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. 2022 Oct;13(5):1071-1080.
doi: 10.1007/s41999-022-00689-3. Epub 2022 Aug 25.

The diagnosis of aspiration pneumonia in older persons: a systematic review

Yuki Yoshimatsu  1   2 , Dorte Melgaard  3   4 , Albert Westergren  5 , Conni Skrubbeltrang  6 , David G Smithard  7   8
Affiliations

The diagnosis of aspiration pneumonia in older persons: a systematic review

Yuki Yoshimatsu et al. Eur Geriatr Med. 2022 Oct.

Abstract

Purpose: Community-acquired pneumonia (CAP) is highly common across the world. It is reported that over 90% of CAP in older adults may be due to aspiration. However, the diagnostic criteria for aspiration pneumonia (AP) have not been widely agreed. Is there a consensus on how to diagnose AP? What are the clinical features of patients being diagnosed with AP? We conducted a systematic review to answer these questions.

Methods: We performed a literature search in MEDLINE®, EMBASE, CINHAL, and Cochrane to review the steps taken toward diagnosing AP. Search terms for "aspiration pneumonia" and "aged" were used. Inclusion criteria were: original research, community-acquired AP, age ≥ 75 years old, acute hospital admission.

Results: A total of 10,716 reports were found. Following the removal of duplicates, 7601 were screened, 95 underwent full-text review, and 9 reports were included in the final analysis. Pneumonia was diagnosed using a combination of symptoms, inflammatory markers, and chest imaging findings in most studies. AP was defined as pneumonia with some relation to aspiration or dysphagia. Aspiration was inferred if there was witnessed or prior presumed aspiration, episodes of coughing on food or liquids, relevant underlying conditions, abnormalities on videofluoroscopy or water swallow test, and gravity-dependent distribution of shadows on chest imaging. Patients with AP were older, more frailer, and had more comorbidities than in non-AP.

Conclusion: There is a broad consensus on the clinical criteria to diagnose AP. It is a presumptive diagnosis with regards to patients' general frailty rather than in relation to swallowing function itself.

Keywords: Aspiration; Diagnosis; Dysphagia; Geriatric; Pneumonia; Swallowing disorders.

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Conflict of interest statement

The authors declare that they have no other competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study process. Through searching databases, 10 716 reports were found. After removing duplicates, 7601 reports were screened, of which 7506 were excluded. A total of 95 studies underwent full-text review, and 9 studies were included in the review
See this image and copyright information in PMC

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