Protect the health of the elderly and beware of aspiration

As the aging society accelerates, the health problems of the elderly are receiving more and more attention. Among them, elderly aspiration, as a health hazard that is easily ignored but has great harm, is quietly threatening the life safety and quality of life of many elderly people. According to studies, the incidence of aspiration in the elderly population cannot be underestimated, and it tends to increase with age, seriously affecting the physical health and quality of life of the elderly.

1. The severity of aspiration in the elderly

Aspiration refers to the accidental entry of food, saliva or gastric contents into the respiratory tract. It is the main cause of aspiration pneumonia, suffocation and even death in the elderly. Data from the World Health Organization show that the global mortality rate due to aspiration in the elderly over 65 years old is as high as 15%-20%. Clinical studies in my country have shown that among elderly patients with aspiration, about 40% will develop aspiration pneumonia, and the mortality rate of severe patients exceeds 50% (Li et al., 2021).

2. Identification of high-risk groups

Elderly people with the following characteristics need to be particularly vigilant:

1. Patients with neurological diseases (stroke, Parkinson's disease, dementia)

2. Swallowing function assessment (Kubota drinking test) ≥ level 3

3. People who are bedridden for a long time or taking sedatives

4. Patients with gastroesophageal reflux disease

5. Patients after surgery for head and neck tumors

Common causes of aspiration in the elderly

Physiological function decline: With age, the swallowing reflex and cough reflex of the elderly will gradually become dull. The movement of the epiglottis cartilage is no longer as agile as when they were young, and it cannot close the airway in time and effectively, which greatly increases the risk of aspiration.

Disease factors: Many common geriatric diseases are closely related to aspiration. For example, neurological diseases, such as stroke and Alzheimer's disease, can interfere with the transmission of nerve signals and affect swallowing function. Stroke patients have a higher probability of aspiration in the acute phase, which is related to the damage to the brain affecting the swallowing center. In addition, Parkinson's patients have muscle stiffness and slow movements, and their swallowing movements will also be significantly affected. Respiratory diseases such as chronic obstructive pulmonary disease (COPD) can cause the elderly to have reduced respiratory function, weak coughs, and difficulty in expelling aspirated foreign bodies.

Drug influence: Some elderly people need to take a lot of drugs for a long time due to multiple chronic diseases. Some drugs, such as sedatives, hypnotics, antipsychotics, etc., may inhibit the function of the nervous system, leading to weakened swallowing reflex and cough reflex, thereby increasing the possibility of aspiration.

Eating habits and environmental factors: Bad eating habits such as eating too fast, talking while eating, and eating while lying down can easily cause food to enter the airway inadvertently. In addition, the noisy environment around the meal distracts the elderly and increases the risk of aspiration.

4. The hazards of aspiration in the elderly

Aspiration is harmful to the elderly in many ways and is serious. In mild cases, it may cause choking, coughing, and wheezing, making the elderly feel very uncomfortable; in severe cases, food or foreign objects completely block the airway, leading to acute suffocation, which can be life-threatening if not effectively treated in a short period of time. Even if it is not life-threatening on the spot, aspiration may cause aspiration pneumonia, and repeated lung infections can seriously damage lung function, further reducing the quality of life of the elderly and increasing the medical burden.

V. Scientific preventive measures

1. Adjust your eating habits:

• Body position selection: When eating, try to let the elderly sit upright and lean forward 15-30 degrees. This position helps food pass through the esophagus smoothly and reduces the possibility of aspiration. For the elderly who cannot sit up, the head of the bed can be raised 30-60 degrees and the head can be tilted to one side.

• Control eating speed: remind the elderly to chew slowly and not to eat too much food per mouthful, generally 1-2 ml is appropriate. At the same time, avoid rushing the elderly to eat, so that they have enough time to complete the swallowing action.

• Choose appropriate food: Choose food with appropriate texture according to the chewing and swallowing ability of the elderly. For example, cut vegetables and meat into small pieces, or make them into puree or paste. Avoid giving the elderly food that is too dry, rough, or sticky, such as glutinous rice balls and rice cakes.

2. Oral care: Good oral hygiene can reduce the growth of oral bacteria and reduce the risk of pneumonia caused by oral secretions. Clean the elderly's mouth at least 2-3 times a day, using warm water, light salt water or special oral care solution, and clean the mouth, teeth and tongue coating in the correct way.

3. Swallowing training: For elderly people with mildly impaired swallowing function, swallowing training can be performed under the guidance of doctors or rehabilitation therapists. For example, empty swallowing training allows the elderly to perform swallowing movements without eating, and practice 3-4 groups a day, 10-15 times per group; there is also nodding swallowing, which can help clear residual food in the pharynx by nodding while swallowing.

4. Regular physical examinations: Take the elderly to the hospital for a comprehensive physical examination regularly to promptly detect and treat diseases that may cause aspiration, such as neurological diseases, respiratory diseases, etc. At the same time, inform the doctor of all the medications the elderly are taking so that the doctor can evaluate the impact of the medication on swallowing function and adjust the medication regimen if necessary.

5. Create a safe eating environment: Keep the eating environment quiet and tidy, and avoid watching TV, chatting or doing other distracting activities while eating.

Elderly aspiration is not unpreventable. As long as we are vigilant, understand the causes of aspiration, master the correct prevention methods, and integrate them into our daily lives, we can build a solid health defense line for the elderly at home and let them enjoy a safe and comfortable life in their later years. Caring for the elderly starts with preventing aspiration.

References

[1] Chinese Medical Association Geriatrics Branch. (2020). Expert consensus on prevention of aspiration in the elderly. Chinese Journal of Geriatrics, 39(5), 498-503.

[2] Smithard DG. (2022).Dysphagia

Management and Aspiration Pneumonia. Clin Interv Aging,17, 685-697.

[3] WHO. (2021). Global report on ageism. Geneva: World Health Organization.

[4] Li Xue et al. (2021). Analysis of risk factors for aspiration in elderly hospitalized patients. Chinese Journal of Nursing Management, 21(3), 412-415.

[5] IDDSI Framework.(2019). International Dysphagia Diet Standardization Initiative Complete IDDSI Framework