Pneumonia

Pneumonia

Introduction

Pneumonia is a breathing condition that is characterized by swelling of the lungs or airways. It is the fourth most frequent cause of death in Japan. Besides, 30% of the people who pass away because of pneumonia get aspiration pneumonia (Sakashita et al., 2015). Japan has the highest incidence of aspiration pneumonia compared to any other European country (Sakashita et al., 2015).   Aspiration Pneumonia is a bacterial infection that occurs when toxic substances such as foods, liquids, or vomit are inhaled into the lungs instead of being swallowed into the esophagus and stomach (Lee & Ryu, 2018).  It is considered to be a dominant type of Community-Acquired Pneumonia (CAP) and HealthCare Associated Pneumonia (HCAP).  The condition is common among the elderly, and it is the leading cause of their mortality in Japan.  Elder people suffering from two or more symptomatic chronic conditions are highly susceptible to aspiration pneumonia.  Aspiration pneumonia has other risk factors such as inadequate oral hygiene, lung disease, diabetes mellitus, age, dysphagia, and male gender (Manabe & Teramoto et al., 2015).

Primarily, the condition affects older people, with 80% of the cases occurring in people who are 65 years and above (Jaiswal et al., 2014).  Besides, 60% of the older people who are diagnosed with Community-Acquired Pneumonia often suffer from aspiration (Lee & Ryu, 2018). The condition is a threat to the lives of older people. Its mortality rate varies from 1% to 48%, and it is related to age, the severity of the disease, and comorbidities (Jaiswal et al., 2014). Notably, older adults aspirate during sleep, and this increases their vulnerability to aspiration pneumonia.   Therefore, several treatment options have been implemented, such as the use of antibiotics and proper oral care (Mohammadi, Franks, & Hines, 2015).  People should adopt the method that works best for them because untreated aspiration pneumonia can cause loss of artificial teeth and disintegration of the crown (Mohammadi, Franks, & Hines, 2015). The project will focus on comparing the reliability of good oral hygiene and regular oral care in decreasing the number of older people suffering from aspiration pneumonia.

Spirit of Inquiry Ignited

Aspiration pneumonia is associated with increased death rates for the aging population, especially in Japan, since it is an aging country (Muller, 2015).   Aspiration pneumonia is either community or healthy acquired results to increased ICU stays (Muller, 2015). It may also result in mechanical ventilation and higher lengths of hospital admissions (Muller, 2015).  Besides, if the condition is not treated on time, it can be life-threatening.  The death rates due to aspiration pneumonia are at 11% to 30%, and they are likely to escalate if patients are not properly handled (Momosaki& Yasunaga et al., 2015). The mental stability of 30% of the patients who suffer from community-acquired aspiration pneumonia is altered (Momosaki & Yasunaga et al., 2015).  In addition, 19% of the patients under nursing care also suffer from mental problems such as anxiety attacks (Momosaki & Yasunaga et al., 2015).  Moreover, the condition may result in stigmatization, which may negatively affect the social life of the patient.

The disease can also cause severe complications, especially on people who take long to seek medical help.  It may spread rapidly and affect other body parts or systems, including the bloodstream. Primarily, aspiration pneumonia results in particular complications that may be detrimental to the life of the patient. These complications include acute respiratory distress (ARDS), respiratory failure, and bacterial pneumonia (Momosaki & Yasunaga et al., 2015).  Subsequently, bacterial pneumonia may result in lung abscess, empyema, and parapneumonic effusion.  People who recover from the condition often experience regular hospital admissions.

Since obesity is associated with low-quality oral hygiene practicing proper oral care can be practical in decreasing the incidence of the disease. Various health care personnel such as physicians, nurses, dentists, dieticians, and counselors should co-operate to offer quality care to the patients. Their collaboration can result in positive health outcomes.

PICOT

In 75-85-year-old patients with presbyesophagus from a skilled nursing facility (P), how does an intensified maintenance of good oral hygiene (I) compared with regular oral care (C) decrease an incidence of aspiration pneumonia (O) in three months (T)?

Search Strategy

The primary databases used to search for relevant information were the Cochrane Database, CINAHL, PubMed, and Dynamed, Trip Medical Database.   The term oral hygiene was used as a keyword during the search.  To get broader results, the phrase, ‘Decreasing the incidence of aspiration pneumonia among the elderly’’ was used as an optional phrase. Other phrases used during the search include Community-Acquired Pneumonia, HealthCare Associated Pneumonia.  The selected articles had to be peer-reviewed and those that were published within the last five years. Useful articles were found in PubMed; however, it was not easy to access them.  The database had more than 500 articles that met the inclusion criteria and were relevant. Thirty-one of the articles found focused on HealthCare Associated Pneumonia. Five of them were prospective observational studies, fourteen reviews, and twelve retrospective observational studies.  The Cochrane Database was the most helpful while trying to find the relevant articles.  It had five articles that were reviews and approximately 150 trials.  It was easy to search the articles by topic, status, and type of article.  Most articles were free to access, and they were currently published.   The main challenge that people come across while searching for articles is getting recent articles that are of the type they want.

Critical Appraisal of the Evidence Performed

A study that used randomized control trials by Muller (2015) investigated hoe oral hygiene is useful in reducing the incidence of aspiration pneumonia in older adults who are vulnerable or frail. The article suggested that oral care should involve people brushing their teeth for five minutes after taking a meal and getting weekly professional hygiene. Iodine was provided to the patients to compliment the remedy (Muller, 2015).  Mechanical hygiene is effective in reducing the incidence of pneumonia.  However, the use of chemicals alone was not consistent in reducing the prevalence of pneumonia and other respiratory infections (Muller, 2015).  The best remedy for reducing the prevalence of aspiration pneumonia involves brushing teeth after every meal, getting rid of removable prostheses, and weekly professional oral health (Mohammadi, Franks, & Hines, 2015).  However, the article did mention that it may be difficult for fragile older adults to visit the hospital.  Besides, the number of participants was too small to be to evaluate larger populations or an entire country.

However, Momosaki (2017) argued that rehabilitative management was the most effective in decreasing the number of older adults suffering from aspiration pneumonia. Rehabilitative management involves dysphagia, pulmonary, and physical control of aspiration pneumonia patients.  Early rehabilitation results in reduced hospital stays and mortality rates (Momosaki, 2017). Combining rehabilitative management with proper nutrition improves the clinical outcomes aspiration pneumonia elderly patients, including swallowing function.

Evidence integrated with clinical expertise and patient preferences to inform a decision and practical change implemented

The implementation plan is examined to determine if the suggested remedy or approach was effective in decreasing the prevalence of aspiration pneumonia in older adults.  Several steps are involved;

Research Setting and population

The setting will be a small-scale nursing facility that handles elderly patients who have aspiration pneumonia.

Patients who are 65 years and above

People suffering aspiration pneumonia and they did not have chronic disorders

Sample strategy

50 patients will be randomly selected from the facility to be used for the research

The health records and medical history of the patients will be assessed to ensure they are not suffering from chronic disorders.

Written concept will be obtained from the patients and their primary care physicians.

The age of the patients will be checked to ensure they are fit for the study.

Management Approach

The medical health professionals involved in handled will taken through formal discussions and conversations about appropriate oral hygiene.  The discussions will teach them about the precautions they should take when handling elderly patients. The weight, age, mental stability, comorbidities, and weight history of the patients will be evaluated

Stakeholders

The medical team involved in taking care of the patients includes physicians, dentists, counselors, nurses, and dieticians. They will combine their expertise to ensure proper care is given to the elderly.

Limitations

The number of participants selected was not enough to be used to make decisions about a larger population.

Data collection and analyzing tool

Questionnaires will be used to collect data from the participants and medical care professionals to find out if the remedy was effective. Proper oral care will be used in one group, while the other group will not receive any form of oral care. The effectiveness and reliability of the remedy will be assessed using the hierarchical regression model.

Outcome Evaluated

Data will be analyzed using the SPSS 20 software.  The overall objective of the research is evaluating the efficiency of oral hygiene in handling older adults who have aspiration pneumonia. The rate of hospitalization, hospital stays, and mortality will be used to assess if oral care is decreasing the prevalence of aspiration pneumonia among the aging population.   The negative impacts that may arise from the use of different chemicals for oral care should also be evaluated.

Project Dissemination

The findings of the study complemented the health outcomes or predictions made by medical care experts.  The results of the survey were positive such as the reduction in mortality and hospital stays. The medical care experts involved in handling the patients will attend a medical seminar. They will examine the limitations and strengths of the study. They will also suggest ways of maintaining the strengths and minimizing the weaknesses or shortcomings. The professionals will evaluate if their findings can be used to implement approaches to taking care of elderly patients suffering from aspiration pneumonia. The primary care physicians will engage their patients in discussions or conversations about oral hygiene. The leaders will publish posters to ensure the findings are accessible to other people.  To get to a broader population, they should publish their findings on papers and post them on the internet.  They can also post their results in Databases that are accessible to all people.

Conclusion

Aspiration Pneumonia is a health condition that results when toxic gastric substances such as food and vomit get into the lungs instead of being swallowed.  The disease primarily affects older adults, and it is a significant cause of their death.  Japan is one country where the prevalence of aspiration pneumonia is high.  The risk factors for this condition include age, male gender, diabetes mellitus, and poor oral care. Remedies such as oral care are effective in decreasing the incidence of aspiration pneumonia in older adults.  The project evaluated the effectiveness of proper oral care in preventing and treating aspiration pneumonia. Good oral hygiene is effective in reducing hospital stays and mortality rates that result from aspiration pneumonia.

References

Lee, A. S., & Ryu, J. H. (2018, June). Aspiration Pneumonia and Related Syndromes. In Mayo Clinic Proceedings (Vol. 93, No. 6, pp. 752-762). Elsevier.

Jaiswal, M., Chaturvedi, T. P., Srivastava, G. N., Parihar, A. V., & Pratap, C. B. (2014). Poor oral dental hygiene and aspiration pneumonia. The Journal of Community Health Management, 1(1), 67-71.

Manabe, T., Teramoto, S., Tamiya, N., Okochi, J., & Hizawa, N. (2015). Risk factors for aspiration pneumonia in older adults. PloS one, 10(10), e0140060.

Mohammadi, J. J. Y., Franks, K., & Hines, S. (2015). Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol. JBI database of systematic reviews and implementation reports, 13(10), 110-122.

Momosaki, R. (2017). Rehabilitative management for aspiration pneumonia in elderly patients. Journal of general and family medicine, 18(1), 12-15.

Momosaki, R., Yasunaga, H., Matsui, H., Horiguchi, H., Fushimi, K., & Abo, M. (2015). Effect of early rehabilitation by physical therapists on in-hospital mortality after aspiration pneumonia in the elderly. Archives of physical medicine and rehabilitation, 96(2), 205-209.

Müller, F. (2015). Oral hygiene reduces the mortality from aspiration pneumonia in frail elders. Journal of dental research, 94(3_suppl), 14S-16S.

Sakashita, R., Takami, M., Ono, H., Nishihira, T., Sato, T., & Hamada, M. (2015). Preventing aspiration pneumonia among the elderly: a review focused on the impact of the consistency of food substances. Interface oral health science, 335.