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Aspiration and Infection in the Elderly

Epidemiology, Diagnosis and Management

  • Therapy In Practice
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Abstract

Aspiration of the oropharyngeal or gastric contents by elderly persons often leads to lower respiratory tract infections, such as aspiration pneumonia or pneumonitis. The existence of dysphagia and aspiration in elderly patients are important factors in the occurrence of aspiration pneumonia, but are not sufficient to cause aspiration pneumonia in the absence of other risk factors. Salivary flow and swallowing can eliminate Gram-negative bacilli from the oropharynx in healthy persons. However, elderly persons may have diminished production of saliva as a result of medications and oral/dental disease, leading to poor oral hygiene and oropharyngeal colonisation with pathogenic organisms. When dysphagic patients aspirate pathogenic bacteria while swallowing food or liquids, they must also have decreased defences, such as impaired immunity or pulmonary clearance, in order to develop aspiration pneumonia.

Elderly patients with cerebrovascular disease often have dysphagia that leads to an increased incidence of aspiration. It was previously reported that patients with silent cerebral infarction affecting the basal ganglia were more likely to experience subclinical aspiration and an increased incidence of pneumonia. Basal ganglia infarction leads to the impairment of dopamine metabolism and, as a consequence, a decrease of substance P in the glossopharyngeal nerve and sensory vagal nerves. Therefore, dysphagia and a decreased cough reflex may be induced by the impairment of dopamine metabolism in some elderly patients with cerebrovascular disease, suggesting that pharmaceutical agents which modulate dopamine metabolism may be able to improve swallowing and the cough reflex in patients with basal ganglia infarction.

The main strategy for controlling aspiration and aspiration-related pulmonary infection in the elderly is to prevent aspiration of pathogenic bacteria along with the oropharyngeal or gastric contents. Because aspiration pneumonia in the elderly is related to certain risk factors, including dysphagia and aspiration, effective preventive measures involve various approaches, such as pharmacological therapy, swallowing training, dietary management, oral hygiene and positioning.

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References

  1. Moine P, Vercken JB, Chevret S, et al. Severe community-acquired pneumonia: etiology, epidemiology, and prognosis factors. French Study Group for Community-Acquired Pneumonia in the Intensive Care Unit. Chest 1994; 105(5): 1487–95

    PubMed  CAS  Google Scholar 

  2. Torres A, Serra-Batlles J, Ferrer A, et al. Severe community-acquired pneumonia: epidemiology and prognostic factors. Am Rev Respir Dis 1991; 144(2): 312–8

    PubMed  CAS  Google Scholar 

  3. Marrie TJ. Community-acquired pneumonia in the elderly. Clin Infect Dis 2000; 31(4): 1066–78

    PubMed  CAS  Google Scholar 

  4. Riquelme R, Torres A, El Ebiary M, et al. Community-acquired pneumonia in the elderly: a multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med 1996; 154(5): 1450–5

    PubMed  CAS  Google Scholar 

  5. Kaplan V, Angus DC, Griffin MF, et al. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med 2002; 165(6): 766–72

    PubMed  Google Scholar 

  6. Marrie TJ. Epidemiology of community-acquired pneumonia in the elderly. Semin Respir Infect 1990; 5(4): 260–8

    PubMed  CAS  Google Scholar 

  7. Rello J, Rodriguez R, Jubert P, et al. Severe community-acquired pneumonia in the elderly: epidemiology and prognosis. Study Group for Severe Community-Acquired Pneumonia. Clin Infect Dis 1996; 23(4): 723–8

    PubMed  CAS  Google Scholar 

  8. Kikuchi R, Watabe N, Konno T, et al. High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med 1994; 150(1): 251–3

    PubMed  CAS  Google Scholar 

  9. Plant RL. Anatomy and physiology of swallowing in adults and geriatrics. Otolaryngol Clin North Am 1998; 31(3): 477–88

    PubMed  CAS  Google Scholar 

  10. Cook IJ, Dodds W, Dantas R, et al. Opening mechanisms of the human upper esophageal sphincter. Am J Physiol 1989; 257 (5 Pt 1): G748–59

    PubMed  CAS  Google Scholar 

  11. Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev 2001; 81(2): 929–69

    PubMed  CAS  Google Scholar 

  12. Fucile S, Wright PM, Chan I, et al. Functional oral-motor skills: do they change with age? Dysphagia 1998; 13(4): 195–201

    PubMed  CAS  Google Scholar 

  13. Jaradeh S. Neurophysiology of swallowing in the aged. Dysphagia 1994; 9(4): 218–20

    PubMed  CAS  Google Scholar 

  14. Tracy JF, Logemann JA, Kahrilas PJ, et al. Preliminary observations on the effects of age on oropharyngeal deglutition. Dysphagia 1989; 4(2): 90–4

    PubMed  CAS  Google Scholar 

  15. Ekberg O, Feinberg MJ. Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. AJR Am J Roentgenol 1991; 156(6): 1181–4

    PubMed  CAS  Google Scholar 

  16. Robbins J, Hamilton JW, Lof GL, et al. Oropharyngeal swallowing in normal adults of different ages. Gastroenterology 1992; 103(3): 823–9

    PubMed  CAS  Google Scholar 

  17. Nilsson H, Ekberg O, Olsson R, et al. Quantitative aspects of swallowing in an elderly nondysphagic population. Dysphagia 1996; 11(3): 180–4

    PubMed  CAS  Google Scholar 

  18. Ren J, Shaker R, Kusano M, et al. Effect of aging on the secondary esophageal peristalsis: presbyesophagus revisited. Am J Physiol 1995; 268 (5 Pt 1): G772–9

    PubMed  CAS  Google Scholar 

  19. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001; 344(9): 665–71

    PubMed  CAS  Google Scholar 

  20. Winfield JB, Sande MA, Gwaltney Jr JM. Aspiration during sleep [letter]. JAMA 1973; 223(11): 1288

    PubMed  CAS  Google Scholar 

  21. Huxley EJ, Viroslav J, Gray WR, et al. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978; 64(4): 564–8

    PubMed  CAS  Google Scholar 

  22. Gleeson K, Eggli DF, Maxwell SL. Quantitative aspiration during sleep in normal subjects. Chest 1997; 111(5): 1266–72

    PubMed  CAS  Google Scholar 

  23. Addington WR, Stephens RE, Gilliland K, et al. Tartaric acid-induced cough and the superior laryngeal nerve evoked potential. Am J Phys Med Rehabil 1998; 77(6): 523–36

    PubMed  CAS  Google Scholar 

  24. Katsumata U, Sekizawa K, Ebihara T, et al. Aging effects on cough reflex [letter]. Chest 1995; 107(1): 290–1

    PubMed  CAS  Google Scholar 

  25. Addington WR, Stephens RE, Gilliland K, et al. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke. Arch Phys Med Rehabil 1999; 80(2): 150–4

    PubMed  CAS  Google Scholar 

  26. Addington WR, Stephens RE, Gililand K, et al. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison. Stroke 1999; 30(6): 1203–7

    PubMed  CAS  Google Scholar 

  27. Wang HD, Nakagawa T, Sekizawa K, et al. Cough reflex in the night [letter]. Chest 1998; 114(5): 1496–7

    PubMed  CAS  Google Scholar 

  28. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anaesthesia. Am J Obstet Gynecol 1946; 52: 191–205

    PubMed  CAS  Google Scholar 

  29. Exarhos ND, Logan Jr WD, Abbott OA, et al. The importance of pH and volume in tracheobronchial aspiration. Dis Chest 1965; 47: 167–9

    PubMed  CAS  Google Scholar 

  30. du Moulin GC, Paterson DG, Hedley-Whyte J, et al. Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet 1982; I(8266): 242–5

    Google Scholar 

  31. Garvey BM, McCambley JA, Tuxen DV. Effects of gastric alkalization of bacterial colonization in critically ill patients. Crit Care Med 1989; 17(3): 211–6

    PubMed  CAS  Google Scholar 

  32. Matsuse T, Oka T, Kida K, et al. Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly. Chest 1996; 110(5): 1289–93

    PubMed  CAS  Google Scholar 

  33. Daniels SK, Brailey K, Priestly DH, et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil 1998; 79(1): 14–9

    PubMed  CAS  Google Scholar 

  34. Daniels SK, Brailey K, Foundas AL. Lingual discoordination and dysphagia following acute stroke: analyses of lesion localization. Dysphagia 1999; 14(2): 85–92

    PubMed  CAS  Google Scholar 

  35. Smithard DG, O’Neill PA, England RE, et al. The natural history of dysphagia following a stroke. Dysphagia 1997; 12(4): 188–93

    PubMed  CAS  Google Scholar 

  36. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognostic factors at 6 months. Stroke 1999; 30(4): 744–8

    PubMed  CAS  Google Scholar 

  37. Meng NH, Wang TG, Lien IN. Dysphagia in patients with brainstem stroke: incidence and outcome. Am J Phys Med Rehabil 2000; 79(2): 170–5

    PubMed  CAS  Google Scholar 

  38. Pinto A, Yanai M, Nakagawa T, et al. Swallowing reflex in the night [letter]. Lancet 1994; 344(8925): 820–1

    PubMed  CAS  Google Scholar 

  39. Langmore SE, Terpenning MS, Schork A, et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia 1998; 13(2): 69–81

    PubMed  CAS  Google Scholar 

  40. Kikawada M, Oyama T, Ogawa K, et al. The characterization of bronchoalveolar lavage fluid in very elderly patients with cerebrovascular disease. J Gerontol A Biol Sci Med Sci 2001; 56(12): M771–4

    PubMed  CAS  Google Scholar 

  41. Kikawada M, Iwamoto T, Takasaki M, et al. Elevation of neutrophils and interleukin-8 in bronchoalveolar lavage fluid from old-old patients with cerebrovascular disease [letter]. J Am Geriatr Soc 2002; 50(12): 2096–8

    PubMed  Google Scholar 

  42. Kobayashi H, Hoshino M, Okayama K, et al. Swallowing and cough reflexes after onset of stroke [letter]. Chest 1994; 105(5): 1623

    PubMed  CAS  Google Scholar 

  43. Teramoto S, Matsuse T, Ouchi Y. Clinical significance of cough as a defense mechanism or a symptom in elderly patients with aspiration and diffuse aspiration bronchiolitis [letter]. Chest 1999; 115(2): 602–3

    PubMed  CAS  Google Scholar 

  44. Orlando RC. Overview of the mechanisms of gastroesophageal reflux. Am J Med 2001; 111(8A): 174S–7S

    PubMed  Google Scholar 

  45. Holloway RH, Hongo M, Berger K, et al. Gastric distention: a mechanism for postprandial gastroesophageal reflux. Gastroenterology 1985; 89(4): 779–84

    PubMed  CAS  Google Scholar 

  46. Freidin N, Fisher MJ, Taylor W, et al. Sleep and nocturnal acid reflux in normal subjects and patients with reflux oesophagitis. Gut 1991; 32(11): 1275–9

    PubMed  CAS  Google Scholar 

  47. Shaker R, Ren J, Podvrsan B, et al. Effect of aging and bolus variables on pharyngeal and upper esophageal sphincter motor function. Am J Physiol 1993; 264 (3 Pt 1): G427–32

    PubMed  CAS  Google Scholar 

  48. Ferriolli E, Oliveira RB, Matsuda NM, et al. Aging, esophageal motility, and gastroesophageal reflux. J Am Geriatr Soc 1998; 46(12): 1534–7

    PubMed  CAS  Google Scholar 

  49. Laforce FM, Hopkins J, Trow R, et al. Human oral defenses against gram-negative rods. Am Rev Respir Dis 1976; 114(5): 929–35

    PubMed  CAS  Google Scholar 

  50. LaForce FM, Thompson B, Trow R. Effect of atropine on oral clearance of a radiolabeled sulfur colloid. J Lab Clin Med 1984; 104(5): 693–7

    PubMed  CAS  Google Scholar 

  51. Palmer LB, Albulak K, Fields S, et al. Oral clearance and pathogenic oropharyngeal colonization in the elderly. Am J Respir Crit Care Med 2001; 164(3): 464–8

    PubMed  CAS  Google Scholar 

  52. Percival RS, Challacombe SJ, Marsh PD. Flow rates of resting whole and stimulated parotid saliva in relation to age and gender. J Dent Res 1994; 73(8): 1416–20

    PubMed  CAS  Google Scholar 

  53. Ben-aryeh H, Miron D, Berdicevsky I, et al. Xerostomia in the elderly: prevalence, diagnosis, complications and treatment. Gerodontology 1985; 4(2): 77–82

    PubMed  CAS  Google Scholar 

  54. Gibson G, Barrett E. The role of salivary function on oropharyngeal colonization. Spec Care Dentist 1992; 12(4): 153–6

    PubMed  CAS  Google Scholar 

  55. Lehtonen L, Eskola J, Vainio O, et al. Changes in lymphocyte subsets and immune competence in very advanced age. J Gerontol 1990; 45(3): M108–12

    PubMed  CAS  Google Scholar 

  56. Sansoni P, Cossarizza A, Brianti V, et al. Lymphocyte subsets and natural killer cell activity in healthy old people and centenarians. Blood 1993; 82(9): 2767–73

    PubMed  CAS  Google Scholar 

  57. Saltzman RL, Peterson PK. Immunodeficiency of the elderly. Rev Infect Dis 1987; 9(6): 1127–39

    PubMed  CAS  Google Scholar 

  58. Nakayama K, Monma M, Fukushima T, et al. Tuberculin responses and risk of pneumonia in immobile elderly patients. Thorax 2000; 55(10): 867–9

    PubMed  CAS  Google Scholar 

  59. Nakagawa T, Sekizawa K, Arai H, et al. High incidence of pneumonia in elderly patients with basal ganglia infarction. Arch Intern Med 1997; 157(3): 321–4

    PubMed  CAS  Google Scholar 

  60. Nakagawa T, Sekizawa K, Nakajoh K, et al. Silent cerebral infarction: a potential risk for pneumonia in the elderly. J Intern Med 2000; 247(2): 255–9

    PubMed  CAS  Google Scholar 

  61. Graybiel AM. Neurotransmitters and neuromodulators in the basal ganglia. Trends Neurosci 1990; 13(7): 244–54

    PubMed  CAS  Google Scholar 

  62. Itoh M, Meguro K, Fujiwara T, et al. Assessment of dopamine metabolism in brain of patients with dementia by means of 18F-fluorodopa and PET. Ann Nucl Med 1994; 8(4): 245–51

    PubMed  CAS  Google Scholar 

  63. Pernow B. Substance P. Pharmacol Rev 1983; 35(2): 85–141

    PubMed  CAS  Google Scholar 

  64. Ujiie Y, Sekizawa K, Aikawa T, et al. Evidence for substance P as an endogenous substance causing cough in guinea pigs. Am Rev Respir Dis 1993; 148 (6 Pt 1): 1628–32

    PubMed  CAS  Google Scholar 

  65. Sekizawa K, Ebihara T, Sasaki H. Role of substance P in cough during bronchoconstriction in awake guinea pigs. Am J Respir Crit Care Med 1995; 151 (3 Pt 1): 815–21

    PubMed  CAS  Google Scholar 

  66. Jia YX, Sekizawa K, Ohrui T, et al. Dopamine D1 receptor antagonist inhibits swallowing reflex in guinea pigs. Am J Physiol 1998; 274 (1 Pt 2): R76–80

    PubMed  CAS  Google Scholar 

  67. Nakagawa T, Ohrui T, Sekizawa K, et al. Sputum substance P in aspiration pneumonia [letter]. Lancet 1995; 345(8962): 1447

    PubMed  CAS  Google Scholar 

  68. Ramsey DJ, Smithard DG, Kalra L. Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke 2003; 34(5): 1252–7

    PubMed  Google Scholar 

  69. Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis 2000; 10(5): 380–6

    PubMed  CAS  Google Scholar 

  70. Langmore SE. Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior? Curr Opin Otolaryngol Head Neck Surg 2003; 11(6): 485–9

    PubMed  Google Scholar 

  71. Davies AE, Kidd D, Stone SP, et al. Pharyngeal sensation and gag reflex in healthy subjects. Lancet 1995; 345(8948): 487–8

    PubMed  CAS  Google Scholar 

  72. Leder SB. Videofluoroscopic evaluation of aspiration with visual examination of the gag reflex and velar movement. Dysphagia 1997; 12(1): 21–3

    PubMed  CAS  Google Scholar 

  73. Zaidi NH, Smith HA, King SC, et al. Oxygen desaturation on swallowing as a potential marker of aspiration in acute stroke. Age Ageing 1995; 24(4): 267–70

    PubMed  CAS  Google Scholar 

  74. Teramoto S, Fukuchi Y, Ouchi Y. Oxygen desaturation on swallowing in patients with stroke: what does it mean? Age Ageing 1996; 25(4): 333–6

    PubMed  CAS  Google Scholar 

  75. Ebihara T, Sekizawa K, Nakazawa H, et al. Capsaicin and swallowing reflex [letter]. Lancet 1993; 341(8842): 432

    PubMed  CAS  Google Scholar 

  76. Kobayashi H, Nakagawa T, Sekizawa K, et al. Levodopa and swallowing reflex [letter]. Lancet 1996; 348(9037): 1320–1

    PubMed  CAS  Google Scholar 

  77. Shore SA, Stimler-Gerard NP, Coats SR, et al. Substance P- induced bronchoconstriction in the guinea pig: enhancement by inhibitors of neutral metalloendopeptidase and angiotensin-converting enzyme. Am Rev Respir Dis 1988; 137(2): 331–6

    PubMed  CAS  Google Scholar 

  78. Tomaki M, Ichinose M, Miura M, et al. Angiotensin converting enzyme (ACE) inhibitor-induced cough and substance P. Thorax 1996; 51(2): 199–201

    PubMed  CAS  Google Scholar 

  79. Nakayama K, Sekizawa K, Sasaki H. ACE inhibitor and swallowing reflex [letter]. Chest 1998; 113(5): 1425

    PubMed  CAS  Google Scholar 

  80. Arai T, Yasuda Y, Takaya T, et al. ACE inhibitors and symptomless dysphagia [letter]. Lancet 1998; 352(9122): 115–6

    PubMed  CAS  Google Scholar 

  81. Sekizawa K, Matsui T, Nakagawa T, et al. ACE inhibitors and pneumonia [letter]. Lancet 1998; 352(9133): 1069

    PubMed  CAS  Google Scholar 

  82. Arai T, Yasuda Y, Toshima S, et al. ACE inhibitors and pneumonia in elderly people [letter]. Lancet 1998; 352(9144): 1937–8

    PubMed  CAS  Google Scholar 

  83. Arai T, Yasuda Y, Takaya T, et al. Angiotensin-converting enzyme inhibitors, angiotensin-II receptor antagonists, and pneumonia in elderly hypertensive patients with stroke [letter]. Chest 2001; 119(2): 660–1

    PubMed  CAS  Google Scholar 

  84. Nakagawa T, Wada H, Sekizawa K, et al. Amantadme and pneumonia [letter]. Lancet 1999; 353(9159): 1157

    PubMed  CAS  Google Scholar 

  85. Yamaya M, Yanai M, Ohrui T, et al. Antithrombotic therapy for prevention of pneumonia [letter]. J Am Geriatr Soc 2001; 49(5): 687–8

    PubMed  CAS  Google Scholar 

  86. Hankey GJ, Eikelboom JW. Homocysteine and vascular disease. Lancet 1999; 354(9176): 407–13

    PubMed  CAS  Google Scholar 

  87. Clarke R, Smith AD, Jobst KA, et al. Folate, vitamin B12, and serum total homocysteine levels in confirmed Alzheimer disease. Arch Neurol 1998; 55(11): 1449–55

    PubMed  CAS  Google Scholar 

  88. Fassbender K, Mielke O, Bertsch T, et al. Homocysteine in cerebral macroangiography and microangiopathy. Lancet 1999; 353(9164): 1586–7

    PubMed  CAS  Google Scholar 

  89. Matsui T, Arai H, Yuzuriha T, et al. Elevated plasma homocysteine levels and risk of silent brain infarction in elderly people. Stroke 2001; 32(5): 1116–9

    PubMed  CAS  Google Scholar 

  90. Selhub J, Jacques PF, Wilson PW, et al. Vitamin status and intake as primary determinations of homocysteinemia in an elderly population. JAMA 1993; 270(22): 2693–8

    PubMed  CAS  Google Scholar 

  91. Homocysteine Lowering Trialists’ Collaboration. Lowering blood homocysteine with folic acid based supplements: metaanalysis of randomized trials. BMJ 1998; 316(7135): 894–8

    Google Scholar 

  92. Sato E, Ohrui T, Matsui T, et al. Folate deficiency and risk of pneumonia in older people [letter]. J Am Geriatr Soc 2001; 49(12): 1739–40

    PubMed  CAS  Google Scholar 

  93. Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA 1999; 282(14): 1365–70

    PubMed  CAS  Google Scholar 

  94. Cole MJ, Smith JT, Molnar C, et al. Aspiration after percutaneous gastrostomy: assessment by Tc-99m labeling of the enterai feed. J Clin Gastroenterol 1987; 9(1): 90–5

    PubMed  CAS  Google Scholar 

  95. Park RH, Allison MC, Lang J, et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ 1992; 304(6839): 1406–9

    PubMed  CAS  Google Scholar 

  96. Strong RM, Condon SC, Solinger MR, et al. Equal aspiration rates from postpylorus and intragastric-placed small-bore nasoenteric feeding tubes: a randomized, prospective study. JPEN J Parenter Enterai Nutr 1992; 16(1): 59–63

    CAS  Google Scholar 

  97. Ciocon JO, Galindo-Ciocon DJ, Tiessen C, et al. Continuous compared with intermittent tube feeding in the elderly. JPEN J Parenter Enterai Nutr 1992; 16(6): 525–8

    CAS  Google Scholar 

  98. Nakajoh K, Nakagawa T, Sekizawa K, et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med 2000; 247(1): 39–42

    PubMed  CAS  Google Scholar 

  99. Yoneyama T, Yoshida M, Ohrui T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002; 50(3): 430–3

    PubMed  Google Scholar 

  100. Yoshino A, Ebihara T, Ebihara S, et al. Daily oral care and risk factors for pneumonia among elderly nursing home patients. JAMA 2001; 286(18): 2235–6

    PubMed  CAS  Google Scholar 

  101. Barker WH, Mullooly JP. Influenza vaccination of elderly persons: reduction in pneumonia and influenza hospitalizations and deaths. JAMA 1980; 244(22): 2547–9

    PubMed  CAS  Google Scholar 

  102. Fukushima T, Nakayama K, Monma M, et al. Benefits of influenza vaccination for bedridden patients [letter]. Arch Intern Med 1999; 159(11): 1258

    PubMed  CAS  Google Scholar 

  103. Sims RV, Steinmann WC, McConville JH, et al. The clinical effectiveness of pneumococcal vaccine in the elderly. Ann Intern Med 1988; 108(5): 653–7

    PubMed  CAS  Google Scholar 

  104. Sisk JE, Moskowitz AJ, Whang W, et al. Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1997; 278(16): 1333–9

    PubMed  CAS  Google Scholar 

  105. Nichol KL, Baken L, Wuorenma J, et al. The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease. Arch Intern Med 1999; 159(20): 2437–42

    PubMed  CAS  Google Scholar 

  106. Ortqvist A, Hedlund J, Burman LA, et al. Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Swedish Pneumococcal Vaccination Study Group. Lancet 1998 Feb 7; 351(9100): 399–403

    PubMed  CAS  Google Scholar 

  107. Finestone HM, Greene-Finestone LS. Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients. CMAJ 2003; 169(10): 1041–4

    PubMed  Google Scholar 

  108. Kollef MH. Ventilator-associated pneumonia: a multivariate analysis. JAMA 1993; 270(16): 1965–70

    PubMed  CAS  Google Scholar 

  109. Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomized trial. Lancet 1999; 354(9193): 1851–8

    PubMed  CAS  Google Scholar 

  110. Matsui T, Yamaya M, Ohrui T, et al. Sitting position to prevent aspiration in bed-bound patients. Gerontology 2002; 48(3): 194–5

    PubMed  CAS  Google Scholar 

  111. Logemann JA, Kahrilas PJ, Kobara M, et al. The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabil 1989; 70(10): 767–71

    PubMed  CAS  Google Scholar 

  112. Mier L, Dreyfuss D, Darchy B, et al. Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures. Intensive Care Med 1993; 19(5): 279–84

    PubMed  CAS  Google Scholar 

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  1. Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Masayuki Kikawada, Toshihiko Iwamoto & Masaru Takasaki

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  1. Masayuki Kikawada
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Correspondence to Masayuki Kikawada.

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Kikawada, M., Iwamoto, T. & Takasaki, M. Aspiration and Infection in the Elderly. Drugs Aging 22, 115–130 (2005). https://doi.org/10.2165/00002512-200522020-00003

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