Three Pillars of Pneumonia
An important point is that all three factors–impaired health status, dysphagia, and poor oral health–must be considered together each with their presence and severity integrated into determining if your patient is at risk for pneumonia from aspiration or not.
Health Status, or severity of illness, can be determined from the medical record including age, current medical diagnoses, how debilitated is the patient and why, and the status of the immune system.
Oral Health Status can be determined by overtly examining the teeth, tongue, and mouth. The Oral Health Assessment Tool (OHAT) is a recognized, proven screening tool for just such purposes.
Swallowing Safety should only be determined using instrumental studies–FEES or VFSS. These important tools must be administered using established standard clinical protocols and procedures. In-depth analyses and interpretations by trained and experienced SLPs provide high-quality useful results needed to make decisions. Screening tests and “clinical bedside assessments” should only be used to determine if the patient has overt signs of dysphagia, and, if so, to refer for an instrumental study. These tools are too insensitive to detect aspiration and explain the underlying biomechanical reasons for the dysphagia.
Below is a chart to assist with making decisions regarding possible pneumonia risks.
Three Pillars of Pneumonia. Below are publications which may assist you in your understanding of this concept and how to use it effectively in your clinical practice.
Ashford, J. R. (2005, March). Pneumonia: Factors Beyond Aspiration. Perspectives in Swallowing and Swallowing Disorders (Dysphagia), 14, 10-16.
Ashford, J. R. & Skelley, M. L. (2008, March). Oral Care and the Elderly. Perspectives in Swallowing and Swallowing Disorders (Dysphagia), 17, 19-26.
Ashford, J. R. (2012, March). Oral Care Across Ages: A Review. Perspectives in Swallowing and Swallowing Disorders (Dysphagia), 21, 3-8.
Mills, R. H. & Ashford, J. R. (2008, December). A Methodology for the Inclusion of Laboratory Assessment in the Evaluation of Dysphagia. Perspectives in Swallowing and Swallowing Disorders (Dysphagia), 17, 128-134.