Reducing Aspiration Pneumonia Risk for Older People: Effect of Evidence-Based Oral Care

Abstract Poor oral health increases the risk of aspiration pneumonia for older people. This is due primarily to six pathogens found in the mouth: five bacteria and one fungus. With a cohort of older people who were dependent on others for their oral care, we analyzed the load and type of bacteria and fungi from swabs of cheek, gum, and tongue mucosa. There were no significant differences between the three sites for load of bacteria (H (2) = .89; p = .64); there were significant differences between the sites for type of bacteria (F (2,78) = 11.97; p <.001) with the tongue showing the greatest diversity. There were no significant differences between the three sites for load (H (2) = 2.94; p = .23) or type (F (2,77) = .46; p = .63) of fungi. We then investigated the effect of regular compared to evidence-based oral care over a six-week period, and whether evidence-based oral care could significantly reduce the absolute count of the six oral pathogens specifically related to aspiration pneumonia. Participants self-selected into Regular Care (n = 10) and Evidence-based Care (n = 17) Groups. Evidence-based oral care resulted in significant decreases (p = .02 to p < .001) in the load of four potentially pathogenic bacterial species, including E. coli, gut-based bacteria, and in an increased load of Lactobacillus reuteri, a host-protective normal flora in the mouth, compared to baseline. There were no significant differences between groups for the abundance and type of fungi.

Download Full-text

Oral care after stroke: Where are we now?

European Stroke Journal ◽

10.1177/2396987318775206 ◽

2018 ◽

Vol 3 (4) ◽

pp. 347-354 ◽

Cited By ~ 9

Author(s):

Mary Lyons ◽

Craig Smith ◽

Elizabeth Boaden ◽

Marian C Brady ◽

Paul Brocklehurst ◽

...

Keyword(s):

Aspiration Pneumonia ◽

Best Practice ◽

Clinical Care ◽

Oral Care ◽

Research Priorities ◽

Stroke Care ◽

Weak Evidence ◽

Perspective Drawing ◽

Increased Risk ◽

Risk Of Aspiration

Purpose There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia – a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. Methods A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities. Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. Discussion Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. Conclusion Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.

Download Full-text

Poor oral hygiene, oral microorganisms and aspiration pneumonia risk in older people in residential aged care: a systematic review

Age and Ageing ◽

10.1093/ageing/afaa102 ◽

2020 ◽

Author(s):

Sangeeta Khadka ◽

Shahrukh Khan ◽

Anna King ◽

Lynette R Goldberg ◽

Leonard Crocombe ◽

...

Keyword(s):

Oral Health ◽

Older People ◽

Aspiration Pneumonia ◽

Oral Hygiene ◽

Oral Care ◽

Aged Care ◽

Oral Microbiome ◽

Residential Aged Care ◽

Pathogenic Microorganisms ◽

Oral Microorganisms

Abstract Background aspiration pneumonia increases hospitalisation and mortality of older people in residential aged care. Objectives determine potentially pathogenic microorganisms in oral specimens of older people with aspiration pneumonia and the effect of professional oral care in reducing aspiration pneumonia risk. Data Sources PUBMED/MEDLINE, CINAHL, EMBASE, COCHRANE, PROQUEST, Google Scholar, Web of Science. Study Eligibility Criteria published between January 2001 and December 2019 addressing oral microorganisms, aspiration pneumonia, oral health and treatment. Participants people 60 years and older in residential aged care. Study Appraisal and Synthesis Methods the Newcastle–Ottawa Scale and the Standard Protocol Items: Recommendations for Intervention Trials checklist. Results twelve studies (four cross-sectional, five cohort and three intervention) reported colonisation of the oral cavity of older people by microorganisms commonly associated with respiratory infections. Aspiration pneumonia occurred less in people who received professional oral care compared with no such care. Isolation of Candida albicans, Staphylococcus aureus, methicillin-resistant S. aureus and Pseudomonas aeruginosa was related to mortality due to aspiration pneumonia. An interesting finding was isolation of Escherichia coli, a gut bacterium. Limitations more information may be present in publications about other co-morbidities that did not meet inclusion criteria. A high degree of heterogeneity prevented a meta-analysis. Issues included sampling size, no power and effect size calculations; different oral health assessments; how oral specimens were analysed and how aspiration pneumonia was diagnosed. Conclusions and Implications of Key Findings pathogenic microorganisms colonising the oral microbiome are associated with aspiration pneumonia in older people in residential care; professional oral hygiene care is useful in reducing aspiration pneumonia risk.

Download Full-text

Evidence-based care of older people with suspected cognitive impairment in general practice: protocol for the IRIS cluster randomised trial

Implementation Science ◽

10.1186/1748-5908-8-91 ◽

2013 ◽

Vol 8 (1) ◽

Cited By ~ 5

Author(s):

Joanne E McKenzie ◽

◽

Simon D French ◽

Denise A O’Connor ◽

Duncan S Mortimer ◽

...

Keyword(s):

General Practice ◽

Cognitive Impairment ◽

Older People ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Evidence Based ◽

Cluster Randomised ◽

Evidence Based Care

Download Full-text

Self-harm in older people: a clear need for specialist assessment and care

The British Journal of Psychiatry ◽

10.1192/bjp.bp.111.104109 ◽

2012 ◽

Vol 200 (5) ◽

pp. 356-358 ◽

Cited By ~ 7

Author(s):

Michael S. Dennis ◽

David W. Owens

Keyword(s):

Older Adults ◽

Older People ◽

Evidence Based ◽

Short Term ◽

Younger Adults ◽

Suicide Rates ◽

Self Harm ◽

Evidence Based Care

SummarySuicide rates are generally elevated after episodes of non-fatal self-harm, especially among older adults. Evidence suggests that non-fatal and fatal self-harm are more closely related in older than in younger adults. Older people who have self-harmed need specialist assessment followed by good short-term and long-term evidence-based care.

Download Full-text

Improving acute care for older people at scale – the Acute Frailty Network

Acute Medicine Journal ◽

10.52964/amja.0634 ◽

2016 ◽

Vol 15 (4) ◽

pp. 185-192

Author(s):

Simon Conroy ◽

◽

Deborah Thompson ◽

Simon Griffiths ◽

Matthew Tite ◽

...

Keyword(s):

Older People ◽

Comprehensive Geriatric Assessment ◽

Functional Decline ◽

Urgent Care ◽

Evidence Based ◽

Care Needs ◽

Key Competencies ◽

Evidence Based Care ◽

Care For Older People

Older people form a growing proportion and volume of those accessing urgent care. Non-specific presentations, multiple comorbidities and functional decline make assessment and management of this cohort challenging. Comprehensive Geriatric Assessment offers an evidence based framework to assess and mange older people, especially those with frailty. In this article we describe the CGA approach, underpinned by specific examples illustrating some of the key competencies required, and describe the role of the Acute Frailty Network (AFN). The AFN is a national improvement collaborative designed to support hospitals in delivering evidence based care for older people with frailty and urgent care needs. We describe the principles underlying the approach of the AFN, derived from working with over 20 hospitals, and some of the early successes.

Download Full-text

Interface geriatrics: evidence-based care for frail older people with medical crises

British Journal of Hospital Medicine ◽

10.12968/hmed.2010.71.2.46488 ◽

2010 ◽

Vol 71 (2) ◽

pp. 98-101 ◽

Cited By ~ 10

Author(s):

Simon Conroy ◽

Cassandra Ferguson ◽

James Woodard ◽

Jay Banerjee

Keyword(s):

Older People ◽

Evidence Based ◽

Frail Older People ◽

Evidence Based Care

Download Full-text

Evidence-based care for older people: where are we now and where to in the future?

Speech Language and Hearing ◽

10.1080/2050571x.2018.1538198 ◽

2019 ◽

Vol 22 (1) ◽

pp. 16-24

Author(s):

Michelle Bennett ◽

Jessica Young ◽

Jade Cartwright

Keyword(s):

Older People ◽

Evidence Based ◽

The Future ◽

Evidence Based Care ◽

Care For Older People

Download Full-text

Efektivitas Perawatan Mulut Menggunakan Madu Terhadap Risiko Pneumonia Aspirasi Pada Pasien Stroke Yang Mengalami Penurunan Kesadaran Dan Disfagia

JOURNAL EDUCATIONAL OF NURSING(JEN) ◽

10.37430/jen.v2i2.40 ◽

2019 ◽

Vol 2 (2) ◽

pp. 24-36

Author(s):

Dyah Untari ◽

I made Kariasa ◽

Muhammad Adam

Keyword(s):

Aspiration Pneumonia ◽

Oral Treatment ◽

Oral Care ◽

Intervention Group ◽

Control Group ◽

Loss Of Consciousness ◽

Stroke Patients ◽

Control Group Design ◽

Increased Risk ◽

Risk Of Aspiration

Aspiration pneumonia in patients with stroke can occur as a result of the gram-positive and gram-negative in the oral cavity that spreads to the respiratory tract of patients due to decreased ability to fight bacteria mouth. Selection of materials for oral care need to consider in terms of the material effectiveness, safety, convenience and cost efficiency. This quantitative study using a quasi-experimental design with pre and post test control group design. This research aims to study the effectiveness of oral care using honey to the risk of aspiration pneumonia in stroke patients who suffered loss of consciousness and dysphagia. In this design 46 respondents 23 respondents were divided into intervention group with oral treatments using honey and 23 respondents into a control group who received oral treatment with 0.2% chlorhexidine. Performed oral care performed by a nurse twice a day in the morning and evening for 30 minutes within 3 days sequentially. Results: There are significant relationships in oral care using honey to the risk of aspiration pneumonia in stroke patients who suffered loss of consciousness and dysphagia (p.0,000: α.0,05). The risk of aspiration pneumonia was lower by 2,522 with oral treatments using honey instead of using Clorhexidine 0.2%. Conclusion: Oral care using honey to effectively prevent the increased risk of aspiration pneumonia in pasein stroke decreased consciousness and dysphagia. Suggestion: Oral care with honey can be used as material for oral care, especially in the choice of antiseptic agent as proven in this study honey can maintain and even reduce the risk of aspiration pneumonia in stroke patients with loss of consciousness and dysphagia. This research can be a reference for subsequent research. Keywords: Chlorhexidine 0.2%, Honey, Oral Care, Stroke

Download Full-text