Severe aspiration pneumonia in the elderly

Abstract

The global population is aging at an unprecedented rate, resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities. In this context, severe aspiration pneumonia, a condition that carries substantial morbidity, mortality, and financial burden, especially among elderly patients requiring admission to the intensive care unit, has attracted greater concern. Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology. Prior episodes of coughing on food or liquid intake, a history of relevant underlying conditions, abnormalities on videofluoroscopy or water swallowing, and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration. Patients with aspiration pneumonia tend to be elderly, frail, and suffering from more comorbidities than those without this condition. Here, we comprehensively address the epidemiology, clinical characteristics, diagnosis, treatment, prevention, and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic, enhance outcomes, and minimize the healthcare costs associated with this illness. Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.

Keywords: Aged; Antibacterial agents; Aspiration pneumonia; Critical illness; Frailty; Swallowing disorders.

Figure 1

Graphic representation of risk-factor overlap in elderly patients with multiple comorbidities. CHF: Congestive heart failure; COPD: Chronic obstructive pulmonary disease; HIV: Human immunodeficiency virus; PPI: Proton pump inhibitor.

Figure 2

Treatment approach to severe community-acquired aspiration pneumonia. COPD: Chronic obstructive pulmonary disease; MRSA: Methicillin-resistant Staphylococcus aureus.