Skip to main content

Advertisement

Log in

Aspiration Pneumonia in the Geriatric Population

  • Pulmonology and Respiratory Care (AI Musani and E Folch, Section Editors)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Aspiration pneumonia is a common infection in older adults and has a high mortality rate. Oropharyngeal dysphagia is the major mechanism leading to aspiration pneumonia in the older adult. Many conditions that are prevalent in the older adult population such as stroke, parkinsonism, dementia, and institutionalization have an increased incidence of oropharyngeal dysphagia. Aspiration pneumonia is a bacterial pulmonary infection which is dependent upon the amount of bacterial inoculum, the virulence of the organism, and the host immune system. It is treated with antibiotic therapy that is similar to therapies for traditional community-acquired or health-care-associated pneumonia. In the advanced stages of terminal illness, a palliative care approach may be most appropriate. This review seeks to look at aspiration pneumonia focusing on oropharyngeal dysphagia, the microbiology of aspiration pneumonia and the palliative care aspects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clave P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing. 2010;39:39–45.

    Article  PubMed  Google Scholar 

  2. Marik P. Pulmonary aspiration syndromes. Cur Opin Pulm Med. 2011;17:148–54. This review points out how pulmonary syndromes are misdiagnosed and poorly managed. It suggests best management.

    Article  Google Scholar 

  3. Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest. 2006;129:154S–68.

    Article  PubMed  Google Scholar 

  4. Rofes L, Arreola V, Almirall J, Cabre M, Campins L, Garcia-Peris P, et al. Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol Res Pract 2010. 2011;3:1–13. This is an extremely comprehensive look at dysphagia and its complications.

    Article  Google Scholar 

  5. Ding R, Logemann JA. Pneumonia in stroke patients: a retrospective study. Dysphagia. 2000;15:51–7.

    Article  CAS  PubMed  Google Scholar 

  6. Rosenbek JC, McCullough GH, Wertz RT. Is the information about a test important? Applying the methods of evidence-based medicine to the clinical examination of swallowing. J Commun Disord. 2004;37:437–50.

    Article  PubMed  Google Scholar 

  7. Smith-Hammond CA, New KC, Pietrobon R, et al. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine. 2004;29:1441–6.

    Article  PubMed  Google Scholar 

  8. Fonda D, Schwarz J, Clinnick S. Parkinsonian medication one hour before meals improves symptomatic swallowing: a case study. Dysphagia. 1995;10:165–6.

    Article  CAS  PubMed  Google Scholar 

  9. Robbins JA, Logemann JA, Kirshner HS. Swallowing and speech production in Parkinson’s disease. Ann Neurol. 1986;19:283–7.

    Article  CAS  PubMed  Google Scholar 

  10. El-Solh AA. Association between pneumonia and oral care in nursing home residents. Lung. 2011;189(3):173–80.

    Article  PubMed  Google Scholar 

  11. Quagliarello V, Ginter S, Han L, Van Ness P, Allore H. Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis. 2005;40:1–6.

    Article  PubMed  Google Scholar 

  12. Flacker JM. What is a geriatric syndrome anyway? J Am Geriatr Soc. 2003;51(4):574–6.

    Article  PubMed  Google Scholar 

  13. McCullough GH, Wertz RT, Rosenbek JC. Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke. J Commun Disord. 2001;34:55–72.

    Article  CAS  PubMed  Google Scholar 

  14. Mann G, Hankey GJ. Initial clinical and demographic—predictors of swallowing impairment following acute stroke. Dysphagia. 2001;16:208–15.

    Article  CAS  PubMed  Google Scholar 

  15. Ney DM, Weiss JM, Kind AJ, Robbins J. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract. 2009;24:395–413.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Hammond CS. Cough and aspiration of food and liquids due to oral pharyngeal dysphagia. Lung. 2008;186(S1):S35–40.

    Article  Google Scholar 

  17. Welch MV, Logemann JA, Rademaker AW, Kahrilas PJ. Changes in pharyngeal dimensions effected by chin tuck. Arch Phys Med Rehabil. 1993;74:178–81.

    CAS  PubMed  Google Scholar 

  18. Logemann JA et al. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech, Lang, Hear Res. 2008;51:173–83.

    Article  Google Scholar 

  19. Robbins J et al. Comparison of 2 interventions for liquid aspiration on pneumonia incidence: a randomized trial. Ann Intern Med. 2008;148(7):509–18.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Lazarus C, Clark H, Arvedson J, Schooling T, Frymark T. Evidence-based systematic review: effects of oral sensory-motor treatments on swallowing in adults. ASHA’s National Center for Evidence-Based Practice in Communication Disorders. 2011. A systematic review – the first of its kind- that points out that many of the therapies we have been using for years may have little or no benefit when studied rigorously.

  21. Oh TH et al. Dysphagia in inflammatory myopathy: clinical characteristics, treatment strategies, and outcome in 62 patients. Mayo Clin Proc. 2007;82(4):441–7.

    Article  PubMed  Google Scholar 

  22. Wunderink RG, Waterer GC. Community-acquired pneumonia: pathophysiology and host factors with focus on possible new approaches to management of lower respiratory tact infections. Infect Dis Clin North Am. 2004;18:743–59.

    Article  PubMed  Google Scholar 

  23. Mason CM, Nelson S. Pulmonary host defenses and factors predisposing to lung infection. Clin Chest Med. 2005;26:11–7.

    Article  PubMed  Google Scholar 

  24. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191–205.

    CAS  PubMed  Google Scholar 

  25. Marik PE, Kaplan D. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344:665–71.

    Article  CAS  PubMed  Google Scholar 

  26. Cameron JL, Sebor J, Anderson RP, Zuidena GD. Aspiration pneumonia. Results of treatment by positive-pressure ventilation in dogs. J Surg Res. 1968;8:447.

    Article  CAS  PubMed  Google Scholar 

  27. Cameron JL, Caldini P, Toung JK, Zuidena GD. Aspiration pneumonia: physiologic data following experimental aspiration. Surgery. 1972;73:238.

    Google Scholar 

  28. Bartlett JG. How important are anaerobic bacteria in aspiration pneumonia. Infect Dis Clin N Am. 2013;27:149–55. An updated report about the lack of anaerobic bacteria that were typical of old pathogens of aspiration pneumonia.

    Article  Google Scholar 

  29. DiBardino DM, Wunderink RG. Aspiration pneumonia: a review of modern trends. J Crit Care. 2014. doi:10.1016/j.jcrc.2014.07.011. An important synthesis of the up to date pathophysiology and management of aspiration pneumonia.

    PubMed  Google Scholar 

  30. Bartlett JG. Anaerobic bacterial infection of the lung. Anaerobe. 2012;18:235–9.

    Article  PubMed  Google Scholar 

  31. Carratala J, Mykietiuk A, Fernandez-Sabe N, et al. Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Med. 2007;167:1393.

    Article  PubMed  Google Scholar 

  32. El-Solh AA, Pietrantoni C, Bhat A, Aquilina AT, Okada M, Grover V, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med. 2003;167:1650–4.

    Article  PubMed  Google Scholar 

  33. Tokuyasu H, Harada T, Wantanabe E, Okazaki R, Touge H, Kawasaki Y, et al. Effectiveness of meropenem for the treatment of aspiration pneumonia in elderly patients. Intern Med. 2009;48:129–35.

    Article  PubMed  Google Scholar 

  34. Takayanagi N, Kagiyama N, Ishiguro T, Tokunaga D, Sugita Y. Etiology and outcome of community-acquired lung abscess. Respiration. 2010;80:98–105.

    Article  PubMed  Google Scholar 

  35. Wang JL, Chen KY, Fang CT, Hsueh PR, Yang PC, Chang SC. Changing bacteriology of adult community-acquired lung abscess in Taiwan: Klebsiella pneumoniae versus anaerobes. Clin Infect Dis. 2005;40:915–22.

    Article  PubMed  Google Scholar 

  36. Bartlett JG. Anaerobic bacterial infections of the lung. Chest. 1987;91:901–9.

    Article  CAS  PubMed  Google Scholar 

  37. Finegold SM, George WL, Mulligan ME. Anaerobic infections. Part 1. Dis Mon. 1985;31:1–77.

    Google Scholar 

  38. Smith DT. Experimental aspiratory abscess. Arch Surg. 1927;14:231.

    Article  Google Scholar 

  39. Restrepo MI, Mortensen EM, Velez JA, Frei C, Anzueto A. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU. Chest. 2008;133:610–7.

    Article  PubMed  Google Scholar 

  40. Wei C, Cheng Z, Zhang L, Yang J. Microbiology and prognostic factors of hospital- and community-acquired aspiration pneumonia in respiratory intensive care unit. Am J Infect Control. 2013;41:880–4.

    Article  PubMed  Google Scholar 

  41. Johanson WG, Pierce AK, Sanford JP. Changing pharyngeal bacterial flora of hospitalized patients. Emergence of gram-negative bacilli. NEJM. 1969;281:1137.

    Article  CAS  PubMed  Google Scholar 

  42. Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H. High incidence of silent aspiration in elderly patients with community acquired pneumonia. Am J Respir Crit Care Med. 1994;150:251–3.

    Article  CAS  PubMed  Google Scholar 

  43. Hu X, Yi ES, Ryu JH. Aspiration-related deaths in 57 consecutive patients: autopsy study. PLoS One. 2014;9(7):e103795. doi:10.1371/journal.pone.0103795.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Bafadhel M, Clark TW, Reid C, Medina MJ, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest. 2011;139:1410–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. El-Solh AA, Vora H, Knight Ill PR, Porhomayon J. Diagnostic use of serum procalcitonin levels in pulmonary aspiration syndromes. Crit Care Med. 2011;39:1251–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Weiss CH, Moazed F, DiBardino D, Swaroop M, Wunderink RG. Bronchoalveolar lavage amylase is associated with risk factors for aspiration and predicts bacterial pneumonia. Crit Care Med. 2013;41:765–73.

    Article  CAS  PubMed  Google Scholar 

  47. Bartlett JG, Rosenblatt JE, Finegold SM. Percutaneous transtracheal aspiration in the diagnosis of anaerobic pulmonary infection. Ann Intern Med. 1973;79:535–40.

    Article  CAS  PubMed  Google Scholar 

  48. Wimberley N, Faling LJ, Bartlett JG. A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am Rev Respir Dis. 1979;119:337–43.

    CAS  PubMed  Google Scholar 

  49. Mier L, Dreyfuss D, Darchy B, Lanore JJ, Djedaïni K, Weber P, et al. Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures. Intensive Care Med. 1993;19:279–84.

    Article  CAS  PubMed  Google Scholar 

  50. Pick N, McDonald A, Bennett N, et al. Pulmonary aspiration in a long-term care setting: clinical and laboratory observations and an analysis of risk factors. J Am Geriatr Soc. 1996;44:763–8.

    Article  CAS  PubMed  Google Scholar 

  51. Loeb M, McGeer A, McArthur M, Walter S, Simor AE. Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Arch Intern Med. 1999;159:2058–64.

    Article  CAS  PubMed  Google Scholar 

  52. El T, Austrian R, Masure HR. Pathogenesis of pneumococcal infection. NEJM. 1995;332:1280–4.

    Article  Google Scholar 

  53. Taylor JK, Fleming GB, Singanayagam A, Hill AT, Chalmers JD. Risk factors for aspiration in community-acquired pneumonia: analysis of a hospitalized UK cohort. Am J Med. 2013;126(11):995–1001.

    Article  PubMed  Google Scholar 

  54. Moine P, Vercken JB, Chevret S, Chastang C, Gajdos P. Severe community-acquired pneumonia, etiology, epidemiology, and prognosis factors. French Study Group for Community-Acquired Pneumonia in the Intensive Care Unit. Chest. 1994;105:1487–95.

    Article  CAS  PubMed  Google Scholar 

  55. Torres A, Serra-Batlles J, Ferrer A, Jimenez P, Celis R, et al. Severe community-acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis. 1991;144:312–8.

    Article  CAS  PubMed  Google Scholar 

  56. Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa, Matsue K, et al. High incidence of aspiration pneumonia in a community and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc. 2008;56:577–9.

    Article  PubMed  Google Scholar 

  57. Reza Shariatzadeh M, Huang JQ, Marrie TJ. Differences in the features of aspiration pneumonia according to site of acquisition: community or continuing care facility. J Am Geriatr Soc. 2006;54:296–302.

    Article  CAS  PubMed  Google Scholar 

  58. Bartlett JG, Gorbach SL. The triple threat of aspiration pneumonia. Chest. 1975;68:560–6.

    Article  CAS  PubMed  Google Scholar 

  59. Bartlett JG. Anaerobic bacterial infections of the lung and pleural space. Clin Infect Dis. 1993;16(4):S248–55.

    Article  PubMed  Google Scholar 

  60. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, et al. Infectious Disease Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(2):S27–72.

    Article  CAS  PubMed  Google Scholar 

  61. Levison ME, Mangura CT, Lorber B, Arbutyn E, Pesanti EL, Levy RS, et al. Clindamycin compared with penicillin for the treatment of anaerobic lung abscess. Ann Intern Med. 1983;98:466–71.

    Article  CAS  PubMed  Google Scholar 

  62. Gudiol F, Manresa F, Pallares R, Dorca J, Rufi G, Boada J, et al. Clindamycin vs. penicillin for anaerobic lung infections. High rate of penicillin failures associated with penicillin-resistant bacteroides melaninogenicus. Arch Intern Med. 1990;150:2529–9.

    Article  Google Scholar 

  63. Fernandez-Sabe N, Carratala J, Roson B, Tubau F, Manresa F, Gudiol F. Efficacy and safety of sequential amoxicillin-clavulanate in the treatment of anaerobic lung infections. Eur J Clin Microbiol Infect Dis. 2013;22:185–7.

    Google Scholar 

  64. Ott SR, Allewelt M, Lorenz J, Reimnitz P, Lode H. German lung abscess study group. Moxifloxacin vs. ampicillin/sulbactam in aspiration pneumonia and primary lung abscess. Infection. 2008;36:22–3.

    Article  Google Scholar 

  65. Perlino CA. Metronidzole vs clindamycin treatment of anaerobic pulmonary infection. Failure of metronidazole therapy. Arch Intern Med. 1981;141:1424–7.

    Article  CAS  PubMed  Google Scholar 

  66. Sanders CV, Hanna BJ, Lewis AC. Metronidazole in the treatment of anaerobic infections. Am Rev Respir Dis. 1979;120:337–43.

    CAS  PubMed  Google Scholar 

  67. Wolfe JE, Bone RC, Ruth WE. Effects of corticosteroids in the treatment of patients with gastric aspiration. Am J Med. 1977;63(5):719–22.

    Article  CAS  PubMed  Google Scholar 

  68. Kadowaki M, Demura Y, Mizuno S, Uesaka D, Amesthim S, Miyamori I, et al. Reappraisal of clindamycin IV monotherapy for treatment of mild to moderate aspiration pneumonia in elderly patients. Chest. 2005;127:1276–82.

    Article  CAS  PubMed  Google Scholar 

  69. Hayashi M, Iwasaki T, Yamazaki Y, Takayasu H, et al. Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia: a retrospective cohort study. J Infect Chemother. 2014;20(7):436–42.

    Article  PubMed  Google Scholar 

  70. Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in the hospitalized patient. Arch Otolaryngol Head Neck Surg. 2010;136(8):784–9.

    Article  PubMed  Google Scholar 

  71. Goldstein NE, Genden E, Morrison RS. Palliative care for patients with head and neck cancer: “I would like a quick return to a normal lifestyle”. JAMA. 2008;299:1818.

    Article  CAS  PubMed  Google Scholar 

  72. Pace A, Di Lorenzo C, Guariglia L, et al. End of life issues in brain tumor patients. J Neurooncol. 2009;91:39.

    Article  PubMed  Google Scholar 

  73. Altman KW, Richards A, Goldberg L, et al. Dysphagia in stroke, neurodegenerative disease, and advanced dementia. Otolaryngol Clin North Am. 2013;46:1137.

    Article  PubMed  Google Scholar 

  74. Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756.

    Article  PubMed  Google Scholar 

  75. Ramsey D, Smithard D, Kalra L. Silent aspiration: what do we know? Dysphagia. 2005;20:218.

    Article  PubMed  Google Scholar 

  76. Warms T, Richards J. “Wet Voice” as a predictor of penetration and aspiration in oropharyngeal dysphagia. Dysphagia. 2000;15:84.

    Article  CAS  PubMed  Google Scholar 

  77. Clinical indicators for instrumental assessment of dysphagia, from the American Speech-Language-Hearing Association. http://www.asha.org/policy/GL2000-00047.htm

  78. Slomka J. Withholding nutrition at the end of life: clinical and ethical issues. Cleve Clin J Med. 2003;70(6):548–52.

    Article  PubMed  Google Scholar 

  79. Borum ML, Lynn J, Zhong Z, et al. The effect of nutritional supplementation on survival in seriously ill hospitalized adults: an evaluation of the SUPPORT data. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc. 2000;48:S33.

    Article  CAS  PubMed  Google Scholar 

  80. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124:328.

    Article  PubMed  Google Scholar 

  81. Simoff MJ, Lally B, Slade MG, et al. Symptom management in patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e455S–97s. This article offers evidence-based clinical practice guidelines in symptom management of Lung Cancer patients. MEDLINE literature reviews, in addition to Cochrane reviews and other databases, were used for this review.

    Article  CAS  PubMed  Google Scholar 

  82. Ruth D, et al. Medical care of older persons in residential aged care facilities; Dysphagia and Aspiration. 4th edition. 2006; 35–37

  83. Hugel H, Ellershaw J, Gambles M. Respiratory tract secretions in the dying patient: a comparison between glycopyrronium and hyoscine hydrobromide. J Palliat Med. 2006;9:279.

    Article  PubMed  Google Scholar 

  84. Ben-Aharon I, Gafter-Gvili A, Paul M, et al. Interventions for alleviating cancer-related dyspnea: a systematic review. J Clin Oncol. 2008;26:2396.

    Article  PubMed  Google Scholar 

  85. Viola R, Kiteley C, Lloyd NS, et al. The management of dyspnea in cancer patients: a systematic review. Support Care Cancer. 2008;16:329.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Katherine T. Ward, Samuel Nam, and Erin Atkinson Cook declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Katherine T. Ward.

Additional information

This article is part of the Topical Collection on Pulmonology and Respiratory Care

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ward, K.T., Nam, S. & Cook, E.A. Aspiration Pneumonia in the Geriatric Population. Curr Geri Rep 4, 202–209 (2015). https://doi.org/10.1007/s13670-015-0125-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13670-015-0125-x

Keywords

Navigation