title: Risk factors for aspiration pneumonia in frail older people: a systematic literature review.
abstract: OBJECTIVE
  To systematically review the risks for aspiration pneumonia in frail older people and the contribution of bad oral health among the risk factors.
  
  
  METHODS
  Systematic literature review.
  
  
  METHODS
  PubMed (Medline), Web of Science, Cochrane Library, EMBASE, and CINAHL were searched for eligible studies, published in English in the period January 2000 to April 2009.
  
  
  METHODS
  Frail older people.
  
  
  METHODS
  Only publications with regard to hospitalized, institutionalized, or frail home-dwelling people of 60 years and older were eligible. Two authors independently assessed the publications for their methodological quality. Unadjusted and adjusted odds ratios and their corresponding 95% confidence intervals for respective risk factors related to aspiration pneumonia were extracted. The results were evaluated according to the levels of evidence of the Oxford Centre for Evidence-based Medicine.
  
  
  RESULTS
  A total of 21 publications fulfilled the quality criteria. Evidence level 2a (systematic review with homogeneity of cohort studies) was found for a positive relationship between aspiration pneumonia and age, male gender, lung diseases, dysphagia, and diabetes mellitus; 2b (individual cohort study) for severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, and bad oral health; 3a (systematic review with homogeneity of case-control studies) for malnutrition; 3b (individual case-control study) for Parkinson's disease and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health among the risk factors seems limited.
  
  
  CONCLUSIONS
  Thirteen significant risk factors were identified: age, male gender, lung diseases, dysphagia, diabetes mellitus, severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, bad oral health, malnutrition, Parkinson's disease, and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health seems limited.
authors: BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Ghent, Belgium/Nijmegen, The Netherlands.
authors: Claar D
authors: CD
authors: van der Maarel-Wierink
authors: Jacques N O
authors: JN
authors: Vanobbergen
authors: Ewald M
authors: EM
authors: Bronkhorst
authors: Jos M G A
authors: JM
authors: Schols
authors: Cees
authors: C
authors: de Baat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D011015:Pneumonia, Aspiration / Q000209:etiology*; D012307:Risk Factors