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

Omar Ortega; Lucilla Guidotti; Yuki Yoshimatsu; Claudia Sitges; Josep Martos; Jaume Miró; Alberto Martín; Cristina Amadó; Pere Clavé

doi:10.1055/a-2445-8952

Seminars in Respiratory and Critical Care Medicine, Inhaltsverzeichnis

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

¹Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain

²Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain

,

Lucilla Guidotti

¹Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain

,

Yuki Yoshimatsu

³Department of Elderly Care, Guy's and St Thomas' Hospitals NHS Trust, London, United Kingdom of Great Britain and Northern Ireland

⁴Centre for Exercise Activity and Rehabilitation, University of Greenwich School of Human Sciences, London, United Kingdom of Great Britain and Northern Ireland

,

Claudia Sitges

⁵Department of Internal Medicine, Hospital de Mataro, Mataro, Catalunya, Spain

,

Josep Martos

⁶Department of Geriatrics, Hospital de Mataro, Mataro, Catalunya, Spain

,

Jaume Miró

¹Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain

⁷AIMS MEDICAL SL, Mataró, Catalunya, Spain

,

Alberto Martín

¹Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain

²Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain

⁷AIMS MEDICAL SL, Mataró, Catalunya, Spain

,

Cristina Amadó

⁷AIMS MEDICAL SL, Mataró, Catalunya, Spain

,

Pere Clavé

¹Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain

²Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain

⁷AIMS MEDICAL SL, Mataró, Catalunya, Spain

› Institutsangaben

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

Volltext

Referenzen

References
1 Raghavendran K, Mylotte JM, Scannapieco FA. Nursing home-associated pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia: the contribution of dental biofilms and periodontal inflammation. Periodontol 2000 2007; 44: 164-177
2 Almirall J, Yoshimatsu Y, Scannapieco FA. Chapter 6.4 - Respiratory infections and aspiration pneumonia. In: Clavé P, Ortega O. eds. A Multidisciplinary Approach to Managing Swallowing Dysfunction in Older People. Cambridge, MA:: Academic Press;; 2024: 169-177
3 Ortega O. Study of Oral Microbiota and Respiratory Complications of Oropharyngeal Dysphagia: Physiopathology, Diagnosis and Treatment of Risk Factors of Oropharyngeal Dysphagia and Aspiration Pneumonia in Older Patients [Dissertation]. Barcelona, Spain:: Universitat Autònoma de Barcelona;; 2016
4 Yoshimatsu Y, Melgaard D, Westergren A, Skrubbeltrang C, Smithard DG. The diagnosis of aspiration pneumonia in older persons: a systematic review. Eur Geriatr Med 2022; 13 (05) 1071-1080
5 Smithard DG, Yoshimatsu Y. Pneumonia, aspiration pneumonia, or frailty-associated pneumonia?. Geriatrics (Basel) 2022; 7 (05) 115
6 Yoshimatsu Y, Thomas H, Thompson T, Smithard DG. Prognostic factors of poor outcomes in pneumonia in older adults: aspiration or frailty?. Eur Geriatr Med 2024; 15 (02) 481-488
7 Ortega O, Martín A, Clavé P. Diagnosis and management of oropharyngeal dysphagia among older persons, state of the art. J Am Med Dir Assoc 2017; 18 (07) 576-582
8 Baijens LWJ, Clavé P, Cras P. et al. European society for swallowing disorders - European union geriatric medicine society white paper: Oropharyngeal dysphagia as a geriatric syndrome. Clinical Interv Aging 2016; 11: 1403-1428
9 Clavé Sr P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol 2015; 12 (05) 259-270
10 World Health Organization. International Classification of Diseases (ICD). Accessed Ocrober 30, 2024 at: https://www.who.int/standards/classifications/classification-of-diseases
11 Mateos-Nozal J, Martos J, Masiero S. Chapter 2 - Oropharyngeal dysphagia as a geriatric syndrome. In: Clavé P, Ortega O. eds. A Multidisciplinary Approach to Managing Swallowing Dysfunction in Older People. Cambridge, MA:: Academic Press;; 2024: 7-23
12 Marin S, Cunillera R. Chapter 8 - Health economics of oropharyngeal dysphagia and its complications: malnutrition and respiratory infections in older people. In: Clavé P, Ortega O. eds. A Multidisciplinary Approach to Managing Swallowing Dysfunction in Older People. Cambridge, MA:: Academic Press;; 2024: 281-291
13 Marin S, Serra-Prat M, Ortega O. et al. Healthcare costs of post-stroke oropharyngeal dysphagia and its complications: malnutrition and respiratory infections. Eur J Neurol 2021; 28 (11) 3670-3681
14 Bloem BR, Lagaay AM, van Beek W, Haan J, Roos RA, Wintzen AR. Prevalence of subjective dysphagia in community residents aged over 87. BMJ 1990; 300 (6726) 721-722
15 Barczi SR, Sullivan PA, Robbins J. How should dysphagia care of older adults differ? Establishing optimal practice patterns. Semin Speech Lang 2000; 21 (04) 347-361
16 Kawashima K, Motohashi Y, Fujishima I. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Dysphagia 2004; 19 (04) 266-271
17 Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol 2007; 116 (11) 858-865
18 Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus 2011; 24 (07) 476-480
19 Yang EJ, Kim MH, Lim JY, Paik NJ. Oropharyngeal dysphagia in a community-based elderly cohort: the korean longitudinal study on health and aging. J Korean Med Sci 2013; 28 (10) 1534-1539
20 Adkins C, Takakura W, Spiegel BMR. et al. Prevalence and characteristics of dysphagia based on a population-based survey. Clin Gastroenterol Hepatol 2020; 18 (09) 1970-1979.e2
21 Mello RP, Xavier MO, Tomasi E, Gonzalez MC, Demarco FF, Bielemann RM. Dysphagia perception among community-dwelling older adults from a municipality in Southern Brazil. Dysphagia 2022; 37 (04) 879-888
22 Serra-Prat M, Hinojosa G, López D. et al. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J Am Geriatr Soc 2011; 59 (01) 186-187
23 Lee A, Sitoh YY, Lieu PK, Phua SY, Chin JJ. Swallowing impairment and feeding dependency in the hospitalised elderly. Ann Acad Med Singap 1999; 28 (03) 371-376
24 Matsuo H, Yoshimura Y, Ishizaki N, Ueno T. Dysphagia is associated with functional decline during acute-care hospitalization of older patients. Geriatr Gerontol Int 2017; 17 (10) 1610-1616
25 Eglseer D, Halfens RJG, Schols JMGA, Lohrmann C. Dysphagia in hospitalized older patients: associated factors and nutritional interventions. J Nutr Health Aging 2018; 22 (01) 103-110
26 Popman A, Richter M, Allen J, Wham C. High nutrition risk is associated with higher risk of dysphagia in advanced age adults newly admitted to hospital. Nutr Diet 2018; 75 (01) 52-58
27 Mañas-Martínez AB, Bucar-Barjud M, Campos-Fernández J, Gimeno-Orna JA, Pérez-Calvo J, Ocón-Bretón J. Association of positive screening for dysphagia with nutritional status and long-term mortality in hospitalized elderly patients. Endocrinol Diabetes Nutr (Engl Ed) 2018; 65 (07) 402-408
28 Issa Okubo PdeC, Dantas RO, Troncon LE, Moriguti JC, Ferriolli E. Clinical and scintigraphic assessment of swallowing of older patients admitted to a tertiary care geriatric ward. Dysphagia 2008; 23 (01) 1-6
29 Cabré M, Serra-Prat M, Force L, Almirall J, Palomera E, Clavé P. Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study. J Gerontol A Biol Sci Med Sci 2014; 69 (03) 330-337
30 Galán Sánchez-Heredero MJ, Santander Vaquero C, Cortázar Sáez M, de la Morena López F, Susi García R, Martínez Rincón MdelC. Relationship between dysphagia and malnutritition in patients over 65 years of age [in Spanish]. Enferm Clin 2014; 24 (03) 183-190
31 Melgaard D, Rodrigo-Domingo M, Mørch MM. The prevalence of oropharyngeal dysphagia in acute geriatric patients. Geriatrics (Basel) 2018; 3 (02) 15
32 Peñalva-Arigita A, Prats R, Lecha M, Sansano A, Vila L. Prevalence of dysphagia in a regional hospital setting: acute care hospital and a geriatric sociosanitary care hospital: a cross-sectional study. Clin Nutr ESPEN 2019; 33: 86-90
33 Mateos-Nozal J, Montero-Errasquín B, Sánchez García E, Romero Rodríguez E, Cruz-Jentoft AJ. High prevalence of oropharyngeal dysphagia in acutely hospitalized patients aged 80 years and older. J Am Med Dir Assoc 2020; 21 (12) 2008-2011
34 Wang T, Zhao Y, Guo A. Association of swallowing problems with frailty in Chinese hospitalized older patients. Int J Nurs Sci 2020; 7 (04) 408-412
35 Olesen MD, Modlinski RM, Poulsen SH, Rosenvinge PM, Rasmussen HH, Holst M. Prevalence of signs of dysphagia and associated risk factors in geriatric patients admitted to an acute medical unit. Clin Nutr ESPEN 2021; 41: 208-216
36 Zhang M, Li C, Zhang F. et al. Prevalence of dysphagia in China: an epidemiological survey of 5943 participants. Dysphagia 2021; 36 (03) 339-350
37 Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 2010; 39 (01) 39-45
38 Almirall J, Rofes L, Serra-Prat M. et al. Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly. Eur Respir J 2013; 41 (04) 923-928
39 Nogueira D, Reis E. Swallowing disorders in nursing home residents: how can the problem be explained?. Clin Interv Aging 2013; 8: 221-227
40 Lin LC, Wu SC, Chen HS, Wang TG, Chen MY. Prevalence of impaired swallowing in institutionalized older people in taiwan. J Am Geriatr Soc 2002; 50 (06) 1118-1123
41 Brochier CW, Hugo FN, Rech RS, Baumgarten A, Hilgert JB. Influence of dental factors on oropharyngeal dysphagia among recipients of long-term care. Gerodontology 2018; 35 (04) 333-338
42 Estupiñán Artiles C, Regan J, Donnellan C. Dysphagia screening in residential care settings: a scoping review. Int J Nurs Stud 2021; 114: 103813
43 Hu Z, Zheng B, Kaminga AC, Xu H. The prevalence of and risk factors for dysphagia among elderly residents in nursing homes: a systematic review and meta-analysis. Published online 2021.
44 Guanyabens N, Cabib C, Ungueti A. et al. The impact of periventricular leukoaraiosis in post-stroke oropharyngeal dysphagia: a swallowing biomechanics and MRI-based study. Dysphagia 2023; 38 (03) 856-865
45 Alvar A, Hahn Arkenberg R, McGowan B, Cheng H, Malandraki GA. The role of white matter in the neural control of swallowing: a systematic review. Front Hum Neurosci 2021; 15: 628424
46 Rofes L, Arreola V, Romea M. et al. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil 2010; 22 (08) 851-858 , e230
47 Guanyabens N, Tomsen N, Palomeras E, Mundet L, Clavé P, Ortega O. Neurophysiological characterization of oropharyngeal dysphagia in older patients. Clin Neurophysiol 2024; 162: 129-140
48 Vilardell N, Rofes L, Arreola V. et al. Videofluoroscopic assessment of the pathophysiology of chronic poststroke oropharyngeal dysphagia. Neurogastroenterol Motil 2017; 29 (10) 1-8
49 Miarons M, Clavé P, Wijngaard R. et al. Pathophysiology of oropharyngeal dysphagia assessed by videofluoroscopy in patients with dementia taking antipsychotics. J Am Med Dir Assoc 2018; 19 (09) 812.e1-812.e10
50 Fujishima I, Wakabayashi H, Milewska M, Wirth R. Chapter 4 - Sarcopenic dysphagia. In: Clavé P, Ortega O. eds. A Multidisciplinary Approach to Managing Swallowing Dysfunction in Older People. Cambridge, MA:: Academic Press;; 2024: 53-68
51 Rofes L, Ortega O, Vilardell N, Mundet L, Clavé P. Spatiotemporal characteristics of the pharyngeal event-related potential in healthy subjects and older patients with oropharyngeal dysfunction. Neurogastroenterol Motil 2017; 29 (02) 1-11
52 Cabib C, Ortega O, Vilardell N, Mundet L, Clavé P, Rofes L. Chronic post-stroke oropharyngeal dysphagia is associated with impaired cortical activation to pharyngeal sensory inputs. Eur J Neurol 2017; 24 (11) 1355-1362
53 Aviv JE. Effects of aging on sensitivity of the pharyngeal and supraglottic areas. Am J Med 1997; 103 (5A): 74S-76S
54 Tomsen N, Ortega O, Rofes L. et al. Acute and subacute effects of oropharyngeal sensory stimulation with TRPV1 agonists in older patients with oropharyngeal dysphagia: a biomechanical and neurophysiological randomized pilot study. Therap Adv Gastroenterol 2019; 12: 17 56284819842043
55 Vilardell N, Rofes L, Nascimento WV, Muriana D, Palomeras E, Clavé P. Cough reflex attenuation and swallowing dysfunction in sub-acute post-stroke patients: prevalence, risk factors, and clinical outcome. Neurogastroenterol Motil 2017;29(01):
56 Niimi A, Matsumoto H, Ueda T. et al. Impaired cough reflex in patients with recurrent pneumonia. Thorax 2003; 58 (02) 152-153
57 Nakashima T, Maeda K, Tahira K. et al. Silent aspiration predicts mortality in older adults with aspiration pneumonia admitted to acute hospitals. Geriatr Gerontol Int 2018; 18 (06) 828-832
58 Ebihara T, Miyamoto T, Kozaki K. Prognostic factors of 90-day mortality in older people with healthcare-associated pneumonia. Geriatr Gerontol Int 2020; 20 (11) 1036-1043
59 The Japanese Respiratory Society adult pneumonia management guideline committee. Guideline for the management of pneumonia in adults 2024. The Japanese Respiratory Society, Tokyo, 2024 (in Japanese)
60 Langmore SE, Terpenning MS, Schork A. et al. Predictors of aspiration pneumonia: how important is dysphagia?. Dysphagia 1998; 13 (02) 69-81
61 Ortega O, Clavé P. Oral hygiene, aspiration, and aspiration pneumonia: from pathophysiology to therapeutic strategies. Curr Phys Med Rehabil Rep 2013; 1 (04) 292-295
62 Ortega O, Sakwinska O, Combremont S. et al. High prevalence of colonization of oral cavity by respiratory pathogens in frail older patients with oropharyngeal dysphagia. Neurogastroenterol Motil 2015; 27 (12) 1804-1816
63 Martín A, Ortega O, Roca M, Arús M, Clavé P. Effect of a minimal-massive intervention in hospitalized older patients with oropharyngeal dysphagia: a proof of concept study. J Nutr Health Aging 2018; 22 (06) 739-747
64 Nart J, Vilarrasa J, de Tapia B. et al. Chapter 6.3 - Oral health. In: Clavé P, Ortega O. eds. A Multidisciplinary Approach to Managing Swallowing Dysfunction in Older People. Cambridge, MA:: Academic Press;; 2024: 159-167
65 Ortega O, Parra C, Zarcero S, Nart J, Sakwinska O, Clavé P. Oral health in older patients with oropharyngeal dysphagia. Age Ageing 2014; 43 (01) 132-137
66 Tsoumani E, Carter JA, Salomonsson S, Stephens JM, Bencina G. Clinical, economic, and humanistic burden of community acquired pneumonia in Europe: a systematic literature review. Expert Rev Vaccines 2023; 22 (01) 876-884
67 Almirall J, Cabré M, Clavé P. Neumonía aspirativa [in Spanish]. Med Clin (Barc) 2007; 129 (11) 424-432
68 Ewig S, Torres A. Community-acquired pneumonia as an emergency: time for an aggressive intervention to lower mortality. Eur Respir J 2011; 38 (02) 253-260
69 Mandell LA, Niederman MS. Aspiration pneumonia. N Engl J Med 2019; 380 (07) 651-663
70 Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest 2003; 124 (01) 328-336
71 Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T. Japanese Study Group on Aspiration Pulmonary Disease. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc 2008; 56 (03) 577-579
72 Komiya K, Ishii H, Kadota J. Healthcare-associated pneumonia and aspiration pneumonia. Aging Dis 2014; 6 (01) 27-37
73 Hayashi M, Iwasaki T, Yamazaki Y. et al. Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia: a retrospective cohort study. J Infect Chemother 2014; 20 (07) 436-442
74 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 (10) 880-884
75 Connolly MJ. Of proverbs and prevention: aspiration and its consequences in older patients. Age Ageing 2010; 39 (01) 2-4
76 Yoshimatsu Y, Tobino K, Ortega O. et al. Development and implementation of an aspiration pneumonia cause investigation algorithm. Clin Respir J 2023; 17 (01) 20-28
77 Chojin Y, Okamoto N, Noguchi S. et al. Clinical efficacy of assessment of swallowing ability for pneumonia and other assessment tools for occurrence and mortality from pneumonia among older inpatients in a long-term care hospital. Respir Investig 2023; 61 (05) 651-659
78 Miyashita N, Matsushima T, Oka M. Japanese Respiratory Society. The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations. Intern Med 2006; 45 (07) 419-428
79 Rodriguez AE, Restrepo MI. New perspectives in aspiration community acquired pneumonia. Expert Rev Clin Pharmacol 2019; 12 (10) 991-1002
80 Yoshimatsu Y, Tobino K, Ko Y, Yasuda M, Ide H, Oku Y. Careful history taking detects initially unknown underlying causes of aspiration pneumonia. Geriatr Gerontol Int 2020; 20 (08) 785-790
81 Tulunay-Ugur OE, Eibling D. Geriatric dysphagia. Clin Geriatr Med 2018; 34 (02) 183-189
82 Puisieux F, D'Andrea C, Baconnier P. et al; Intergroupe PneumoGériatrie SPLF–SFGG placé sous l'égide de la Société de pneumologie de langue française (SPLF) et de la Société française de gériatrie et gérontologie (SFGG). Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly. Rev Mal Respir 2011; 28 (08) e76-e93
83 Riera SA, Marin S, Serra-Prat M. et al. A systematic and a scoping review on the psychometrics and clinical utility of the volume-viscosity swallow test (V-VST) in the clinical screening and assessment of oropharyngeal dysphagia. Foods 2021; 10 (08) 1900
84 Clavé P, Arreola V, Romea M, Medina L, Palomera E, Serra-Prat M. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr 2008; 27 (06) 806-815
85 Helliwell K, Hughes VJ, Bennion CM, Manning-Stanley A. The use of videofluoroscopy (VFS) and fibreoptic endoscopic evaluation of swallowing (FEES) in the investigation of oropharyngeal dysphagia in stroke patients: a narrative review. Radiography (Lond) 2023; 29 (02) 284-290
86 Yoshimatsu Y, Smithard DG. A paradigm shift in the diagnosis of aspiration pneumonia in older adults. J Clin Med 2022; 11 (17) 5214
87 Martin-Martinez A, Miró J, Amadó C. et al. A systematic and universal artificial intelligence screening method for oropharyngeal dysphagia: improving diagnosis through risk management. Dysphagia 2023; 38 (04) 1224-1237
88 Momosaki R. Rehabilitative management for aspiration pneumonia in elderly patients. J Gen Fam Med 2017; 18 (01) 12-15
89 Ortega Fernández O, Clavé i Civit P, Falcó V. Estudio de la microbiota oral y de las complicaciones respiratorias de la disfagia orofaríngea: fisiopatología, diagnóstico y tratamiento de los factores de riesgo de la disfagia orofaríngea y la neumonía aspirativa en pacientes de edad avanzada [PhD thesis]. Barcelona, Spain:: Universitat Autònoma de Barcelona;; 2016
90 Viñas P, Martín-Martínez A, Cera M. et al. Characteristics and therapeutic needs of older patients with oropharyngeal dysphagia admitted to a general hospital. J Nutr Health Aging 2023; 27 (11) 996-1004
91 Wirth R, Dziewas R, Beck AM. et al. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging 2016; 11: 189-208
92 Rofes L, Arreola V, Mukherjee R, Swanson J, Clavé P. The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia. Aliment Pharmacol Ther 2014; 39 (10) 1169-1179
93 Bolivar-Prados M, Tomsen N, Hayakawa Y. et al. Proposal for a standard protocol to assess the rheological behavior of thickening products for oropharyngeal dysphagia. Nutrients 2022; 14 (23) 5028
94 Viñas P, Bolivar-Prados M, Tomsen N. et al. The hydration status of adult patients with oropharyngeal dysphagia and the effect of thickened fluid therapy on fluid intake and hydration: results of two parallel systematic and scoping reviews. Nutrients 2022; 14 (12) 2497
95 Bolivar-Prados M, Rofes L, Arreola V. et al. Effect of a gum-based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia. Neurogastroenterol Motil 2019; 31 (11) e13695
96 Ortega O, Bolívar-Prados M, Arreola V. et al. Therapeutic effect, rheological properties and xanthan gum thickener on four different. Nutrients 2020; 12 (06) 1873
97 O'Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?. BMC Geriatr 2018; 18 (01) 167
98 Sworn G. Rheology modifiers for the management of dysphagia. In: Soft and Biological Matter. Tokyo:: Springer Japan;; 2017: 233-263
99 Costa A, Carrión S, Puig-Pey M, Juárez F, Clavé P. Triple adaptation of the mediterranean diet: design of a meal plan for older people with oropharyngeal dysphagia based on home cooking. Nutrients 2019; 11 (02) 1-17
100 Lam P, Stanschus S, Zaman R, Cichero J. The International Dysphagia Diet Standardisation Initiative (IDDSI) framework: the Kempen pilot. Br J Neurosci Nurs 2017; 13: S18-S26
101 National Patient Safety Agency Dysphagia Expert Reference Group (NPSA).. Dysphagia diet food texture descriptors. Accessed July 18, 2024 at: http://www.hospitalcaterers.org/media/1160/dysphagia-descriptors.pdf
102 Ismael-Mohammed K, Bolívar-Prados M, Laguna L, Nuñez Lara A, Clavé P. Exploring texture and biomechanics of food oral processing in fork-mashable dishes for patients with mastication or swallowing impairments. Foods 2024; 13 (12) 17
103 Ismael-Mohammed K, Bolivar-Prados M, Laguna L, Clavé P. Measuring the rheological and textural properties of thick purees used to manage patients with swallowing disorders. Nutrients 2023; 15 (17) 3767
104 Hou L, Lei Y, Li X. et al. Effect of protein supplementation combined with resistance training on muscle mass, strength and function in the elderly: a systematic review and meta-analysis. J Nutr Health Aging 2019; 23 (05) 451-458
105 Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2009; 2009 (02) CD003288
106 Bauer JM, Verlaan S, Bautmans I. et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 2015; 16 (09) 740-747
107 Kaur D, Rasane P, Singh J. et al. Nutritional interventions for elderly and considerations for the development of geriatric foods. Curr Aging Sci 2019; 12 (01) 15-27
108 Campbell SM. Hydration needs throughout the lifespan. J Am Coll Nutr 2007; 26 (05) 585S-587S
109 EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). Scientific Opinion on Dietary reference values for water. EFSA Journal 2010; 8 (03) 1459
110 Armstrong LE. Challenges of linking chronic dehydration and fluid consumption to health outcomes. Nutr Rev 2012; 70 (Suppl. 02) S121-S127
111 Goroff H, Herzog L, Cardi R, Reding M. Use of oral hydration protocols for dysphagic patients following stroke. Rehabil Nurs 2018; 43 (05) 290-296
112 Sezgin B, Durusoy D, Demirci MS. et al. The effect of “xanthan gum-based fluid thickener” on hydration, swallowing functions and nutritional status in total maxillectomy patients. Eur Arch Otorhinolaryngol 2018; 275 (12) 2997-3005
113 Whelan K. Inadequate fluid intakes in dysphagic acute stroke. Clin Nutr 2001; 20 (05) 423-428
114 Kalil AC, Metersky ML, Klompas M. et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63 (05) e61-e111
115 Bass CC. An effective method of personal oral hygiene; part II. J La State Med Soc 1954; 106 (03) 100-112
116 Yaacob M, Worthington HV, Deacon SA. et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev 2014; 2014 (06) CD002281
117 American Dental Association. Brushing Your Teeth. Accessed July 18, 2024 at: https://www.mouthhealthy.org/all-topics-a-z/brushing-your-teeth
118 Scannapieco FA. Pneumonia in nonambulatory patients. The role of oral bacteria and oral hygiene. J Am Dent Assoc 2006; 137 (October, Suppl): 21S-25S
119 Hollaar VRY, van der Putten GJ, van der Maarel-Wierink CD, Bronkhorst EM, de Swart BJM, Creugers NHJ. The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study. BMC Geriatr 2017; 17 (01) 128
120 Van Strydonck DAC, Slot DE, Van der Velden U, Van der Weijden F. Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin Periodontol 2012; 39 (11) 1042-1055
121 Silvestri L, Weir I, Gregori D. et al. Effectiveness of oral chlorhexidine on nosocomial pneumonia, causative micro-organisms and mortality in critically ill patients: a systematic review and meta-analysis. Minerva Anestesiol 2014; 80 (07) 805-820
122 Vieira PC, de Oliveira RB, da Silva Mendonça TM. Should oral chlorhexidine remain in ventilator-associated pneumonia prevention bundles?. Med Intensiva (Engl Ed) 2022; 46 (05) 259-268
123 Dale CM, Rose L, Carbone S. et al. Effect of oral chlorhexidine de-adoption and implementation of an oral care bundle on mortality for mechanically ventilated patients in the intensive care unit (CHORAL): a multi-center stepped wedge cluster-randomized controlled trial. Intensive Care Med 2021; 47 (11) 1295-1302
124 De Cassai A, Pettenuzzo T, Busetto V. et al. Chlorhexidine is not effective at any concentration in preventing ventilator-associated pneumonia: a systematic review and network meta-analysis. J Anesth Analg Crit Care 2024; 4 (01) 30
125 Calvo I, Sunday KL, Macrae P, Humbert IA. Effects of chin-up posture on the sequence of swallowing events. Head Neck 2017; 39 (05) 947-959
126 Li M, Huang S, Ding Y, Li X, Cui Y, Chen S. The effectiveness of chin-down manoeuvre in patients with dysphagia: a systematic review and meta-analysis. J Oral Rehabil 2024; 51 (04) 762-774
127 Forbes J, Humbert I. Impact of the chin-down posture on temporal measures of patients with dysphagia: a pilot study. Am J Speech Lang Pathol 2021; 30 (03) 1049-1060
128 Macrae P, Anderson C, Humbert I. Mechanisms of airway protection during chin-down swallowing. J Speech Lang Hear Res 2014; 57 (04) 1251-1258
129 Young JL, Macrae P, Anderson C, Taylor-Kamara I, Humbert IA. The sequence of swallowing events during the chin-down posture. Am J Speech Lang Pathol 2015; 24 (04) 659-670
130 Nagy A, Peladeau-Pigeon M, Valenzano TJ, Namasivayam AM, Steele CM. The effectiveness of the head-turn-plus-chin-down maneuver for eliminating vallecular residue. CoDAS 2016; 28 (02) 113-117
131 Balou M, McCullough GH, Aduli F. et al. Manometric measures of head rotation and chin tuck in healthy participants. Dysphagia 2014; 29 (01) 25-32
132 Seo M, Park JW. Head rotation as an effective compensatory technique for dysphagia caused by unilateral cervical osteophytes. J Int Med Res 2022; 50 (08) 30 00605221116757
133 Kim CK, Ryu JS, Song SH. et al. Effects of head rotation and head tilt on pharyngeal pressure events using high resolution manometry. Ann Rehabil Med 2015; 39 (03) 425-431
134 Logemann JA. Dysphagia: evaluation and treatment. Folia Phoniatr Logop 1995; 47 (03) 140-164
135 McCullough GH, Kamarunas E, Mann GC, Schmidley JW, Robbins JA, Crary MA. Effects of Mendelsohn maneuver on measures of swallowing duration post stroke. Top Stroke Rehabil 2012; 19 (03) 234-243
136 Kim JH, Kim YA, Lee HJ. et al. Effect of the combination of Mendelsohn maneuver and effortful swallowing on aspiration in patients with dysphagia after stroke. J Phys Ther Sci 2017; 29 (11) 1967-1969
137 Bülow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia 2001; 16 (03) 190-195
138 Donzelli J, Brady S. The effects of breath-holding on vocal fold adduction: implications for safe swallowing. Arch Otolaryngol Head Neck Surg 2004; 130 (02) 208-210
139 Chaudhuri G, Hildner CD, Brady S, Hutchins B, Aliga N, Abadilla E. Cardiovascular effects of the supraglottic and super-supraglottic swallowing maneuvers in stroke patients with dysphagia. Dysphagia 2002; 17 (01) 19-23
140 Langmore SE, Pisegna JM. Efficacy of exercises to rehabilitate dysphagia: a critique of the literature. Int J Speech Lang Pathol 2015; 17 (03) 222-229
141 Speyer R, Cordier R, Sutt AL. et al. Behavioural interventions in people with oropharyngeal dysphagia: a systematic review and meta-analysis of randomised clinical trials. J Clin Med 2022; 11 (03) 685
142 Carnaby G, Hankey GJ, Pizzi J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurol 2006; 5 (01) 31-37
143 Yoshimatsu Y, Tobino K, Kawabata T. et al. Hemorrhaging from an intramedullary cavernous malformation diagnosed due to recurrent pneumonia and diffuse aspiration bronchiolitis. Intern Med 2021; 60 (09) 1451-1456

Zusatzmaterial

Supplementary Material