medwireNews: Findings from a US study suggest that improving oral hygiene could reduce rates of pneumonia in community-dwelling older adults.
Manisha Juthani-Mehta (Yale University, New Haven, Connecticut) and colleagues found that 22% of hospitalizations for pneumonia were attributable to high levels of oral plaque or incident mobility limitation.
Writing in the Journal of the American Geriatric Society, they suggest that the former could be a consequence of the latter and, "as mobility limitation ensues, oral hygiene begins to decline as well, and oral hygiene may be the greater pneumonia risk factor."
Their data were taken from the Health, Aging, and Body Composition (Health ABC) Study which began in 1998. By the end of follow up in 2008, 193 (13.4%) of 1441 well-functioning, community dwelling adults aged 70 to 79 years required hospitalization for pneumonia.
The authors found that several non-modifiable factors were associated with a significant risk for pneumonia hospitalization, which was elevated 2.1-fold in men, 1.4-fold by White race, 3.1-fold by history of pneumonia, 1.8-fold by moderate lung disease, and 2.9-fold by severe lung disease.
But only two modifiable risk factors were significantly associated with pneumonia: incident mobility limitation was associated with a 1.8-fold increased risk, and higher mean oral plaque score, reflecting impaired oral hygiene, was associated with a 1.3-fold increased risk.
And, using average attributable fractions, the authors estimate that 11.5% of pneumonia hospitalizations were due to incident mobility limitation and 10.3% were due to having a mean oral plaque score of 1 or more.
Juthani-Mehta and colleagues say that their findings add to a growing body of evidence that oral plaque can provide a reservoir for respiratory pathogens that can lead to pneumonia on aspiration.
They suggest that enhanced oral care in geriatric patients at risk for pneumonia, for example more frequent tooth and gum brushing and the use of chlorhexidine mouthwash, could be a simple measure to increase the removal of oral pathogenic bacteria.
However, while they say that their research presents novel preventive avenues, the authors note implementing such strategies could be difficult practically.
"Implementation of interventions to change these risk factors would require a cognitively intact group of older adults who could self-administer care," they note, adding that "it is unclear whether such interventions could be implemented in real-world practice."
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