Risk Factors for Aspiration Pneumonia in Frail Older People: A Systematic Literature Review

Claar D. van der Maarel-Wierink, Jacques N. O. Vanobbergen, Ewald M. Bronkhorst, Jos M. G. A. Schols, Cees de Baat*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

140 Citations (Web of Science)

Abstract

Objective: To systematically review the risks for aspiration pneumonia in frail older people and the contribution of bad oral health among the risk factors. Design: Systematic literature review. Setting: PubMed (Medline), Web of Science, Cochrane Library, EMBASE, and CINAHL were searched for eligible studies, published in English in the period January 2000 to April 2009. Participants: Frail older people. Measurements: Only publications with regard to hospitalized, institutionalized, or frail home-dwelling people of 60 years and older were eligible. Two authors independently assessed the publications for their methodological quality. Unadjusted and adjusted odds ratios and their corresponding 95% confidence intervals for respective risk factors related to aspiration pneumonia were extracted. The results were evaluated according to the levels of evidence of the Oxford Centre for Evidence-based Medicine. Results: A total of 21 publications fulfilled the quality criteria. Evidence level 2a (systematic review with homogeneity of cohort studies) was found for a positive relationship between aspiration pneumonia and age, male gender, lung diseases, dysphagia, and diabetes mellitus; 2b (individual cohort study) for severe dementia, angiotensin l-converting enzyme deletion/deletion genotype, and bad oral health; 3a (systematic review with homogeneity of case-control studies) for malnutrition; 3b (individual case-control study) for Parkinson's disease and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health among the risk factors seems limited. Conclusion: Thirteen significant risk factors were identified: age, male gender, lung diseases, dysphagia, diabetes mellitus, severe dementia, angiotensin l-converting enzyme deletion/deletion genotype, bad oral health, malnutrition, Parkinson's disease, and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health seems limited. (J Am Med Dir Assoc 2011; 12: 344-354)
Original languageEnglish
Pages (from-to)344-354
JournalJournal of the American Medical Directors Association
Volume12
Issue number5
DOIs
Publication statusPublished - Jun 2011

Keywords

  • Aspiration pneumonia
  • risk factor
  • older people
  • frailty

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