Of proverbs and prevention: aspiration and its consequences in older patients

摘要

According to an African proverb, ‘there are two things overnwhich you have complete dominion, authority and control—nyour mind and your mouth’. Geriatricians are fully aware thatnin many of their patients the first half of the proverb may, atnleast temporarily, not apply. The current edition of Age andnAgeing contains two original contributions which, especiallynwhen taken in conjunction, may challenge our perceptionnand practice relating to the second half, and in particular tonprevention of upper respiratory infection in the frail hospitalisednor institutionalised older person.nIn the first contribution, Ewan and colleagues [1] demonstratenthat in a convenience sample of 29 cognitively intactnorthopaedic inpatients (24 women), with a mean age ofn81.5 years, bacteria known to be responsible for hospital-acquirednpneumonia can be isolated from the mouthoropharynx (hereafter abbreviated as ‘mouth’) of ~45% ofnsubjects. Culture of a simple 20-s oral rinse with sterile waternseems to be the most sensitive method of detection. In thensecond contribution, Cabre and colleagues [2] showed in anprospective study that, in 134 patients (80 men) with a meannage of 84.5 years, consecutively admitted to an acute geriatricsnunit with well-documented pneumonia, 55% hadnclinical signs of dysphagia on bedside assessment usingnwell-validated and discriminative methodology. The patientsnin Cabre’s study, though pre-selected for a diagnosis of pneumonia,nwere otherwise representative of the clinical spectrumnof hospitalised acutely ill elderly people, with multiple comorbiditynand high levels of both functional and cognitivenimpairment.