Factors associated with aspiration pneumonia and preventive measures in hospitalized elderly: a systematic review of observational studies

ABSTRACT Purpose: to identify associated factors and preventive measures for aspiration pneumonia in hospitalized elderly patients. Methods: the PPOT (population, predictor, outcome, and type of study) was the strategy used to define the eligibility criteria: (1) Population: people over 60 years of age; (2) predictor: hospitalized patients (3) Outcomes: associated factors and measures to prevent aspiration pneumonia; (4) Type of study: Observational Studies (transversal and case-control). We performed the data collection in the PubMed, Lilacs, Scielo, Google Scholar, Science Direct, and Web of Science databases. Observational studies on factors associated with aspiration pneumonia and preventive measures in the elderly, without language restriction and available in full, were included. Data on authors/year/country, objective, methodology, sample, and results, were collected. The risk of bias was assessed, according to the JBI Critical Appraisal Checklist. Results: a case-control and two cross-sectional studies were analyzed. One paper presented a smaller sample with 86 patients, and another presented a larger sample comprising 443 patients. The median age was 77 years old. Conclusion: factors such as severe stroke, dysphagia, advanced age, male gender, coronary heart disease, lower Glasgow coma scale score, use of mechanical ventilation for more than 48 hours, and aspiration of colonized gastric juice were associated with aspiration pneumonia.

摘要
研究目的：明确住院老年患者吸入性肺炎的相关危险因素及预防措施。
研究方法：采用PPOT（Population, Predictor, Outcome, and Type of study）策略明确纳入标准：(1) 研究人群：60岁以上人群；(2) 预测因素：住院患者；(3) 研究结局：吸入性肺炎的相关危险因素及预防措施；(4) 研究类型：观察性研究（横断面研究与病例对照研究）。本研究在PubMed、LILACS、SciELO、Google Scholar、Science Direct及Web of Science数据库中开展文献检索与数据收集工作，最终纳入无语言限制且可获取全文的、针对老年人群吸入性肺炎相关危险因素及预防措施的观察性研究。提取的文献数据涵盖作者、发表年份、研究国家、研究目的、研究方法、样本量及研究结果。采用JBI关键评价清单（JBI Critical Appraisal Checklist）对纳入研究的偏倚风险进行评估。
研究结果：共纳入1项病例对照研究与2项横断面研究进行分析。其中1项研究样本量较小，仅纳入86例患者，另1项研究样本量较大，包含443例患者。纳入研究的患者年龄中位数为77岁。
研究结论：重度脑卒中、吞咽困难、高龄、男性性别、冠心病、格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评分较低、机械通气时长超过48小时以及定植胃内容物吸入等因素与吸入性肺炎显著相关。