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.
The main factors that have been found to increase the risk of suffering the condition among patients in long term care include difficulty in swallowing (dysphagia), the use of certain medications among these patients and poor oral hygiene. Addressing these factors significantly helps to minimize the risk and reduce the morbidity associated with aspiration that include pneumonia, pneumonitis, abscess formation and obstruction. Pneumonia is likely to be encountered if the aspirated contents contain bacterial organisms.
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.
Poor oral hygiene has been demonstrated in a majority of patients on long term care. As a matter of fact, statistics indicate that close to 70% of them have not been examined by a dentist in five years. The poor state of oral hygiene is a major contributor of aspiration. One of the major challenges that exist is that many of these patients cannot clean their own teeth. They need to be assisted on a regular basis but this assistance is often lacking.
Most patients that are on long term care receive multiple drugs. Some of these medications grossly inhibit the swallowing function. Healthcare providers need to consider all the drugs that are given and whenever possible replace those that are likely to predispose to aspiration. Examples of medications that are known to increase the risk include proton pump inhibitors, sedatives, hypnotics, muscle relaxants and antiemetics.
There are a number of drugs that can be used to reduce the chance of aspirating gastric or oropharyngeal contents. One of the drugs that has been shown to be beneficial is the drug levodopa. This drug works by increasing the levels of dopamine, an important chemical in the swallowing function (maintains the tome in muscles used for swallowing). Enalapril and other angiotensin converting enzyme inhibitor drugs also reduce the risk due to their ability to reduce oral secretions.
Aspiration pneumonia is potentially life-threatening if timely intervention is not undertaken. While there are treatments available, the major focus should be on prevention. A multi-disciplinary team that includes swallowing and speech therapists, physicians, physiotherapists and the nursing team should be involved in the management to reduce the risk of this condition.
The main factors that have been found to increase the risk of suffering the condition among patients in long term care include difficulty in swallowing (dysphagia), the use of certain medications among these patients and poor oral hygiene. Addressing these factors significantly helps to minimize the risk and reduce the morbidity associated with aspiration that include pneumonia, pneumonitis, abscess formation and obstruction. Pneumonia is likely to be encountered if the aspirated contents contain bacterial organisms.
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.
Poor oral hygiene has been demonstrated in a majority of patients on long term care. As a matter of fact, statistics indicate that close to 70% of them have not been examined by a dentist in five years. The poor state of oral hygiene is a major contributor of aspiration. One of the major challenges that exist is that many of these patients cannot clean their own teeth. They need to be assisted on a regular basis but this assistance is often lacking.
Most patients that are on long term care receive multiple drugs. Some of these medications grossly inhibit the swallowing function. Healthcare providers need to consider all the drugs that are given and whenever possible replace those that are likely to predispose to aspiration. Examples of medications that are known to increase the risk include proton pump inhibitors, sedatives, hypnotics, muscle relaxants and antiemetics.
There are a number of drugs that can be used to reduce the chance of aspirating gastric or oropharyngeal contents. One of the drugs that has been shown to be beneficial is the drug levodopa. This drug works by increasing the levels of dopamine, an important chemical in the swallowing function (maintains the tome in muscles used for swallowing). Enalapril and other angiotensin converting enzyme inhibitor drugs also reduce the risk due to their ability to reduce oral secretions.
Aspiration pneumonia is potentially life-threatening if timely intervention is not undertaken. While there are treatments available, the major focus should be on prevention. A multi-disciplinary team that includes swallowing and speech therapists, physicians, physiotherapists and the nursing team should be involved in the management to reduce the risk of this condition.
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