Contact: Lyn Goldberg
Reducing aspiration pneumonia risk through evidence-based oral care for adults with dementia.
Poor oral health increases the risk of aspiration pneumonia for older people. This is due primarily to six pathogens found in the mouth: five bacteria and one fungus. With a cohort of older people who were dependent on others for their oral care, we analysed the load and type of bacteria and fungi from swabs of cheek, gum, and tongue mucosa. There were no significant differences between the three sites for load of bacteria (H (2) = .89; p = .64); there were significant differences between the sites for type of bacteria (F (2,78) = 11.97; p <.001) with the tongue showing the greatest diversity. There were no significant differences between the three sites for load (H (2) = 2.94; p = .23) or type (F (2,77) = .46; p = .63) of fungi. We then investigated the effect of regular compared to evidence-based oral care over a six-week period, and whether evidence-based oral care could significantly reduce the absolute count of the six oral pathogens specifically related to aspiration pneumonia. Participants self-selected into Regular Care (n = 10) and Evidence-based Care (n = 17) Groups. Evidence-based oral care resulted in significant decreases (p = .02 to p < .001) in the load of four potentially pathogenic bacterial species, including E. coli, gut-based bacteria, and in an increased load of Lactobacillus reuteri, a host-protective normal flora in the mouth, compared to baseline. There were no significant differences between groups for the abundance and type of fungi. Attention now turns to investigating the practicality of microbial analysis as a marker of oral health for older people in residential care.
Objectives:
- Understand the increased risk for aspiration pneumonia related to poor oral health for older people who are dependent on others for their oral care
- Appreciate the value of next generation sequencing techniques in documenting the type and load of bacteria and fungi in the mouths of older people and identifying potential pathogenic microorganisms in the mouth, including E. coli, gut-based bacteria
- Support the call for increased involvement of dentists, oral and allied health therapists in residential care to guide staff in evidence-based care and promote the health and wellbeing of residents who are dependent on others for oral care.
Research Team:
- Assoc Prof Lyn Goldberg
- Prof Anna King
- Dr S Bettiol
- Assoc/Prof L Crocombe
Funding:
- Developing a robust laboratory protocol for analysing oral swabs for pathogenic or key microbiological flora. Wrigley Company Australian Dental Health Foundation Community Service Grant ($6,000, 2018)
- Developing a protocol to predict health outcomes through oral microbes. College of Health and Medicine Research Enhancement Program ($9,917, 2018)
- Improving the oral health of Tasmanians in residential aged care. Tasmanian Community Fund ($28,336, 2017-2018)
- Sustained effective oral care to significantly reduce aspiration pneumonia experienced by adults with dementia in residential care. NHMRC/National Institute for Dementia Research (NNIDR) Dementia Collaborative Research Centres ($99,752, 2016-2017)
Outputs:
Khadka S, Khan S, King AE, Goldberg LR, Crocombe LA, & Bettiol S. (2021). Poor oral hygiene, oral microorganisms and aspiration pneumonia risk in older people in residential aged care: a systematic review. Age and Ageing, 50, 81-87. doi: 10.1093/ageing/afaa102.
Goldberg LR. (2019). Opening keynote address. Why interprofessiojnal education and collaborative care is quality care. Australian Society of Special Care in Dentistry. Melbourne, Victoria, July 19-20.
Goldberg LR, Crocombe LA, Westbury J, Bettiol S, King AE, Kent K, Lea E, & McInerney F. (2019). Working interprofessionally to improve oral health and reduce aspiration pneumonia risk. National Rural Health Conference, Hobart, Tasmania, March 24-27.
Goldberg LR, Westbury J, Langmore SE, Crocombe LA, Kent K, & Heiss, CJ. (2018). Oral health screening may decrease aspiration pneumonia risk for adults with dementia in residential aged care. American Speech-Language-Hearing Association, Boston, Massachusetts, USA, November 15-17.
Khadka S, Bettiol S, Goldberg LR, King AE, & Crocombe LA. (2018). Comparison of DNA extraction and quantification methods to analyse bacterial load in the oral cavity. Molecular Microbiology Meeting, Sydney, April 11-12.
