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Poor oral hygiene, oral microorganisms and aspiration pneumonia risk in older people in residential aged care: a systematic review


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Khadka, S, Khan, S ORCID: 0000-0002-6695-4013, Goldberg, LR ORCID: 0000-0002-8217-317X, King, A ORCID: 0000-0003-1792-0965 and Bettiol, SS ORCID: 0000-0002-4355-4498 2021 , 'Poor oral hygiene, oral microorganisms and aspiration pneumonia risk in older people in residential aged care: a systematic review' , Age and Ageing, vol. 50, no. 1 , pp. 81-87 , doi: 10.1093/ageing/afaa102.

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Background: aspiration pneumonia increases hospitalisation and mortality of older people in residential aged care.Objectives: determine potentially pathogenic microorganisms in oral specimens of older people with aspiration pneumonia and the effect of professional oral care in reducing aspiration pneumonia risk.Data sources: PUBMED/MEDLINE, CINAHL, EMBASE, COCHRANE, PROQUEST, Google Scholar, Web of Science.Study eligibility criteria: published between January 2001 and December 2019 addressing oral microorganisms, aspiration pneumonia, oral health and treatment.Participants: people 60 years and older in residential aged care.Study appraisal and synthesis methods: the Newcastle-Ottawa Scale and the Standard Protocol Items: Recommendations for Intervention Trials checklist.Results: twelve studies (four cross-sectional, five cohort and three intervention) reported colonisation of the oral cavity of older people by microorganisms commonly associated with respiratory infections. Aspiration pneumonia occurred less in people who received professional oral care compared with no such care. Isolation of Candida albicans, Staphylococcus aureus, methicillin-resistant S. aureus and Pseudomonas aeruginosa was related to mortality due to aspiration pneumonia. An interesting finding was isolation of Escherichia coli, a gut bacterium.Limitations: more information may be present in publications about other co-morbidities that did not meet inclusion criteria. A high degree of heterogeneity prevented a meta-analysis. Issues included sampling size, no power and effect size calculations; different oral health assessments; how oral specimens were analysed and how aspiration pneumonia was diagnosed.Conclusions and implications of key findings: pathogenic microorganisms colonising the oral microbiome are associated with aspiration pneumonia in older people in residential care; professional oral hygiene care is useful in reducing aspiration pneumonia risk.

Item Type: Article
Authors/Creators:Khadka, S and Khan, S and Goldberg, LR and King, A and Bettiol, SS
Keywords: poor oral hygiene, oral microorganisms, aspiration pneumonia risk, older people, residential aged care, review
Journal or Publication Title: Age and Ageing
Publisher: Oxford Univ Press
ISSN: 0002-0729
DOI / ID Number: 10.1093/ageing/afaa102
Copyright Information:

Copyright 2020 The Authors. This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record is available online at:

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