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Semin Respir Crit Care Med 2024; 45(06): 678-693
DOI: 10.1055/a-2445-8952
Review Article

Swallowing and Aspiration: How to Evaluate and Treat Swallowing Disorders Associated with Aspiration Pneumonia in Older Persons

Omar Ortega
1   Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain
2   Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
,
Lucilla Guidotti
1   Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain
,
Yuki Yoshimatsu
3   Department of Elderly Care, Guy's and St Thomas' Hospitals NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
4   Centre for Exercise Activity and Rehabilitation, University of Greenwich School of Human Sciences, London, United Kingdom of Great Britain and Northern Ireland
,
Claudia Sitges
5   Department of Internal Medicine, Hospital de Mataro, Mataro, Catalunya, Spain
,
Josep Martos
6   Department of Geriatrics, Hospital de Mataro, Mataro, Catalunya, Spain
,
Jaume Miró
1   Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain
7   AIMS MEDICAL SL, Mataró, Catalunya, Spain
,
Alberto Martín
1   Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain
2   Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
7   AIMS MEDICAL SL, Mataró, Catalunya, Spain
,
Cristina Amadó
7   AIMS MEDICAL SL, Mataró, Catalunya, Spain
,
Pere Clavé
1   Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain
2   Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain
7   AIMS MEDICAL SL, Mataró, Catalunya, Spain
› Author Affiliations Funding This study was supported by research grants from:
● Instituto de Salud Carlos III (ISCIII), Investigación Clínica Independiente: ICI20/00117; and co-funded by the European Union (FEDER funds).
● Instituto de Salud Carlos III (ISCIII), Fondo de Investigaciones Sanitarias: PI22/01101; and co-funded by the European Union (FEDER funds).
● The Transformative Project with code PT-092023-CSC promoted by CatSalut within the framework of SISCAT, funding with non-finalist affected funds (FANF). The content of this publication reflects only the opinions of the authors. CatSalut is not responsible for the use that may be made of the information contained herein.
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Abstract

Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. We performed a narrative review, including our experience with prior studies at Hospital de Mataró, on the diagnosis and treatment of AP. AP refers to pneumonia occurring in patients with swallowing disorders, frequently coinciding with poor oral health and vulnerability. Its main risk factors include oropharyngeal aspiration, impaired health status, malnutrition, frailty, immune dysfunction, and oral colonization by respiratory pathogens. Incidence is estimated at between 5 and 15% of cases of CAP, but it is highly underdiagnosed. Diagnostic criteria for AP have not been standardized but should include its main pathophysiological element, oropharyngeal aspiration. Recently, a clinical algorithm was proposed, based on the recommendations of the Japanese Respiratory Society, that includes aspiration risk factors and clinical evaluation of OD. To facilitate the task for health care professionals, new artificial intelligence (AI)-based screening tools for OD combined with validated clinical methods such as the volume–viscosity swallowing test (V-VST) for the detection of AP are being validated. Prevention and treatment of AP require multimodal interventions aimed to cover the main risk factors: textural adaptation of fluids and diets to avoid oropharyngeal aspiration; nutritional support to avoid malnutrition; and oral hygiene to reduce oral bacterial load. The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection of AP.

Keywords

oropharyngeal dysphagia - swallowing disorders - oropharyngeal aspiration - aspiration pneumonia - artificial intelligence

Supplementary Material



Publication History

Accepted Manuscript online:
21 October 2024

Article published online:
29 November 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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