Food bolus‐forming ability predicts incidence of aspiration pneumonia in nursing home older adults: A prospective observational study

Abstract

Background Food boluses in the pharynx without enough bolus formation sometimes cause aspiration among older adults; however, the relationship between food bolus‐forming ability and incidence of aspiration pneumonia is unclear. Objective To investigate the relationship between food bolus‐forming ability and incidence of aspiration pneumonia by evaluating the condition of chew‐swallow managing food transported into the pharynx. Methods A prospective observational study conducted in a nursing home for the elderly between April 2016 and February 2018. Seventy‐three residents who swallowed thickened liquids and consistent boluses without aspiration were included. Food boluses were graded into three categories in the pharynx using videoendoscopic evaluation. Boluses that retained their original shape were defined as Grade 1. A mixture of large and small boluses was defined as Grade 2. Boluses that had completely transformed into a paste were defined as Grade 3. The relationship between the bolus formation grade and incidence of aspiration pneumonia over 6‐month follow‐up was investigated. Results Seventeen residents developed aspiration pneumonia. The incidence rate of aspiration pneumonia was highest among residents with Grade 1 boluses, at an incidence rate of .187 cases per person‐month (95% confidence interval (CI): 0.097‐0.359). Cox regression showed residents with Grade 1 boluses had a hazard ratio of 4.548 (1.393‐14.85) for incidence of aspiration pneumonia compared with residents who had Grade 2 or 3 boluses. Conclusion Insufficient food bolus‐forming ability predicted high incidence of aspiration pneumonia. Healthcare professionals should evaluate the food bolus‐forming ability, as well as swallowing function, to prevent aspiration pneumonia.

Characteristic Factors of Aspiration Pneumonia to Distinguish from Community-Acquired Pneumonia among Oldest-Old Patients in Primary-Care Settings of Japan

“…However, in the present study, witnessed meal dysphagia was reported by family members and caregivers in patients with AsP, whereas meal dysphagia was not reported for any patients with CAP. Meal dysphagia is influenced by a decreased food bolus-forming ability [ 41 ]. Insufficient food-bolus formation and chewing owing to missing teeth, as well as deterioration in tongue movements, increase the risk of aspiration [ 41 , 42 , 43 ].…”

“…Meal dysphagia is influenced by a decreased food bolus-forming ability [ 41 ]. Insufficient food-bolus formation and chewing owing to missing teeth, as well as deterioration in tongue movements, increase the risk of aspiration [ 41 , 42 , 43 ]. In Japan, older adults who live in nursing homes receive 24-h supervision by caregivers.…”

Risk Factors for Aspiration Pneumonia among Elderly Patients in a Community-Based Integrated Care Unit: A Retrospective Cohort Study

“…Further, it has been reported that 71% of elderly patients with pneumonia develop silent aspiration while sleeping [ 6 ], and the main cause of aspiration pneumonia in older patients is thought to be silent aspiration of oral bacteria [ 7 ]. Risk factors for the incidence of aspiration pneumonia include cognitive decline [ 8 ], dysphagia [ 9 ], failure to use dentures [ 10 ], the motor component of the Functional Independence Measure (FIM) score [ 11 ], poor nutritional status [ 12 ], poor oral environment [ 13 ], reduced chewing ability [ 14 ], low albumin level [ 15 ], and tube feeding [ 16 ]. These factors increase the amount of aspiration and oral bacteria and decrease resistance to invasion.…”

Prosthetic rehabilitation status, dental prosthesis functionality and masticatory function in nursing home residents

“…Missing teeth, especially premolars and molars, cause major chewing difficulty 4 . In older people, poor masticatory function can lead to adverse health outcomes 5‐10 . Accordingly, missing teeth should be replaced by dental prostheses.…”

“…4 In older people, poor masticatory function can lead to adverse health outcomes. [5][6][7][8][9][10] Accordingly, missing teeth should be replaced by dental prostheses.…”