80 years, the proportion approaches 50%. It is thought that these challenges arise due to the changes occurring in the oropharynx as one advances in age. Other factors that may increase the risk include cerebral palsy, stroke and dementia among others.
One of the interventions that have been shown to lower the risk of aspirating is a change in feeding posture. The position that is chosen should be less than 90 degrees from the horizontal plane. There is a need for the caregiver and the patient to be taken through maneuvers that can be adopted to reduce this risk as much as possible. Several sessions of training are typically needed.
The numerous medications that are prescribed for this group of patients may in some cases inhibit the swallowing reflex. For this reason all drugs need to be carefully considered with regard to their effect on swallowing. Other interventions that may be undertaken include dietary modification, administration of medications to reduce gastric acid secretion (proton pump inhibitors) and to minimize the secretions by giving drugs such as angiotensin converting enzymes.
Most of the elderly patients undergoing long term care also suffer a suppression in their oral functions. This is mainly due to their depressed level of consciousness. The cavity is initially abnormally dry resulting in reflex production of mucosal secretions and saliva. The secretions get mixed up with solid residuals that have not been cleared and form a sticky paste which adheres on mucosal surfaces and the teeth.
With self-cleaning mechanisms of the oral cavity suppressed, there is a need to artificially remove this sticky paste from the cavity. If this is not done, the area will be colonized by harmful bacteria that can easily cause upper respiratory tract infections and aspiration pneumonia. Gram negative bacteria are the most commonly isolated organisms in such settings. Even if overt aspiration does not occur, silent aspiration of microorganisms may cause pneumonia.
Good oral hygiene among elderly patients on long term nursing care is an important step in not only lowering the risk of aspiration but also preventing local and systemic complications. Some of these complications include abscess formation infective endocarditis. The poor hygiene in this group of patients is due to a number of factors. Eliminating as many of them as possible significantly reduces the possible risks.
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