LOEB M, BECKER M, EADY A, WALKER-DILKS C; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. K-1363.

McMaster University, Hamilton, ON, Canada.

BACKGROUND: Aspiration pneumonia is increasingly being recognized as an important cause of pneumonia in older adults. To assess the efficacy of interventions to reduce aspiration pneumonia in seniors, we conducted a systematic review. METHODS: We searched electronic databases including MEDLINE, EMBASE, COCHRANE library, CLINAHL, HEALTHSTAR. Selection criteria included a study population aged 65 years and older at risk for aspiration. Only randomized controlled trials were included. RESULTS: 27 trials were retrieved of which 8 met eligibility criteria. One trial compared three graded levels of therapist prescribed diet consistency and compensatory swallowing techniques. No differences in aspiration pneumonia were found between the groups (P=0.67). Prophylaxis with amantadine reduced pneumonia in elderly stroke patients in one trial, relative risk [RR] 0.22 (95%CI 0.09 to 0.55). Treatment of stroke patients with an anti-thrombotic (cyclic AMP diesterase inhibitor) in another trial reduced aspiration pneumonia (RR 0.33, 95% CI 0.18 to 0.6). Use of a viscometer to assess fluid thickness showed no difference between intervention and control arms (RR 1.11, 95%CI 0.56 to 2.22). In a study of residents of long-term care facilities, active oral care therapy had borderline significance in reducing pneumonia (RR 0.61, 95% CI 0.37 to 1.01). Three studies evaluating various strategies for tube feeding did not find significant differences between study arms: post pylorus placement of a feeding tube (versus intragastric placement) (P=0.62), continuous nasagastric (versus intermittent) (P=0.14), use of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes (P =0.15). All trials reviewed were either at medium or high risk of bias. CONCLUSIONS: Few strategies have been demonstrated to reduce aspiration pneumonia in older adults. The validity of studies that have demonstrated an effect are limited by methodologic flaws. Rigorous trials to reduce aspiration pneumonia are needed.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Aged
• Clinical Trials as Topic
• Enteral Nutrition
• Gastrostomy
• Homes for the Aged
• Humans
• Intubation, Gastrointestinal
• Jejunostomy
• Long-Term Care
• Patient Selection
• Pneumonia
• Pneumonia, Aspiration
• Randomized Controlled Trials as Topic
• Stroke
• United States
• methods
• surgery
• therapy

Other ID:

• GWAIDS0028004

UI: 102267628

From Meeting Abstracts