Reducing the Risk of Aspiration Pneumonia
Reducing the Risk of Aspiration Pneumonia among Elderly Patients in Long-Term Care Facilities through Oral Health Interventions Aspiration Pneumonia (AP) is a major reason for admission to the hospital from nursing homes and the second most common type of nosocomial infection in hospitalized patients. AP is also the leading cause of death with the risk for AP increasing with age and the presence of dysphagia.
Researchers have found poor oral health to be among the most common risk factors of AP in nursing homes. In fact, the only two risk factors to show significant associations with AP were difficulty swallowing and poor oral care.
Recent studies have demonstrated that microbacterium and fungi present in plaque of patients with poor oral hygiene can also be found in lung aspirates of patients with AP. These organisms are associated with poor oral hygiene practices in residents of LTC facilities in both edentulous and non-edentulous residents.
Based on these findings, recommendations were made to provide optimal oral health care to the elderly in long term care facilities (LTC) by assessing the patient upon admission, communicating oral health findings to other health care providers to establish potential risks for AP and to develop and maintain individualized health care plans to reduce risks for AP.
Despite mandates by the federal and state governments for requirements of oral examinations upon admission to the LTC, residents in 20% of nursing homes did not have access to dental care of which the majority of these facilities lacking in the provision of care were government facilities.
Some of these recommendations are to have oral care performed at least twice per day after meals (breakfast and dinner), use of flossing, interdental cleaners or waterpiks and to be assisted by a caregiver if self-care is not possible. Regardless of the presence or absence of teeth, cleaning of the oral mucosa is recommended, particularly for dependent residents. Prostheses, if present, should be removed and the oral mucosa cleaned thoroughly with gauze soaked in saline or chlorhexidine, .12%. Use of flouride mouthwash, gels and varnishes may be used in residents with past histories of dental decay. Dentures should be removed at bedtime, cleaned and soaked in denture-cleaning solution.
The conclusion of these recommendations is that good oral hygiene can prevent AP. Complete recommendations may be found online at:
http://www.jamda.com/article/S1525-8610(07)00443-4/fulltext
About the Author
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.
