Pneumonia is a very frightening disease for the elderly. In many cases, pneumonia leads to death, making it a daily health challenge for the elderly and their families. Therefore, it is important to understand dysphagia, which can trigger pneumonia, and aspiration pneumonia, which is common among the elderly, for prevention and daily health care.

 

*Aspiration pneumonia is common in the elderly.

 Aspiration is when saliva, food, or gastric juices enter the trachea. Aspiration pneumonia occurs when bacteria contained in the food or saliva enter the lungs through the trachea.

While awake, people may notice if something gets into the trachea by choking on it, but it is difficult to notice if saliva is aspirated little by little while they are asleep.

As a result, aspiration pneumonia occurs more frequently in the elderly, and the bacteria become resistant to medications, making them less effective. Therefore, it is important to prevent aspiration pneumonia, and when it does occur, it is important to cure it completely.

Treatment is with antibiotics and sometimes steroids. If the patient is unable to breathe properly and becomes oxygen-deprived, he or she may be given oxygen inhalation or, depending on his or her condition, a ventilator.

*Prevention of Aspiration Pneumonia

 To prevent aspiration pneumonia, the following precautions should be taken

(1) Maintain cleanliness of the oral cavity.

 The oral cavity is the gateway to the lungs and gastrointestinal tract. Bacteria thrive in the mouth where moderate humidity and temperature are maintained, and they can multiply quickly if you do not brush your teeth or rinse your mouth. Therefore, it is important to brush one's teeth thoroughly to prevent the growth of bacteria in the mouth and to prevent them from being carried into the lungs.

(2) Prevent gastric reflux.

 If you experience burping or heartburn, reflux of gastric juices can occur. In such cases, sitting up and keeping the body upright for 2 hours after eating can prevent reflux.

(3) Improve the swallowing reflex.

 Swallowing is the act of taking something down. The condition in which this does not work is called dysphagia and is one of the causes of aspiration pneumonia. Dysphagia is explained in the next section.

(4) Use of medications.

 Drugs to prevent cerebral infarction are effective in preventing the recurrence of aspiration pneumonia and may be used.

 

*What is dysphagia?

 Dysphagia is a condition in which a person has difficulty chewing food or swallowing saliva or crushed food. We eat by chewing food in the mouth, sending it to the back of the mouth with the tongue, and swallowing. During this process, the roof of the mouth (soft palate) blocks the nasal cavity, and the epiglottis, the lid of the trachea, closes. This allows food from the mouth to pass through the esophagus to the stomach without entering the trachea or nose.

However, in the event of a stroke or damage to the cranial nervous system or muscles, this sequence of movements can be disturbed. This is called dysphagia, and the following symptoms are seen:

- Difficulty swallowing.

- Pain or distress when swallowing.

- Food spills from the mouth or remains in the mouth.

- Drooling.

- Dry mouth.

- Takes a long time to eat.

- Voice changes after swallowing.

- Coughing or gagging before, during, or after swallowing

- Swallowing before, after, or during swallowing may cause swallowing, coughing, or regurgitation.

If any of these symptoms are observed, visit your family doctor and consult with him or her about eating and care methods suited to the patient, to prevent aspiration.

 

*Considerations for daily life

 As the general function of the elderly declines, their swallowing function also declines, making them prone to swallowing and making it difficult to swallow food due to dryness in the mouth. Therefore, the following considerations should be made daily:

 

<Eating posture> 

When eating, the patient should be in a forward-bent posture. Some people who require nursing care and who eat in bed or need assistance in eating may eat in an upward position, leaning against a bed or chair.

However, it is difficult to swallow when facing up, and there is a risk of aspiration if food slips out of the airway before the airway lid closes. It is important to bend forward when eating, whether in a chair or bed. When eating in a chair, care should be taken to maintain proper posture.

 

<Consideration for meal content>

 To ensure smooth eating, it is important to determine which part of the swallowing process is causing the problem and to consider the meal content accordingly.

 

1. Problems with mastication (chewing and crushing).

 Chopping, boiling softly, or mashing like mashed potatoes will make it easier to eat.

2. Problems with food mass formation (reassembling chewed food).

 Since the child is unable to put food together in the mouth, finely chopped food becomes floppy and easily swallowed. Cut the food into bite-sized pieces, make it soft, or thicken it.

3. Swallowing problems.

 Swallowing may be caused by solid foods or water. When swallowing solid foods, soften or thicken the food to make it easier to eat. If the swallowing problem occurs with water, it is recommended to thicken tea or soup.

If the patient has difficulty chewing or swallowing, it is easy to switch him or her to a liquid diet or chopped food, but there are various ways to deal with this problem, depending on where the problem lies between putting food in the mouth and swallowing it.

However, the response varies depending on where the patient is in the process of taking food into the mouth and swallowing it. Make sure that the patient can fully enjoy eating by taking care of his or her condition.

In addition, to prevent oral dryness and dehydration, be sure to drink about 5 to 6 glasses of water a day.

 

<Preventing Decline in Swallowing Function >

 Simple exercises stimulate the muscles of the mouth, tongue, and cheeks necessary for eating, stimulate saliva secretion, and reduce difficulty in swallowing and swallowing. By performing these exercises before each meal, you can enjoy your meals more.

Eating is not only about nutrition but also about communication and enjoyment, which greatly affects our sense of fulfillment. To maintain good eating habits and good health, it is important to take proper care of your patients and prevent pneumonia."

 

(Note: The translation has been provided to the best, but there may be slight variations or interpretations. Please refer to the original Japanese article for complete accuracy.)

 

References

Southern TOHOKU Hospital Group嚥下障害と誤嚥性肺炎｜高齢者｜予防｜体操｜食事 (minamitohoku.or.jp)