Comprehensive Approaches to Aspiration Pneumonia and Dysphagia in the Elderly on the Disease Time-Axis

Abstract

Pneumonia in the elderly has been increasing on an annual basis. To a greater or lesser extent, aspiration is a major contributor to the development of pneumonia in the elderly. Antimicrobials alone are not sufficient for the treatment of pneumonia, and the condition may become intractable or even recur repeatedly. In addition, some patients with pneumonia may have no problems with eating, while others are unable to receive the necessary nutrition due to severe dysphagia. It has recently been found that pneumonia decreases both the muscle mass and strength of the swallowing and respiratory muscles, a condition named pneumonia-associated sarcopenia. This contributes to a pathophysiological time-axis of aspiration pneumonia and dysphagia in the elderly, in which silent aspiration leads to the development of pneumonia, and further to dysphagia, malnutrition, and low immunity. Therefore, it is recommended that the treatment and prevention of developing pneumonia should also differ according to an individual’s placement in the disease time-axis. In particular, approaches for preventing aspiration based on scientific findings are able to be implemented at home.

The role of transcranial direct current stimulation in diminishing the risk of pneumonia in patients with dysphagia: A double-blinded randomized clinical trial

“…Therefore, alongside the approaches which we mentioned before, we should consider a comprehensive approach to prevent aspiration at home. 34 …”

“…Some of these techniques are regarding preparing the meals such as: changing the physical properties of the meals under the supervision of swallowing experts which can be done by using thickeners to modify the texture of the diet, 34 , 35 changing the temperature of, and spices in the meals which can stimulate the transient receptor potential (TRP) receptors that have the potential to sharpen the swallowing and cough reflexes. Hot temperatures above 60 ° C have the potential to stimulate TRP vanilloid 1 (TRPV1) receptors and cold temperatures below 17 0 C have the potential to stimulate TRP melastatin 8 (TRPM8) receptors.…”

Impacts of body positions on the geniohyoid muscle contraction and swallowing difficulty in healthy adults

“…From the point of view of the onset of pneumonia, previous studies focused on the effects of body positions on gastroesophageal reflux and subsequent aspiration of stomach contents to the lower airways (Drakulovic et al, 1999 ; Matsui et al, 2002 ). They examined the 30 and 45 degrees semi‐recumbent and sitting positions and recommended 30 degrees or higher semi‐recumbent position for 2 h after eating to prevent pneumonia (Ebihara, 2022 ; Fernandez‐Crehuet et al, 1997 ). Combined with our result for swallowing easiness, 60 degrees or higher semi‐recumbent position may have a better potential.…”

“…Older pneumonia patients often visit hospitals with nonapparent symptoms, such as anorexia and general illness. In addition, their disease condition is often severe (Ebihara, 2022). Thus, the detection of aspiration is important, and prevention is central among management strategies for aspiration pneumonia (Ebihara, 2022; Okazaki et al, 2020).…”

Who treats older patients with aspiration pneumonia?

“…In addition, rehabilitation doctors are familiar with various ways to improve dysphagia. 5,6 Therefore, the study by Nagai et al 3 may suggest that cases of aspiration pneumonia should be primarily treated by the rehabilitation department, particularly those due to sarcopenic dysphagia. If the condition becomes severe, rehabilitation doctors should consult the respiratory medicine or emergency departments.…”