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.
The risk of suffering from aspiration pneumonia is significantly increased in the presence of oral cavity diseases such as dental caries and periodontal disease. This is mainly because of the existence of pockets of infections where bacterial organisms are trapped. Other conditions that are also known to increase this risk include inability to feed, the use of nasogastric tube feeding, swallowing difficulties and poor motor function.
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 most important interventions that should be considered is a change in posture during swallowing. A posture that will reduce the risk of aspiration should be adopted. In general, this should be less than 90 degrees from the horizontal. Additional maneuvers that are aimed at optimizing on this can be taught to both the patient and their caregiver over several sessions.
The patients in long term care typically receive numerous medications for their many medical conditions. Some of these medications have the potential to interfere with the process of swallowing. It is important for the doctor to evaluate the medications and to determine which among them may be causing the problem. As this is being done, drugs that help reduce the amount of secretions and gastric acid production should be included.
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.
The self-cleaning mechanism is ineffective among these patients. The sticky paste that is formed has to be removed through mechanical cleaning. Failure to do this predisposes the patient to infections by varied bacterial organisms which may also spread to the respiratory tract. Even when overt aspiration is not taking place, the bacterial organisms may be aspirated and lead to pneumonia. This is also termed micro-aspiration.
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.
The risk of suffering from aspiration pneumonia is significantly increased in the presence of oral cavity diseases such as dental caries and periodontal disease. This is mainly because of the existence of pockets of infections where bacterial organisms are trapped. Other conditions that are also known to increase this risk include inability to feed, the use of nasogastric tube feeding, swallowing difficulties and poor motor function.
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 most important interventions that should be considered is a change in posture during swallowing. A posture that will reduce the risk of aspiration should be adopted. In general, this should be less than 90 degrees from the horizontal. Additional maneuvers that are aimed at optimizing on this can be taught to both the patient and their caregiver over several sessions.
The patients in long term care typically receive numerous medications for their many medical conditions. Some of these medications have the potential to interfere with the process of swallowing. It is important for the doctor to evaluate the medications and to determine which among them may be causing the problem. As this is being done, drugs that help reduce the amount of secretions and gastric acid production should be included.
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.
The self-cleaning mechanism is ineffective among these patients. The sticky paste that is formed has to be removed through mechanical cleaning. Failure to do this predisposes the patient to infections by varied bacterial organisms which may also spread to the respiratory tract. Even when overt aspiration is not taking place, the bacterial organisms may be aspirated and lead to pneumonia. This is also termed micro-aspiration.
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.
About the Author:
The following article explains about the effectiveness of oral care and aspiration pneumonia prevention. To read the informative post now, check out the blog at http://www.swallowstudy.com.
No comments:
Post a Comment