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Risk factors for aspiration pneumonia in frail older people: a systematic literature review.

Abstract：

OBJECTIVE:To systematically review the risks for aspiration pneumonia in frail older people and the contribution of bad oral health among the risk factors. DESIGN:Systematic literature review. SETTING:PubMed (Medline), Web of Science, Cochrane Library, EMBASE, and CINAHL were searched for eligible studies, published in English in the period January 2000 to April 2009. PARTICIPANTS:Frail older people. MEASUREMENTS:Only publications with regard to hospitalized, institutionalized, or frail home-dwelling people of 60 years and older were eligible. Two authors independently assessed the publications for their methodological quality. Unadjusted and adjusted odds ratios and their corresponding 95% confidence intervals for respective risk factors related to aspiration pneumonia were extracted. The results were evaluated according to the levels of evidence of the Oxford Centre for Evidence-based Medicine. RESULTS:A total of 21 publications fulfilled the quality criteria. Evidence level 2a (systematic review with homogeneity of cohort studies) was found for a positive relationship between aspiration pneumonia and age, male gender, lung diseases, dysphagia, and diabetes mellitus; 2b (individual cohort study) for severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, and bad oral health; 3a (systematic review with homogeneity of case-control studies) for malnutrition; 3b (individual case-control study) for Parkinson's disease and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health among the risk factors seems limited. CONCLUSION:Thirteen significant risk factors were identified: age, male gender, lung diseases, dysphagia, diabetes mellitus, severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, bad oral health, malnutrition, Parkinson's disease, and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health seems limited.

journal_name

J Am Med Dir Assoc

journal_title

Journal of the American Medical Directors Association

authors

van der Maarel-Wierink CD,Vanobbergen JN,Bronkhorst EM,Schols JM,de Baat C

doi

10.1016/j.jamda.2010.12.099

subject

Has Abstract

pub_date

2011-06-01 00:00:00

pages

344-54

issue

5

eissn

1525-8610

issn

1538-9375

pii

S1525-8610(11)00002-8

journal_volume

12

pub_type

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