Abstract：
The number of older people with impaired swallowing function increases with aging population. Aspiration pneumonia is one of the most cases of pneumonia developing among older people. As aspiration pneumonia may develop as a result of age-related deterioration, it is crucial to consider it as an unavoidable event with aging. While pneumonia is diagnosed based on respiratory symptoms and radiological features, the lung involvement of aspiration pneumonia may be undetectable via a frontal chest radiograph in some cases. Bacterial profiles show the predominance of drug-resistant bacteria, such as Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), but isolated bacteria from respiratory samples do not necessarily indicate causative pathogens. Furthermore, there is no evidence regarding treatment superiority using broad-spectrum antibiotics compared with narrow-spectrum antibiotics. Even if isolated pathogens are a causative factor for pneumonia among older patients, the use of broad-spectrum antibiotics covering the bacteria may not improve their outcomes. Therefore, we propose a treatment strategy independent of the risk of drug resistance focusing on the discrimination of patients who are unlikely to respond to broad-spectrum antibiotics. An aspiration risk is associated with increased in-hospital mortality in patients with pneumonia, which could also lead to a greater risk of poor long-term outcomes with increased 1-year mortality. Advance care planning is now recognized as a process for communication and medical decision-making across the life course. This approach would be widely recommended for older people with aspiration risk.
摘要：
吞咽功能受损的老年人数量随着人口老龄化而增加。吸入性肺炎是老年人中最常见的肺炎病例之一。吸入性肺炎可能是由于年龄相关的恶化而发展的，将其视为衰老不可避免的事件至关重要。虽然肺炎是根据呼吸道症状和放射学特征诊断的，在某些情况下，通过正面胸片可能无法检测到吸入性肺炎的肺部受累。细菌谱显示耐药细菌占优势，如铜绿假单胞菌和耐甲氧西林金黄色葡萄球菌（MRSA），但是从呼吸道样本中分离出的细菌并不一定表示病原体。此外，与窄谱抗生素相比,没有证据表明使用广谱抗生素的治疗优势.即使分离的病原体是老年患者肺炎的致病因素，使用覆盖细菌的广谱抗生素可能无法改善其结局.因此,我们提出了一种独立于耐药风险的治疗策略,重点是对不太可能对广谱抗生素产生反应的患者的歧视.误吸风险与肺炎患者住院死亡率增加有关，这也可能导致不良长期结局的风险增加,1年死亡率增加.提前护理计划现在被认为是整个生命过程中沟通和医疗决策的过程。这种方法将被广泛推荐给有误吸风险的老年人。
