The oral cavity is colonized by millions of bacterial and fungal organisms. Many of these do not cause disease and are thus described as being normal flora. The opposite is true for the organisms that will colonize the oral cavity in an individual with poor hygiene such as the typical elderly patient on long term care. In this article we will discuss oral care and aspiration pneumonia.
It has been established that the risk for aspiration among patients on long term care is markedly increased if there is a concomitant disease in the cavity. Examples of these diseases and medical conditions include periodontal diseases and dental caries. Other conditions that may worsen the situation include the existence of swallowing difficulties, inability to feed and poor motor coordination. The elderly are at a higher risk of suffering from this conditions than the general population.
Findings from various studies show that approximately 15% of adults within the general population have difficulties in swallowing. This problem appears to worsen with advancing age such that among those aged above 80 years, the proportion approaches 50%. It is thought that these challenges arise due to the changes occurring in the oropharynx as one advances in age. Other factors that may increase the risk include cerebral palsy, stroke and dementia among others.
One of the most important interventions that should be considered is a change in posture during swallowing. A posture that will reduce the risk of aspiration should be adopted. In general, this should be less than 90 degrees from the horizontal. Additional maneuvers that are aimed at optimizing on this can be taught to both the patient and their caregiver over several sessions.
It is not uncommon for patients that are undergoing long term care to have numerous prescriptions due to the existence of many illnesses and medical conditions. Some of the medications commonly used among this group of patients have been shown to have inhibitory effects on swallowing. Frequent evaluations need to be undertaken to determine which drugs may have such effects. Drugs that may have to be added are those that will help reduce secretions and gastric acid production.
Suppression of oral functions is common in patients on care. The causes behind this are the depressed consciousness and the presence of feeding tubes. A lot of saliva and mucous secretions are produced at this point to help and deal with the problem. Unfortunately, these secretions mix with solid residues in the mouth to form a sticky paste that will be seen adhering to the mucosal surfaces and teeth.
The self-cleaning mechanism is ineffective among these patients. The sticky paste that is formed has to be removed through mechanical cleaning. Failure to do this predisposes the patient to infections by varied bacterial organisms which may also spread to the respiratory tract. Even when overt aspiration is not taking place, the bacterial organisms may be aspirated and lead to pneumonia. This is also termed micro-aspiration.
Good oral hygiene among elderly patients on long term nursing care is an important step in not only lowering the risk of aspiration but also preventing local and systemic complications. Some of these complications include abscess formation infective endocarditis. The poor hygiene in this group of patients is due to a number of factors. Eliminating as many of them as possible significantly reduces the possible risks.
It has been established that the risk for aspiration among patients on long term care is markedly increased if there is a concomitant disease in the cavity. Examples of these diseases and medical conditions include periodontal diseases and dental caries. Other conditions that may worsen the situation include the existence of swallowing difficulties, inability to feed and poor motor coordination. The elderly are at a higher risk of suffering from this conditions than the general population.
Findings from various studies show that approximately 15% of adults within the general population have difficulties in swallowing. This problem appears to worsen with advancing age such that among those aged above 80 years, the proportion approaches 50%. It is thought that these challenges arise due to the changes occurring in the oropharynx as one advances in age. Other factors that may increase the risk include cerebral palsy, stroke and dementia among others.
One of the most important interventions that should be considered is a change in posture during swallowing. A posture that will reduce the risk of aspiration should be adopted. In general, this should be less than 90 degrees from the horizontal. Additional maneuvers that are aimed at optimizing on this can be taught to both the patient and their caregiver over several sessions.
It is not uncommon for patients that are undergoing long term care to have numerous prescriptions due to the existence of many illnesses and medical conditions. Some of the medications commonly used among this group of patients have been shown to have inhibitory effects on swallowing. Frequent evaluations need to be undertaken to determine which drugs may have such effects. Drugs that may have to be added are those that will help reduce secretions and gastric acid production.
Suppression of oral functions is common in patients on care. The causes behind this are the depressed consciousness and the presence of feeding tubes. A lot of saliva and mucous secretions are produced at this point to help and deal with the problem. Unfortunately, these secretions mix with solid residues in the mouth to form a sticky paste that will be seen adhering to the mucosal surfaces and teeth.
The self-cleaning mechanism is ineffective among these patients. The sticky paste that is formed has to be removed through mechanical cleaning. Failure to do this predisposes the patient to infections by varied bacterial organisms which may also spread to the respiratory tract. Even when overt aspiration is not taking place, the bacterial organisms may be aspirated and lead to pneumonia. This is also termed micro-aspiration.
Good oral hygiene among elderly patients on long term nursing care is an important step in not only lowering the risk of aspiration but also preventing local and systemic complications. Some of these complications include abscess formation infective endocarditis. The poor hygiene in this group of patients is due to a number of factors. Eliminating as many of them as possible significantly reduces the possible risks.
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