The oral cavity holds thousands of colonies of microorganisms. These organisms are largely beneficial to the body and that is why they are also called normal flora. In persons on long term care in nursing homes, poor oral hygiene is fairly common. This predisposes them to infections that may lead to various compilations including aspiration pneumonia. We will look at how oral care and aspiration pneumonia should be handled.
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.
It has been shown through research that close to 15% of adults have swallowing difficulties. This figure appears to increase as we advance in age due to what are believed to be changes taking place in the physiology and anatomy of the oropharynx. At the age of 80 years, it appears that almost half of the people have varying degrees of swallowing challenges. Other factors that may contribute to the problem include stroke, cerebral palsy 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.
Maintaining good oral health will not only lower the risk of aspiration but that of other local and systemic complications as well. Such may include abscess formation and infective endocarditis. It is important to bear in mind that the elderly are at an increased risk of poor hygiene and aspiration due to multiple factors. Preventing aspiration is done through eliminating as many of the risk factors as possible.
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.
It has been shown through research that close to 15% of adults have swallowing difficulties. This figure appears to increase as we advance in age due to what are believed to be changes taking place in the physiology and anatomy of the oropharynx. At the age of 80 years, it appears that almost half of the people have varying degrees of swallowing challenges. Other factors that may contribute to the problem include stroke, cerebral palsy 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.
Maintaining good oral health will not only lower the risk of aspiration but that of other local and systemic complications as well. Such may include abscess formation and infective endocarditis. It is important to bear in mind that the elderly are at an increased risk of poor hygiene and aspiration due to multiple factors. Preventing aspiration is done through eliminating as many of the risk factors as possible.
About the Author:
The following article explains about the effectiveness of oral care and aspiration pneumonia prevention. To read the informative post now, check out the blog at http://www.swallowstudy.com.
إرسال تعليق