Association of oral hypofunction with aspiration pneumonia, fractures, and mortality in older Japanese adults.

AIM: In Japan's public health system, dentists can assess and intervene in oral hypofunction cases. However, the associations between oral hypofunction and health outcomes and costs remain unclear. This study aimed to identify these associations. METHODS: This retrospective cohort study using a Japanese health insurance claims database included 45 916 individuals aged ≥65 years who underwent dental examinations for oral hypofunction. The primary outcomes were incidence rates of aspiration pneumonia, femoral or vertebral fractures and all-cause mortality. Secondary outcomes were annual medical and dental costs. We used competing risk regression and Cox models to estimate primary outcomes, and gamma regression models for secondary outcomes. RESULTS: The adjusted hazard ratios were 0.84 (95% CI 0.74-0.96) for the incidence of aspiration pneumonia, 1.11 (1.02-1.21) for the incidence of femoral or vertebral fractures and 1.27 (1.07-1.50) for all-cause mortality in individuals with oral hypofunction compared with those without. The adjusted relative risk was 1.05 (1.01-1.10) for annual medical costs and 0.94 (0.81-1.09) for annual dental costs in individuals with oral hypofunction compared with those without. CONCLUSIONS: Individuals with oral hypofunction were at increased risk of femoral or vertebral fractures and all-cause mortality, and they incurred significantly higher annual medical costs, compared with those without this condition. Notably, they showed a lower risk of aspiration pneumonia, suggesting potential benefits of dental intervention. Integrating dental care into medical strategies might be necessary to improve health outcomes and reduce healthcare costs for those with oral hypofunction. Geriatr Gerontol Int 2024; ••: ••-••.

Risk of aspiration pneumonia and hospital mortality in Parkinson disease: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: This study was undertaken to conduct a meta-analysis on the prevalence of aspiration pneumonia (AP) and hospital mortality in Parkinson disease (PD) as well as the risk of AP in PD patients compared to controls. METHODS: We searched MEDLINE and Embase from inception to 19 March 2024 to identify cross-sectional, cohort, and case-control studies comparing the frequency of AP and hospital mortality in PD patients. We computed risk ratios (RRs) with accompanying 95% confidence intervals (CIs) for each study and pooled the results using a random-effects meta-analysis. RESULTS: A total of 781 studies were initially screened, and 13 studies involving 541,785,587 patients were included. Patients with PD had >3 times higher risk of AP compared to controls (RR = 3.30, 95% CI = 1.82-6.00, p < 0.0001). This increased risk was similar in both cohort studies (RR = 3.01, 95% CI = 1.10-8.24, p = 0.03) and case-control studies (RR = 3.86, 95% CI = 3.84-3.87, p < 0.00001). The prevalence of AP in 12 studies was 2.74% (95% CI = 1.69-4.41), and hospital mortality was 10% in six studies (10.0%, 95% CI = 5.32-18.0). Prevalence of AP was higher in studies with smaller sample size (5.26%, 95% CI = 3.08-8.83 vs. 2.06%, 95% CI = 1.19-3.55, p = 0.02). CONCLUSIONS: Our meta-analysis showed that patients with PD had >3 times higher risk of AP, with an average 2.74% prevalence and 10.0% hospital mortality. Early recognition and treatment of AP in PD patients will help reduce morbidity and mortality. A multidisciplinary holistic approach is needed to address the multifactorial causes of AP.

Complications in Intracranial Surgery of Companion Animals.

The most common complications of intracranial surgery in companion animals chiefly consist of brain swelling, hemorrhage, seizures, and worsening of neurologic status, aspiration pneumonia, and anesthetic death. Further dividing these into intraoperative and postoperative complications, postoperative are more common. Preventative measures can include careful surgical planning, cerebro-protective anesthetic regimes, seizure prophylaxis, and postoperative sedation/pain management that allows for an early return to function and ambulation and an adequate and accelerated nutrition.

Suspected acute respiratory distress syndrome secondary to laundry detergent pod aspiration in a dog.

OBJECTIVE: To describe the successful management of a pediatric canine with acute respiratory distress syndrome secondary to detergent aspiration. ANIMAL: An 11-week-old female Pembroke Welsh Corgi. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The dog was referred for treatment of respiratory distress secondary to aspiration and ingestion of an unquantifiable amount of detergent from a laundry detergent pod. The dog presented dyspneic, cyanotic, and too weak to stand. Thoracic auscultation revealed increased bronchovesicular sounds bilaterally, without crackles or wheezes. TREATMENT AND OUTCOME: The dog required intubation and mechanical ventilation for 5 days. During hospitalization, the dog developed severe pulmonary edema, hypotension, seizures, and inappropriate mentation. Case management additionally included placement of a nasogastric tube and urinary catheter, nebulization, telemetry, and supportive medications. After 12 days of hospitalization, the dog was discharged. Follow-up examinations were performed weekly for 5 weeks following discharge. There was significant improvement noted on thoracic radiographs and complete resolution of respiratory signs. CLINICAL RELEVANCE: To the authors' knowledge, this is the first report to describe successful treatment with mechanical ventilation for clinical signs associated with detergent aspiration in a canine.

Aspiration pneumonia in nursing literature-a mapping review.

Introduction: Aspiration pneumonia (AP) is an infection of the lungs caused by inhalation of material. The reported incidences vary across literature and clinical populations and is associated with high morbidity and mortality. Management of AP is best carried out by a multidisciplinary team. Methods: This aim of this review was to collate and describe the available evidence on AP to develop a greater understanding of the concept of AP as it is represented in the nursing literature. As a collaborative team, we undertook the six stages of a systematic mapping review. We searched for the term aspiration pneumonia in 200 peer reviewed nursing journals across 10 databases, over a ten-year period (2013-2023). Results: In this review, 293 papers were coded. Dysphagia, oral health and tube feeding emerged as the most frequent risk factors for AP, and the most reported factors for preventing this condition. Mortality was the most commonly described consequence of AP, followed by hospitalisations and morbidity. Multiple management approaches were reported including dysphagia assessment, risk evaluation, oral care and texture modification of food and fluids. The role of nurses and interprofessional collaborations were described. Discussion: Despite limited evidence related to the topic of AP in the nursing literature, the complexity of the causes, prevention, management and consequences of AP emerged. Certain factors, such as dysphagia, oral health, and tube feeding, were described under prevention, cause and management of AP. The importance of multidisciplinary approach in the management and prevention of AP was presented.

Efficacy of an Aspiration Prevention Program That Utilizes the Gugging Swallowing Screen in Older Patients.

Purpose: Older patients have a higher risk of aspiration pneumonia and mortality if they are hospitalized. We aimed to assess the effectiveness of an aspiration prevention quality improvement (QI) program that utilizes the Gugging Swallowing Screen (GUSS) in older patients. Patients and Methods: This retrospective cohort study was conducted in an acute medical care unit of a tertiary hospital in South Korea. The study used one-to-one propensity matching and included 96 patients who received the QI program and 96 who did not. All patients were aged 65 years or older and had risk factors for aspiration, including neurological and non-neurological disorders, neuromuscular disorders, impaired airway defenses, and dysphagia due to esophageal or gastrointestinal disorders. The primary outcomes included the duration of the fasting period during hospitalization, changes in nutritional status before admission and at discharge, in-hospital mortality, and readmission due to pneumonia within 90 days. Results: Fasting period, changes in weight and albumin levels upon discharge after hospitalization, and length of stay did not differ significantly between patients in the GUSS and non-GUSS groups. However, the risk of readmission within 90 days was significantly lower in patients who underwent the GUSS than in those who did not (hazard ratio, 0.085; 95% confidence interval, 0.025-0.290; p = 0.001). Conclusion: The GUSS aspiration prevention program effectively prevented readmission due to pneumonia within 90 days in older patients with acute illnesses. This implies that the adoption of efficient aspiration prevention methods in older patients with acute illnesses could play a pivotal role by enhancing patient outcomes and potentially mitigating the healthcare costs linked to readmissions.

Aspiration pneumonia after SARS-CoV-2 Omicron infection frequently induced physical functional decline in Japan.

Introduction. Nursing and healthcare-associated pneumonia (NHCAP) mainly occurs in older people whose physical functions have declined, and it is the most common type of pneumonia in Japan, a super-ageing society. In older people who meet NHCAP criteria, respiratory tract infections are often accompanied by aspiration pneumonia.Gap statement. The SARS-CoV-2 Omicron variant frequently causes aspiration pneumonia and has induced a decline in physical function.Aim. To clarify functional outcomes at 1 year after hospital discharge in SARS-CoV-2 Omicron-related NHCAP cases.Methodology. We compared the functional outcomes between 259 patients with primary SARS-CoV-2 pneumonia and 223 patients with aspiration pneumonia.Results. Functional decline rates for calculating the Barthel index at the time of hospital discharge were higher in the aspiration pneumonia group than the primary SARS-CoV-2 pneumonia group [114 patients (51.6%) vs 70 patients (27.0%), P<0.0001]. Of 114 patients with aspiration pneumonia who had a decline in physical function at the time of hospital discharge, 91 (79.8%) still showed functional decline 1 year later. In contrast, 9.3% of patients had functional decline at 1 year after hospital discharge in the primary SARS-CoV-2 pneumonia group, which was significantly lower than in the aspiration pneumonia group.Conclusions. The Omicron variant showed decreased infectivity in the lungs and was less pathogenic compared with the Delta and former variants. However, physicians should recommend SARS-CoV-2 vaccination and non-pharmaceutical interventions, depending on the presence or absence of applicable criteria for NHCAP, even when the predominant strain is the Omicron variant.

Association between self-reported difficulty in chewing or swallowing and frailty in older adults: A retrospective cohort study.

Oral frailty can contribute to physical and mental health disorders. Previous research has shown an association between frailty and self-reported difficulty in chewing or swallowing. However, their combined assessment has obscured their specific impact on frailty-related outcomes. To investigate the independent associations between difficulty in chewing or swallowing and 1-year frailty outcomes, while also examining their interactions. This retrospective cohort study utilized the DeSC database to identify older adults aged ≥ 75 years who underwent health checkups between April 2014 and November 2022. Multivariate Cox regression analyses were conducted to assess the association between self-reported difficulty in chewing or swallowing and outcomes, including hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality within 1 year. Interactions between chewing and swallowing difficulties were also evaluated. Among 359,111 older adults, 39.0% reported oral function difficulties. Swallowing difficulty alone lacked significant outcome association. However, chewing difficulty alone was significantly associated with higher risks of hospitalization due to aspiration pneumonia (hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.15-1.58; P < 0.001), all-cause hospitalization (HR, 1.08; 95% CI, 1.05-1.11; P < 0.001), and all-cause mortality (HR, 1.28; 95% CI, 1.14-1.44; P < 0.001) compared with no self-reported difficulty. A significant positive interaction between self-reported difficulty in chewing and swallowing was observed for all-cause mortality (P = 0.009). Self-reported difficulty in chewing was significantly associated with higher risks of hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality among older adults. Chewing and swallowing difficulties showed a synergistic effect, significantly increasing all-cause mortality risk.

Complexities in diesel oil inhalation: case study of respiratory injury and coagulation anomalies.

Diesel inhalation poisoning represents a rare yet critical medical condition necessitating prompt medical attention due to its potential to induce severe respiratory distress and coagulation dysfunction. The present case study describes the distinctive clinical presentation of a male patient in his early 40s who experienced acute respiratory distress and manifested coagulation factor VII deficiency subsequent to unintentional inhalation of diesel oil during engine repair. The patient demonstrated symptoms including chest tightness and dyspnea, indicative of chemical aspiration pneumonia, alongside an unforeseen coagulation abnormality. Treatment involved rigorous intervention, comprising endotracheal intubation, mechanical ventilation, and administration of pharmacotherapy, including ambroxol, dihydroxypropylline, and methylprednisolone. Moreover, procedural measures, such as repeated bronchoscopic alveolar lavage, pathogen culture, and targeted antibiotic therapy, were employed to mitigate respiratory complications. The patient's clotting disorder was treated with blood transfusions, and he was discharged with improvement. The present case highlights the imperative nature of immediate medical intervention in instances of diesel inhalation to avert further clinical deterioration and unfavorable outcomes. Additionally, it underscores the necessity for expanded research endeavors aimed at elucidating the indirect repercussions of diesel inhalation on the coagulation cascade, an area that remains relatively underexplored within the medical literature.

Impact of the quantity and quality of erector spinae muscles on the short-term prognosis of elderly patients with aspiration pneumonia in Japan.

BACKGROUND: Whether muscle mass and muscle quality affect the prognosis of elderly patients with aspiration pneumonia is unclear. This study aimed to evaluate the relationship between erector spinae muscle mass and muscle quality on the 30-day prognosis of elderly patients with aspiration pneumonia. METHODS: Two hundred fifty-eight patients who were diagnosed with aspiration pneumonia and admitted to Sanuki Municipal Hospital for pulmonary rehabilitation intervention were included. The cross-sectional area (ESMCSA/BSA) and CT values (ESMCT) of the erector spinae muscles at the 12th thoracic vertebra were measured on chest CT images to represent muscle mass and quality, respectively. The primary outcome was defined as 30-day survival. RESULTS: Twenty-six patients died within 30 days after hospitalization. The ESMCSA/BSA ratio was significantly greater in the survival group than in the nonsurvival group (p = 0.001). The cutoff values for 30-day survival were calculated as follows: the ESMCSA/BSA was 11.046 cm2/m2 in male patients and 9.600 cm2/m2 in female patients; the ESMCT was 26.85 HU in male patients and 8.00 HU in female patients. A higher ESMCSA/BSA significantly improved 30-day survival, while ESMCT did not show a significant difference. Cox proportional hazards regression analysis revealed that the ESMCSA/BSA was independently associated with 30-day short-term prognosis (hazard ratio 0.34, p = 0.034). CONCLUSION: The short-term prognosis of elderly patients with aspiration pneumonia may be more strongly influenced by muscle mass than by the muscle quality of the erector spinae muscles.

Impact of Cilostazol Administration on Prevention of Aspiration Pneumonia in Patients With Chronic Limb-Threatening Ischemia.

Background: Cilostazol has reported effectiveness for preventing aspiration pneumonia in patients with ischemic stroke, but whether it is similarly beneficial for patients with chronic limb-threatening ischemia (CLTI) is unclear. Methods and Results: This retrospective single-center study enrolled 1,368 CLTI patients treated with endovascular therapy (EVT). In the multivariate analysis, predictors for aspiration pneumonia were age (hazard ratio [HR] 1.06 [95% confidence interval (CI) 1.03-1.10]), non-ambulatory status (HR 2.54 [95% CI 1.38-4.65]), the Geriatric Nutritional Risk Index (HR 0.97 [95% CI 0.95-0.99]), and cilostazol (HR 0.37 [95% CI 0.16-0.87]). Conclusions: Cilostazol administration reduced the risk of aspiration pneumonia in patients with CLTI undergoing EVT.

Association between new insertion of a long-term enteral feeding tube and mortality in adults admitted to the hospital with aspiration: A retrospective cohort study.

BACKGROUND: We aimed to describe the association between insertion of a new long-term enteral feeding tube during admission for aspiration and in-hospital mortality. METHODS: This retrospective cohort study across 28 Canadian hospitals from 2015 to 2022 included consecutive patients who were admitted for aspiration. Patients were categorized based on new long-term enteral feeding tube insertion during hospital stay or not. The primary outcome was the time to death in hospital. Secondary outcomes included time to discharge alive and hospital readmission for aspiration within 90 days. We used propensity score weighting to balance covariates, and a competing risk model to describe in-hospital death and discharge. RESULTS: Of 12,850 patients admitted for aspiration, 852 (6.6%) patients received a long-term enteral feeding tube. In the hospital, 184 (21.6%) and 2489 (20.8%) patients in the enteral feeding tube group and no enteral feeding tube group died, respectively. Within 90 days of discharge, 127 (14.9%) and 1148 (9.6%) patients in the enteral feeding tube and no enteral feeding tube group were readmitted for aspiration, respectively. After balancing covariates, an enteral feeding tube was associated with a similar in-hospital mortality risk (subdistribution hazard ratio [sHR] = 1.05, 95% CI = 0.89-1.23; P = 0.5800), longer time to discharge alive (sHR = 0.58, 95% CI = 0.54-0.63; P < 0.0001), and a higher risk of readmission (risk difference = 5.0%, 95% CI = 2.4%-7.6%; P = 0.0001). CONCLUSION: Initiation of long-term enteral tube feeding was not uncommon after admission for aspiration and was not associated with an improvement in the probability of being discharged alive from the hospital or readmitted for aspiration.

Severe aspiration pneumonia in the elderly.

The global population is aging at an unprecedented rate, resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities. In this context, severe aspiration pneumonia, a condition that carries substantial morbidity, mortality, and financial burden, especially among elderly patients requiring admission to the intensive care unit, has attracted greater concern. Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology. Prior episodes of coughing on food or liquid intake, a history of relevant underlying conditions, abnormalities on videofluoroscopy or water swallowing, and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration. Patients with aspiration pneumonia tend to be elderly, frail, and suffering from more comorbidities than those without this condition. Here, we comprehensively address the epidemiology, clinical characteristics, diagnosis, treatment, prevention, and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic, enhance outcomes, and minimize the healthcare costs associated with this illness. Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.

Does atrial fibrillation occur exclusively in the elderly?

Although atrial fibrillation is a prevalent condition, it is crucial to recognize that it can be effectively addressed by identifying the underlying disease and not merely assuming that it is caused by aging.

Nil per os in the management of oropharyngeal dysphagia-exploring the unintended consequences.

Nil per os (NPO), also referred to as Nil by Mouth (NBM), is a health-related intervention of withholding food and fluids. When implemented in the context of a person with dysphagia, NPO aims to mitigate risks of aspiration. However, evidence demonstrating that NPO is beneficial as an intervention for people with dysphagia is lacking. This paper explores the theoretical and empirical evidence relating to the potential benefits and adverse effects of NPO and asserts that NPO is not a benign intervention. This paper argues for applying an ethics framework when making decisions relating to the use of NPO as an intervention for dysphagia, in particular addressing informed consent and a person's right to self-determination.

Malignant tracheoesophageal fistula treated with septal occluder device.

Septal occluder devices can be used with palliative intent to close tracheoesophageal fistulas and improve the quality of life of patients.

Linking the impact of aspiration to host variables using the BOLUS framework: support from a rapid review.

Purpose: The purpose of this rapid review was to identify the level of evidence for a previously proposed theoretical framework to assess risks associated with prandial aspiration using the host as a central theme. Methods: Covidence software was used to search two databases (PubMed and Web of Science). PEDro scale was utilized to determine the quality of individual studies. Data points were evaluated for level of support and determined to be either conclusive, suggestive, unclear, or not supportive. Within each component of the framework, data points were clustered to determine the level of evidence as strong, moderate, insufficient, or negative. Results: The rapid review process resulted in a limited number of publications investigating host variables impact on outcomes for patients with swallowing disorders. Overall, it yielded 937 articles, of which, upon review, 16 articles were selected for data extraction. There was a strong level of evidence to support that (a) as viscosity and density of aspirate increased, so did the likelihood of general medical complications, (b) poor oral care and oral health increase the risk of a pulmonary or general medical complication, and (c) the presence of oropharyngeal or laryngeal tubes increases the risk of a pulmonary consequence. There was moderate evidence to support the impact of amount and frequency of aspiration on outcomes. There was insufficient evidence to determine relationships for all other aspects of the BOLUS framework. Conclusion: Additional evidence to support the BOLUS framework was obtained; however, the number of studies was limited. A more thorough review such as a systematic review should be employed.

Sealing the Breach: A Surgical Solution for Tracheoesophageal Fistula With a Simple Two-Layer Closure.

Tracheoesophageal puncture (TEP) followed by voice prosthesis placement stands as the primary method for voice rehabilitation after laryngectomy, heralded for its effectiveness. While generally well-tolerated, the procedure does pose potential long-term complications. These include prosthesis valve leakage, scarring, and prosthesis displacement, all of which can impede phonation capabilities. Of these, prosthesis leakage emerges as the most critical concern, precipitated by the progressive widening of the fistula. This complication can precipitate aspiration pneumonitis, stemming from the loss of physical separation between the esophagus and trachea. This case series details three instances where persistent tracheoesophageal fistula arose following TEP, necessitating surgical intervention. Herein, we present the clinical manifestations, surgical approach employing a simple two-layer closure, and ensuing outcomes.

Pharyngeal Residues Following Swallowing of Pureed Diets Thickened with a Gelling Agent or a Xanthan Gum-Based Thickener in Elderly Patients with Dysphagia.

The ideal texture of pureed diets to prevent aspiration pneumonia remains unclear. The aim of this study was to evaluate the effectiveness of a pureed diet with either a gelling agent or a xanthan gum-based thickener to prevent pharyngeal residues in patients with dysphagia. We retrospectively analyzed a randomized, crossover trial of pureed rice with either a gelling agent or a xanthan gum-based thickener in patients with dysphagia. The enrolled patients were classified into mild and moderate-to-severe dysphagia groups. The primary outcome measure was degree of need for cyclic ingestion using test jelly for pharyngeal residuals (cyclic ingestion score). The secondary outcome was the patient's sense of material remaining in the throat following swallowing. Sixty-two patients (58% men; mean age 83 ± 9 years) with dysphagia were included. They were classified into mild dysphagia (n = 26) and moderate-to-severe dysphagia (n = 36) groups. In the moderate-to-severe dysphagia group, pharyngeal residuals were significantly less likely with pureed diets using a gelling agent than with those using a xanthan gum-based thickener, with respective median cyclic ingestion scores (range) of 1 (0-4) vs. 2.5 (0-4) (p = 0.001). There was no significant difference in pharyngeal residuals between the pureed diets in the mild dysphagia group. The multivariate analysis identified gelling agent as an important factor significantly associated with less pharyngeal residual after swallowing of pureed diet in patients with moderate-to-severe dysphagia. Pureed diets thickened by a gelling agent decrease pharyngeal residues in patients with moderate-to-severe dysphagia and may reduce risk of aspiration pneumonia.