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Dysphagia, dystussia, and aspiration pneumonia in elderly people

Satoru Ebihara1, Hideki Sekiya1, Midori Miyagi1

  • 11 Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan ; 2 Department of Oral Surgery, Toho University Faculty of Medicine, Tokyo, Japan ; 3 Department of Geriatric Medicine, Kyorin University School of Medicine, Tokyo, Japan ; 4 Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.

Journal of Thoracic Disease
|April 15, 2016
PubMed

Insights

Increasing pneumonia deaths in the elderly are linked to aging populations. A new approach shifts focus from infection to functional decline, specifically addressing dysphagia and silent aspiration in older adults.

Area of Science:

  • Gerontology
  • Pulmonology
  • Pathology

Background:

  • Despite existing guidelines, pneumonia mortality is rising, particularly in aging populations.
  • Conventional understanding of aspiration pneumonia as solely infectious is challenged.
  • Chronic aspiration of even sterile material can induce lung inflammation.

Purpose of the Study:

  • To investigate the non-infectious mechanisms of aspiration pneumonia in the elderly.
  • To propose a paradigm shift in aspiration pneumonia treatment towards function-oriented therapy.
  • To highlight the role of dysphagia and silent aspiration in elderly pneumonia.

Main Methods:

  • Induction of chronic aspiration in mouse models.
  • Observation of inflammatory responses in mouse lungs and frail elderly individuals.
  • Analysis of the aging process cascade: dementia, dysphagia, dystussia, atussia, and silent aspiration.

Main Results:

  • Chronic aspiration of small amounts of sterile material causes aspiration pneumonia in mice.
  • This chronic aspiration induces inflammation in both elderly individuals and mouse lungs.
  • Silent aspiration, resulting from atussia (impaired cough reflex), is a critical factor in severe pneumonia.

Conclusions:

  • A shift from pathogen-oriented to function-oriented therapy is crucial for managing elderly aspiration pneumonia.
  • Therapy should focus on addressing functional decline, particularly dysphagia and cough dysfunction.
  • Further research into strategies for restoring function in the elderly is essential to reduce pneumonia mortality.
Keywords:
Dysphagiaaspiration pneumoniadystussia

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