, Volume 5, Issue 2, pp 61–71 | Cite as

Aspiration and the elderly

  • Michael J. Feinberg
  • Janice Knebl
  • Joann Tully
  • Linda Segall


Aspiration is prevalent in the elderly but its association with impairment of oral intake and gastroesophageal reflux is often misunderstood. This paper describes the causes, pathophysiology, and consequences of aspiration and their unique features in aged persons. It also explains how videofluoroscopic evaluation can assess current function while limiting factors that result in misinformation. The management of aspiration is discussed, emphasizing the importance and difficulties in maintaining functional well-being and possible complications of therapy.

Key words

Aspiration Aspiration pneumonia Swallowing, geriatrics Deglutition Deglutition disorders 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Huxley EJ, Viroslav J, Gray WR, Pierce AK: Pharyngeal aspiration in normal adults and patients with depressed consciousness.Am J Med 64:564–568, 1978CrossRefPubMedGoogle Scholar
  2. 2.
    Logemann JA:Evaluation and Treatment of Swallowing Disorders. San Diego: College-Hill Press, 1983Google Scholar
  3. 3.
    Linden PL: Another view on the evaluation and treatment of swallowing problems. Paper presented at the American Congress of Rehabilitation Medicine, Baltimore, 1986Google Scholar
  4. 4.
    Groher ME:Dysphagia: Diagnosis and Management. Stoneham MA: Butterworth, 1984Google Scholar
  5. 5.
    Kramer SS: Radiologie examination of the swallowing impaired child.Dysphagia 3:117–125, 1989CrossRefPubMedGoogle Scholar
  6. 6.
    Mendelson CL: The aspiration of stomach contents into the lungs during obstetric anesthesia.Am J Obstet Gynecol 52:191–205, 1946Google Scholar
  7. 7.
    Cameron JL, Zuidema GD: Aspiration pneumonia: magnitude and frequency of the problem.JAMA 219:1194–1196, 1972CrossRefPubMedGoogle Scholar
  8. 8.
    Arms RA, Dines DE, Tinstman TC: Aspiration pneumonia.Chest 65:136–139, 1974PubMedGoogle Scholar
  9. 9.
    Bartlett JG, Corbach SL, Feingold SM: The bacteriology of aspiration pneumonia.Am J Med 56:202–207, 1974CrossRefPubMedGoogle Scholar
  10. 10.
    Johanson Jr WG, Harris GD: Aspiration pneumonia, anaerobic infections, and lung abscesses.Med Clin North Am 64:385–395, 1980PubMedGoogle Scholar
  11. 11.
    Berk SL, Verghese AC, Holtsclaw SA, Smith JK: Enteroccal pneumonia.Am J Med 74:153–164, 1983CrossRefPubMedGoogle Scholar
  12. 12.
    Sheth N, Diner WC: Swallowing problems in the elderly.Dysphagia 2:209–215, 1988CrossRefPubMedGoogle Scholar
  13. 13.
    Zerhouni EA, Bosma JF, Donner MW: Relationship of cervical spine disorders to dysphagia.Dysphagia 1:129–144, 1987Google Scholar
  14. 14.
    Ellis FH, Schlegel JF, Lynck VP, Olsen SA: Cricopharyngcal myotomy for pharyngo-oesophageal diverticulum.Am Surg 170:340–349, 1969Google Scholar
  15. 15.
    Curtis DJ, Cruess DF, Berg T: The cricopharyngeal muscle: a videofluoroscopic review.AJR 142:497–500, 1984PubMedGoogle Scholar
  16. 16.
    Soergel KH, Zboralski FF, Amberg JR: Presbyesophagus: esophageal motility in nonagenarians.J Clin Invest 48:1472–1478, 1964Google Scholar
  17. 17.
    Hollis JB, Castell DO: Esophageal function in elderly men: a new look at “presbyesophagus.”Ann Intern Med 80:371–374, 1974PubMedGoogle Scholar
  18. 18.
    Mittal RK, Siskind BN, Hongo M, Flye MW, McCallum RW: Dysphagia aortico: clinical, radiological, and manometric findings.Dig Dis Sci 31:379–384, 1986CrossRefPubMedGoogle Scholar
  19. 19.
    Pries JM: Coping with reflux esophagitis in the aged.Geriatrics 37:57–67, 1982PubMedGoogle Scholar
  20. 20.
    Feinberg MJ, Ekberg O: Oral versus pharyngeal dysfunction as the cause of aspiration — analysis of 50 cases. Paper presented at the Society of Gastrointestinal Radiologists. Hawaii, 1990Google Scholar
  21. 21.
    Bartlett JG, Gorbach SL: The triple threat of aspiration pneumonia.Chest 68:560–566, 1975PubMedGoogle Scholar
  22. 22.
    Newman GE, Effman EL, Putman CE: Pulmonary aspiration complexes in adults.Curr Prob Diagn Radiol 9:3–47, 1982Google Scholar
  23. 23.
    Exarhos ND, Logan WD, Abbott OA, Hatcher CR: The importance of pH and volume in tracheobronchial aspiration.Dis Chest 47:167–169, 1965PubMedGoogle Scholar
  24. 24.
    Teabeaut JR: Aspiration of gastric contents — an experimental study.Am J Pathol 28:51–67, 1952PubMedGoogle Scholar
  25. 25.
    Hamelberg W, Bosomworth PP: Aspiration pneumonitis: experimental studies and clinical observations.Anesth Analg 43:669–677, 1964PubMedGoogle Scholar
  26. 26.
    Bynum LJ, Pierce AK: Pulmonary aspiration of gastric contents.Am Rev Respir Dis 114:1129–1136, 1976PubMedGoogle Scholar
  27. 27.
    Landay MJ, Christensen EE, Bynum LJ: Pulmonary manifestations of acute aspiration of gastric contents.AJR 131:587–592, 1978PubMedGoogle Scholar
  28. 28.
    Belcher JR: The pulmonary complications of dysphagia.Thorax 4:44–56, 1949PubMedCrossRefGoogle Scholar
  29. 29.
    Kennedy JH: “Silent” gastroesophageal reflux: an important but little known cause of pulmonary complications.Dis Chest 42:42–45, 1962Google Scholar
  30. 30.
    Barish CF, Wu WC, Castell DO: Respiratory complications of gastroesophageal reflux.Arch Intern Med 145:1882–1888, 1985CrossRefPubMedGoogle Scholar
  31. 31.
    Garb JL, Brown RB, Garb JR, Tuthill RW: Differences in etiology of pneumonias in nursing home and cumminity patients.JAMA 240:2169–2172, 1978CrossRefPubMedGoogle Scholar
  32. 32.
    Ebright JR, Rytel MW: Bacterial pneumonia in the elderly.J Am Geriatr Soc 28:220–223, 1980PubMedGoogle Scholar
  33. 33.
    Palmer L: Bacterial colonization: pathogenesis and clinical significance.Clin Chest Med 8:455–467, 1987PubMedGoogle Scholar
  34. 34.
    Valenti WM, Trudell RG, Bentley DW: Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged.N Engl J Med 298:1108–1111, 1978PubMedCrossRefGoogle Scholar
  35. 35.
    Pontoppidan H, Beecher HK: Progressive loss of protective reflexes in the airway with advance age.JAMA 174:2209–2213, 1960PubMedGoogle Scholar
  36. 36.
    Verghese A, Berk SL: Bacterial pneumonia in the elderly.Medicine 62:271–285, 1983PubMedGoogle Scholar
  37. 37.
    Terry PB, Fuller SD: Pulmonary consequences of aspiration.Dysphagia 3:179–183, 1989CrossRefPubMedGoogle Scholar
  38. 38.
    Head MA: Foreign body reaction to inhalation of lentil soup: giant cell pneumonia.J Clin Pathol 9:295–299, 1956PubMedGoogle Scholar
  39. 39.
    Crome L, Valentine JC: Pulmonary nodular granulomatosis caused by inhaled vegetal particles.J Clin Pathol 15:21–25, 1962PubMedGoogle Scholar
  40. 40.
    Vidyarthi SC: Diffuse miliary granulomatosis of the lungs due to aspirated vegetal cells.Arch Pathol 83:215–218, 1967PubMedGoogle Scholar
  41. 41.
    Pinkerton H: The reaction to oils and fats in the lung.Arch Pathol 5:380–401, 1928Google Scholar
  42. 42.
    Crausaz FM, Favez G: Aspiration of solid food particles into lungs of patients with gastroesophageal reflux and chronic bronchial disease.Chest 93:376–378, 1988PubMedGoogle Scholar
  43. 43.
    Niederman MS, Fein AM: Pneumonia in the elderly.Geriatr Clin North Am 2:241–168, 1986Google Scholar
  44. 44.
    Bentley DW: Bacterial pneumonia in the elderly.Hosp Pract 23:99–116, 1988Google Scholar
  45. 45.
    Puxty JAH, Andrews K: The role of chest radiology in the evaluation of the “geriatric giants.”Age Ageing 15:174–176, 1986PubMedGoogle Scholar
  46. 46.
    Kross DE, Effmann EL, Putman CE: Adult aspiration pneumonia.Am Fam Physician 22:73–78, 1980PubMedGoogle Scholar
  47. 47.
    Gelperin A: Sudden death in an elderly population from aspiration of food.J Am Geriatr Soc 22:135–136, 1974PubMedGoogle Scholar
  48. 48.
    Irwin RS, Ashba JK, Braman SS, Lee HY, Corrao WM: Food asphyxiation in hospitalized patients.JAMA 237:2744–2745, 1977CrossRefPubMedGoogle Scholar
  49. 49.
    Feinberg MJ, Ekberg O: Radiologic evaluation of deglutition after near-fetal choking episode. Paper presented at the Radiologic Society of North America, Chicago, 1989Google Scholar
  50. 50.
    Widdicombe JG: Respiratory reflexes from trachea and bronchi of cat.J Physiol 123:55–70, 1954PubMedGoogle Scholar
  51. 51.
    Braman SS, Corrao WM: Cough: differential diagnosis and treatment.Clin Chest Med 8:177–188, 1987PubMedGoogle Scholar
  52. 52.
    Logemann JA (ed):Manual for the Videofluorographic Study of Swallowing. San Diego: College-Hill Press, 1988Google Scholar
  53. 53.
    Linden P: Videofluoroscopy in the rehabilitation of swallowing dysfunction.Dysphagia 3:189–191, 1989CrossRefPubMedGoogle Scholar
  54. 54.
    Jones B, Kramer SS, Donner MW: Dynamic imaging of the pharynx.Gastrointest Radiol 10:213–224, 1985CrossRefPubMedGoogle Scholar
  55. 55.
    Robbins UH, Sufit R, Rosenbek J, Levine R, Hyland J: A modification of the modified barium swallow.Dysphagia 2:83–86, 1987CrossRefPubMedGoogle Scholar
  56. 56.
    Linden P, Siebens AA: Dysphagia: predicting laryngeal penetration.Arch Phys Med Rehab 64:281–283, 1983Google Scholar
  57. 57.
    Modell JH: Biology of drowning.Annu Rev Med 29:1–39, 1978CrossRefPubMedGoogle Scholar
  58. 58.
    Dodds WJ, Man KM, Cook IJ, Kahrilas PJ, Stewart ET, Kern MK: Influences of bolus volume on swallow-induced hyoid movement in normal subjects.AJR 150:1307–1309, 1988PubMedGoogle Scholar
  59. 59.
    Cook IJ, Dodds WJ, Dantes RO, Benson M, Kern MK, Lang IM, Brasseur JG, Hogan JH: Opening mechanisms of the human upper esophageal sphincter.Am J Physiol 257 (Gastrointest Liver Physiol 20):G748-G759, 1989PubMedGoogle Scholar
  60. 60.
    Reich SB: Production of pulmonary edema by aspiration of water soluble nonabsorable contrast media.Radiology 92:367–370, 1969PubMedGoogle Scholar
  61. 61.
    Gelfand DW: Complications of gastrointestinal radiologic procedures: I. Complications of routine fluoroscopic studies.Gastrointest Radiol 5:295–315, 1980Google Scholar
  62. 62.
    Nelson SW, Christoridis AJ, Pratt PC: Further experience with barium sulphate as a bronchographic contrast medium.Am J Roentenol 92:595–614, 1964Google Scholar
  63. 63.
    Almy TP: Comprehensive functional assessment for elderly patients.Ann Intern Med 109:70–72, 1988Google Scholar
  64. 64.
    Olins NJ: Feeding decisions for incompetent patients.J Am Geriatr Soc 34:317, 1986Google Scholar
  65. 65.
    Campbell-Taylor I, Fisher RH: The clinical case against tube feeding in palliative care of the elderly.J Am Geriatr Soc 35:1100–1104, 1987PubMedGoogle Scholar
  66. 66.
    Lo B, Dornbrand L: Guiding the hand that feeds: caring for the demented elderly.N Engl J Med 311:402–404, 1984PubMedCrossRefGoogle Scholar
  67. 67.
    Kirby DF, Craig RM, Tsang TK, Plotnick BH: Percutaneous endoscopic gastrostomies: a prospective evaluation and review of the literature.J Parenteral Enteral Nutr 10:155–159, 1986CrossRefGoogle Scholar
  68. 68.
    Larson DE, Burton DD, Schroeder KW, Di Magno EP: Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients.Gastroenterology 93:48–52, 1987PubMedGoogle Scholar
  69. 69.
    Olivares L, Segovia A, Revuelta R: Tube feeding and lethal aspiration in neurological patients: a review of 720 autopsy cases.Stroke 5:645–657, 1974Google Scholar
  70. 70.
    Ciocon JO, Silverstone FA, Graver M, Foley CJ: Tube feeding in elderly patients: indications, benefits, and complications.Arch Intern Med 148:429–433, 1988CrossRefPubMedGoogle Scholar
  71. 71.
    Hassett JM, Sunby C, Flint LM: No elimination of aspiration pneumonia in neurologically disabled patients with feeding gastrostomy.Surg Gynecol Obstet 167:383–388, 1988PubMedGoogle Scholar
  72. 72.
    Feinberg M, Kneble J, Tully J: Pneumonia and aspiration: findings in an elderly population. Poster presented at the International Congress of Radiology, Paris, 1989Google Scholar
  73. 73.
    Ponsky JL, Aszodi A: Percutaneous endoscopic jejunostomy.Am J Gastroenterol 79:113–116, 1984PubMedGoogle Scholar
  74. 74.
    Alzate GD, Coons HG, Elliot J, Carey PH: Percutaneous gastrostomy for jejunal feeding: a new technique.AJR 147:822–825, 1986PubMedGoogle Scholar
  75. 75.
    Blitzer A, Krespi YP, Oppenheimer RW, Levine TM: Surgical management of aspiration.Otolaryngol Clin North Am 21:743–750, 1988PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1990

Authors and Affiliations

  • Michael J. Feinberg
    • 3
  • Janice Knebl
    • 1
  • Joann Tully
    • 2
  • Linda Segall
    • 2
  1. 1.Department of MedicineFort Worth Osteopathic HospitalFort WorthUSA
  2. 2.Department of Physical Medicine and RehabilitationPhiladelphia Geriatric CenterPhiladelphiaUSA
  3. 3.Department of RadiologyAlbert Einstein Medical CenterPhiladelphiaUSA

Personalised recommendations