2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

O. Ortega et al.

Neurogastroenterology and Motility

without OD and 6.7 in those with OD. 9 Therefore, as we are currently doing in our hospital, we suggest systematically screening for dysphagia, MN and oral health and hygiene in FOP to prevent complications; and we recommend that multidisciplinary dysphagia teams include a dental care professional. In summary, in this study we have found three main elements contributing to the pathophysiology of AP in older people: firstly, oral dysbiosis and colo- nization by respiratory pathogens; secondly, OD and impaired safety of swallow with aspirations, and thirdly a frail or vulnerable patient with impaired nutritional status and altered immunity. Today, with simple and economic tools, we are able to treat these three main elements to avoid AP by teaching oral hygiene to improve oral health status and avoid colonization, rheologically adapting fluids and solid foods to prevent aspirations and supplementing diet- ary intake to manage malnutrition and improve nutritional status.

groups. This suggests that impaired functional status of dysphagic patients had more impact on respiratory pathogens than it did on commensal microbiota. The finding that microbiota composition was similar among patient groups further supports this notion. Interestingly, microbiota composition and TBL were very different in nasopharynx compared to oral loca- tions. These results agree with previous studies com- paring oral and nasal microbiota of healthy individuals. 51 – 54 Oral colonization by respiratory pathogens together with impaired health status and impaired safety of swallow make patients very vulnerable to respiratory infections and AP. Specific interventions treating oral health and hygiene in these patients are needed and treatment against oral respiratory pathogens to restore healthy microbiota. One systematic review recom- mended that ‘oral health care consisting of tooth brushing after each meal, cleaning dentures once a day, and regular professional oral healthcare, as the best intervention to reduce the incidence of AP’. 21 It is important to note that more than 50% OHI-S compo- sition found in all groups was caused by the accumu- lation of dental plaque, which is a soft bacterial biofilm easily removable by correct tooth brushing. In a review, Sjogren et al. found a preventive effect of mechanical oral hygiene on pneumonia and respiratory tract infection in hospitalized and institutionalized older people. 19 The importance of good oral care evaluations and practices has been stated in several publications that have demanded the participation of nurses and/or dentists to improve and manage older patients’ mouths and to advise and educate relatives and carers about oral hygiene. 55 Several studies, including randomized clinical trials, have shown that improving oral hygiene reduces the incidence of pneu- monia 19,20,56 – 58 and would prevent 10% of deaths from pneumonia in older nursing-home residents. 19 This indicates the great importance of mouth care in older patients at risk of AP. Recently, the WHO has recom- mended strategies to enhance oral health in older people. In addition, the US Centers for Disease Control and Prevention recognizes aspiration of microorgan- isms as an important etiological route for the develop- ment of AP in older patients and recommends ‘comprehensive hygiene programs’. 59 However, oral healthcare in older patients is still not properly man- aged or standardized in many hospitals and nursing homes. 60 We recently found that OD is a very preva- lent and relevant risk factor associated with hospital readmission for pneumonia in the elderly; the inci- dence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years in individuals

ACKNOWLEDGMENTS

We would like to thank Dr. Rajat Mukherjee for proposing the method to estimate the pathogen load; Dr. Ivana Jankovic and Dr. Harald Br € ussow for the contribution to the design of study; Irene Lopez for her help with sample taking, processing and conserva- tion; Viridiana Arreola and Alberto Martın for performing the dysphagia clinical and instrumental assessment; Maria Roca for the nutritional evaluation and Dr. Laia Rofes for methodological support. We would like to thank Mrs. Jane Lewis for reviewing the manuscript.

FUNDING

This work has been supported by Nestle Health Science, Vevey, Switzerland and Nestec Ltd. P. Clave is funded by CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.

DISCLOSURE

PC has served as consultant and received research funding from Nestle Health Science. OS, SC, BB, and JS are employees of Nestec Ltd., Switzerland.

AUTHOR CONTRIBUTION

OO recruited patients, collected, and analyzed the samples, analyzed clinical data and wrote the manuscript; OS designed the study, analyzed the samples and data and wrote part of the manuscript; SC analyzed the samples; BB and JS analyzed microbiological data and performed microbiota statistical analy- sis; CP and SZ performed the dental assessment and collected dental plaque samples; JN designed and supervised dental exam- inations; SCa collected nutritional data; PC designed and super- vised the study and manuscript redaction. All authors have revised and approved the final version of the manuscript.

© 2015 John Wiley & Sons Ltd

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