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Medical Care for the Elderly
Aspiration and Aspiration Pneumonia
JMAJ 46(1): 12–18, 2003
Tsuyoshi NAGATAKE
Professor, Department of Internal Medicine,
Institute of Tropical Medicine, Nagasaki University
Abstract: It is not rare for aspiration to occur in association with a severe parox-
ysm of coughing in elderly people. In such cases, a depressed cough reflex may
result in severe aspiration pneumonia. Aspiration becomes clinically evident when
the patient chokes or has a fit of coughing during a meal. In contrast, a less obvious
form of aspiration, which is almost asymptomatic, is called micro-aspiration. When
food or drink, saliva containing oral microbial flora, or regurgitated gastric acid is
aspirated into the airway, severe inflammation of the lower respiratory tract and
lung parenchyma occurs. Since aspiration can cause pneumonia and serious
airway damage, the prevention of aspiration is important, particularly in elderly
people. Pathogenic microorganisms are more likely to colonize the oral cavity in
patients with swallowing disorders. Thus, when patients with swallowing disorders
are admitted to a hospital, they are at a higher risk of encountering nosocomial
pathogens, i.e., multidrug-resistant bacteria. Therefore, protection against aspi-
ration and prevention of lower respiratory tract infection by ensuring good oral
hygiene may be the most practical and effective means for the prevention of
pneumonia in the elderly.
Key words: Aspiration pneumonia; Hospital-acquired pneumonia;
Depressed cough reflex; Anaerobic infections
Introduction Aspiration b
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