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Elderly Patients Are At Higher Risk For Developing Aspiration Pneumonia When Facilities Fail To Account For Patient Needs

Picture-105I’m not sure if it’s matter of inadequate staff training or simply a manifestation of inadequate staffing levels to meet patients needs, but the number if cases involving aspiration pneumonia is on the rise.

Aspiration pneumonia occurs when you aspirate foreign matter (usually food or vomit) into your lungs. Elderly adults are particularly susceptible to aspiration pneumonia because they are more likely to suffer from predisposing factors (including illness or disease that compromises the ability to swallow) or they might be too weak to cough, which can let foreign material enter the windpipe, allowing bacteria to enter the lungs. This can result in severe lung infections, which can require hospitalization, especially in older adults who are already weak because of age, illness, or disease.

Aspiration pneumonia can be caused by:

  • stomach content entering your lungs after you throw up;
  • a brain injury or other condition that affects your normal gag reflex;
  • diseases such as ALS (amyotrophic lateral sclerosis), Parkinson’s disease or strokes, which can make swallowing difficult; or
  • throwing up when passed out due to over-medication 

There are two types of aspiration pneumonia syndromes:

  • Chemical pneumonia (CP) – aspiration of gastric acid
  • Bacterial pneumonia (BP) – aspiration of bacteria from the mouth and throat
  • Aspiration of gastric acid can cause acid burns when the stomach acid passes down the windpipe, which can leave lung tissue vulnerable to infection. 

Bacterial pneumonia occurs when a person suffers from an illness or condition that compromises their ability to cough or swallow (see causes above) and aspirates foreign material allowing bacteria to enter the lungs, resulting in infection. 

Chemical pneumonia usually has an acute onset, with symptoms occurring within a few minutes to two hours of the aspiration event. Symptoms include: respiratory distress, rapid breathing, wheezing, fever, and cough with pink or frothy sputum. Bacterial pneumonia, on the other hand, has a sub-acute onset, with symptoms occurring after a couple days to weeks after the aspiration event. Symptoms include: bad breath, putrid odor of sputum, fever, and weight loss. 

Aspiration pneumonia is a serious concern in the elderly. This is because swallowing is a complex activity, requiring coordinated opening and closing of the mouth and lips, chewing while inhaling and exhaling, mixing saliva with food, moving food to the back of the tongue, and having the swallow reflex send food down the esophagus. If any of these steps does not occur properly, you can be at risk of chocking, aspirating, or suffocating. 

The number of hospitalizations for aspiration pneumonia has been increasing, with the largest increase in the very old. From 1991 to 1996, the number of hospital discharges of Medicare patients, whose reason for admission was reported to be aspiration pneumonia, increased by 76% (while the number of elderly persons covered by Medicare grew by less than 7%). 

Nursing home staff must take care to closely monitor the food given to residents who have difficulty swallowing. Usually, thicker, colder liquids are easier to swallow. Thin liquids, including water, can be dangerous because they are difficult to control within the mouth. Straws can help a person swallow by limiting the amount of liquid that can be taken at a time and directing the liquid to the back of the mouth. 

Nursing home facilities can also craft special menus for people with difficulty swallowing so that the food resembles normal food, but still has a soft pureed consistency (for example, chicken cooked and pureed with thickening agent and molded into a chicken leg shape, meatloaf, and casseroles). However, this would require the facility to design different meals for some residents, which would require additional time and efforts, which not all facilities are willing to undertake. 

Nursing home staff should consult the doctor if a resident has difficulty swallowing. The physician might recommend that the resident be placed on a liquid or pureed diet or even use a feeding tube in severe situations. Many residents would probably prefer a diet of solid foods because it is more pleasurable to eat and does not insult their pride by basically having them eat baby food. 

Staff can also have residents who have difficulty swallowing do a “dry swallow” (swallow without any food or liquid in their mouth) after taking a bite of food. However, this requires expensive supervision, which isn’t always possible at crowded nursing homes, where several residents might need monitoring during mealtimes. 

Aspiration pneumonia can result in serious lung infections in elderly nursing home residents. Many of these residents already suffer from underlying illness or disease, which makes it more difficult for them to fight infection. Infections can be dangerous and often require hospitalization. Therefore, nursing home staff should take extra precautions to prevent aspiration pneumonia in order to maintain the best possible health of residents. 

Sources:

eMedicine: Pneumonia, Aspiration

Health Resources: Guidelines Aspiration Pneumonia

 

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  • Wish there is a way to make stroke patients eat a meal without being constantly worried about the risk of aspiration. It is heart breaking to see a loved one suffering from stroke, let alone having extreme difficulty consuming a simple meal. 

  • My dad 82yo died within 2 weeks after aspiration pneumonia.  His intake of food was completely stopped, and he practically starved to death.  IV fluid and antibiotics were instilled, but NPO.  What whould the diet be, nothing showed abnormal in the cookie swallowing test.  Please help me understand.

  • My dad died after 2 weeks of getting aspiration pneumonia after shoking at breakfast.  NOP for 2 weeks, with IV fluids, steroids and antibiotics.  I saw him withered day by day, developed delirium and finally died at home with Hospice services.  Please help me understand.  NPO, he could swallow most of the time, but no food for 2 weeks. 

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