Oral Care, Monitored Meals, and Aspiration Pneumonia: “What We Don’t Know We Don’t Know” in Health Care:

Author

Carson Eldercare Consulting & Management

For more information about the author, click to view their website: Carson Eldercare Management and Consulting

Posted on

Sep 25, 2024

Book/Edition

Pennsylvania - Greater Pittsburgh Area

“What We Don’t Know We Don’t Know” in Health Care:

September 24, 2024 -

Oral Care, Monitored Meals, and Aspiration Pneumonia

Proper oral care is crucial for maintaining optimal health. Keeping the mouth clean not only helps maintain the protective properties of saliva but also reduces bacteria in the mouth which can be a source of infection in aspiration pneumonia. In addition, monitoring meals and assisting with feeding for those at high risk for aspiration is also a necessity. The process of swallowing involves dozens of muscles that start in the mouth and include the pharynx, larynx, and esophagus. These muscles can become weakened with age and from various, often age-related diseases.  The aging population is especially at risk for aspiration pneumonia due to comorbidities, frailty, and conditions that can impair swallowing.  As a result, aspiration pneumonia is one of the leading causes of death from infection in individuals over the age of 65. One study shows that 1 in 10 deaths from pneumonia in elderly nursing home residents may be prevented by improving oral hygiene (Sjogren et al., 2008).

 

Unfortunately, proper oral care and monitoring of meals is often overlooked in the health care setting.  Perhaps the greatest reason for this is the challenge that almost every health facility faces today: adequate staffing. When I started working in acute care as an RN over 20 years ago, nursing assistants (these are the staff generally responsible for proving oral care in an acute care setting) were typically responsible for 5-7 patients. Nurses had 3-5 patients (this was on a step down cardiac unit). Between the nurse and the assistant, we were able to provide oral care at every meal and offer one-on-one assistance to any patient that was at risk for aspiration. This is no longer the case.  RNs oftentimes look after upwards of 8 patients, and there is generally either no nursing assistant on the floor or only 1 for a patient load that can exceed 20.  Consequently, proper oral care is neglected.  I have often seen patients that are aspirating during meals, but do not have adequate staffing on hand to provide them with the supervision and monitoring that they need. This presents a hazardous catch-22: the aging individual needs to eat to maintain nutritional needs yet he/she needs assistance with eating to prevent aspirating pneumonia. 

 

How can this be remedied? If the family is present, they can provide oral care and meal monitoring. If meal monitoring is required for an at-risk individual, it’s recommended to touch base with the health care team to inquire as to what the specific aspiration precautions are (every individual may have a different need and/or recommendation). A care companion can also be hired to provide the needed care. I hired a companion for my father when he was in a skilled nursing facility. He was not getting his teeth brushed or flossed regularly, and I was seeing a decline in his dentition. Having this extra support provided him with much needed assistance and the care companion had the added benefit of encouraging him to eat more at every meal, something that was a bonus as he was not meeting his nutrient needs. Touching base with staff to request that oral care and meal monitoring be done can also be helpful. Having an advocate to ensure necessary care is getting done can also be very effective in the health care setting.

 

What is proper oral care and effective meal monitoring?

 

Proper oral care includes brushing the teeth for at least 1 minute after every meal. It also includes using a soft bristle brush, fluoride toothpaste, flossing daily. A final component of oral care that is often not discussed is denture care. Dentures should be cleaned at least once per day and removed at bedtime. Removing them prior to sleeping can greatly reduce the risk of pneumonia (Iinuma et al. 2014). Effective meal monitoring includes adequate supervision during mealtime for those at risk of aspiration. Such supervision includes ensuring the individual is properly positioned for a meal (head of bed as high as can be tolerated and supine position), takes small bites, eats slowly, swallows a couple times in between each bite, and intermittently takes a sip of liquid to clear the mouth of food particles. The use of straws is generally not recommended for an individual at risk for aspiration as it propels the food to the back of the throat and hence can increase risk. I recall when I was working as a Registered Nurse (RN) in acute care that I was constantly removing straws from the bedside of ‘at risk’ individuals and often reminding them to eat slowly and swallow at least twice between each bite to ensure food clearance. Individuals at risk for aspiration often require a modified texture diet as it can further prevent the aspiration of food and liquids. 

 

This is a brief summary of the attention to detail needed in addressing oral hygiene and meal monitoring amongst the aging population. Both measures can play a significant role in reducing aspiration pneumonia.  If you would like more information on understanding proper oral care or any other questions that you may have regarding aging life care, please feel free to reach out to me.   

 

Sources:

1.      Sjogren P, Nilsson E, Forsell M, Johansson O, Hoogstraate J. 2008. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 56:2124–2130.

 

2.      Iinuma T, Arai Y, Abe Y, Takayama M, Fukumoto M, Fukui Y, et al. 2014. Denture wearing during sleep doubles the risk of pneumonia in the very elderly. J Dent Res. doi: 10.1177/0022034514552493

 

3.      F Muller, 2015. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541086/#

 

 

Other Articles You May Like

Why Every Family Needs a Senior Care Advocate: Your Guide to Smarter, Safer Aging

Navigating the complexities of aging can feel overwhelming. Whether you're a senior making plans for your future or a family caregiver trying to provide the best care for a loved one, knowing where to turn for reliable help is critical. Thats where a Senior Care Advocate steps inyour trusted partner in managing aging-related decisions, healthcare planning, and long-term support.What is a Senior Care Advocate?A Senior Care Advocate is a professional who specializes in supporting older adults and their families as they face the many challenges of aging. Their role is part guide, part liaison, and part problem-solver. Whether it's managing healthcare appointments, understanding confusing medical diagnoses, or finding the right long-term care options, a Senior Care Advocate is there to help every step of the way.These advocates bring years of experience in elder care, healthcare systems, and long-term care planning. They often have backgrounds in social work, nursing, gerontology, or senior services. But more importantly, they understand the emotional weight that comes with caregiving and agingand they offer compassion alongside their professional expertise.Do I Need a Senior Care Advocate?One of the most common questions families ask is: How do I know if I need a Senior Care Advocate? The answer depends on your unique situation, but here are a few telltale signs: Youre overwhelmed with coordinating medical care and doctor appointments. You're unsure about long-term care options like assisted living, memory care, or skilled nursing. Youre facing legal, financial, or insurance questions you dont know how to answer. Youre a long-distance caregiver who cant always be present. Youre worried about the safety or well-being of a loved one who lives alone. In all these situations, a Senior Care Advocate can provide guidance, coordinate services, and even represent you or your loved one at medical appointments or facility meetings.What Services Does a Senior Care Advocate Provide?Senior Care Advocates wear many hats and offer a wide range of services, including:1. In-Home Care CoordinationIf remaining at home is a priority, an advocate can help make it happen safely. They evaluate care needs, hire and supervise caregivers, and provide training for both families and professionals. They ensure that home care is not just availablebut effective, compassionate, and tailored to the individual.2. Medical Support and NavigationUnderstanding the healthcare system can be confusing, especially when dealing with chronic illness or multiple diagnoses. A Senior Care Advocate will: Arrange and attend medical appointments. Help interpret diagnoses and treatment plans. Coordinate testing, therapies, and even emergency room visits. Act as a liaison between seniors, family members, and healthcare providers. Their support can be life-changing, particularly for seniors managing complex conditions or families trying to stay informed.3. Long-Term Care Planning and TransitionsWhen living at home is no longer possible, finding the right long-term care community is essential. A Care Advocate knows the ins and outs of senior living optionsfrom assisted living to memory care and nursing homes. Theyll arrange facility tours, help with admissions paperwork, and even assist with the physical move.After the transition, they continue providing oversight to ensure your loved one is safe, comfortable, and receiving quality care.4. Benefit Application AssistanceUnderstanding what financial and medical benefits you qualify for can be overwhelming. Senior Care Advocates help determine eligibility and assist with applications for: Veterans benefits Social Security and SSDI Medicaid/Medical Assistance Private insurance coverage This process is often time-consuming and complex, but an experienced advocate can streamline it and ensure nothing is missed.What to Look for in a Senior Care AdvocateNot all advocates are the same. When choosing one, ask about their background, training, and areas of specialization. Dont hesitate to request references or testimonials from other families.A qualified Senior Care Advocate should have: Experience in elder care or healthcare systems Knowledge of local resources and support programs A compassionate and proactive communication style Clear professional boundaries and confidentiality standards Real Support for Real FamiliesAt Solutions for Independence, we understand how emotionally and physically demanding caregiving can be. For over 20 years, we've helped hundreds of seniors and their families navigate the aging journey with confidence. Whether its in-home care planning, crisis management, or senior housing transitions, we provide the kind of expert support that brings peace of mind.We believe in providing Care, Advocacy, and Compassion as a Professionbecause every older adult deserves to age with dignity, and every caregiver deserves support.Why Senior Care Advocacy Matters More Than EverTodays aging population is living longer but often with more complex health needs. Family caregivers are often juggling full-time jobs, raising children, and managing their own health. The role of a Senior Care Advocate is no longer a luxuryits becoming a necessity.By working with a trusted advocate, families can: Avoid caregiver burnout. Prevent medical or financial crises. Make informed choices about care options. Save time, money, and emotional energy. Whether youre planning ahead or in the middle of a crisis, a Senior Care Advocate can be your greatest ally. They provide the tools, knowledge, and hands-on support you need to make the best decisions for yourself or your loved one. If youre feeling uncertain or overwhelmed, remember this: You dont have to do it alone. Let an expert advocate help you find clarity, confidence, and comfort in every stage of the aging journey.At Solutions for Independence we have specialized in and provided Care Advocacy and long-term care planning services for over 20 years and have helped hundreds of seniors and families. Give us a call today at 412.999.7892.

Navigating the Emotional Journey of Moving a Loved One into Senior Living

Making the decision to move a loved one into senior living is never easy. Its a choice that often comes with a swirl of emotionsgrief, guilt, uncertainty, and even relief. For many families, it marks the beginning of a new chapter that is both necessary and deeply emotional.At Assisted Living Locators, we understand the complexity of this transition. We're not just here to help you find the right placewere here to walk alongside you as you navigate the feelings, questions, and challenges that come with it.The Emotional Weight of the DecisionMoving a parent or loved one out of their homewhere memories were made and independence was cherishedcan feel like a loss. Even when its the right time, the reality of change can be overwhelming.Families often struggle with questions like: Are we doing the right thing? Will they feel abandoned? How do we even begin to choose the right place? These are not just logistical concerns. They're emotional ones. And theyre completely valid.You Are Not AloneEvery family has a unique story, and no two transitions look the same. Thats why a one-size-fits-all approach doesnt work. At Assisted Living Locators, we start by listeningreally listeningto your concerns, your hopes, and your loved ones needs.We help you: Understand the options available, from independent and assisted living to memory care and beyond. Navigate conversations with compassion, helping your loved one feel heard and included in the decision-making process. Find peace of mind in knowing that a knowledgeable, local expert is by your side. More Than a Placement ServiceWhat sets us apart is that were not just matching families to facilities. Were guiding people through one of lifes most sensitive and significant transitions. We offer not only practical guidance, but emotional supporthelping you make decisions with confidence, clarity, and care.Well tour communities with you, ask the hard questions, and advocate for what matters most to your family. And we do it all at no cost to you.A Step Toward Peace of MindIts okay to feel the weight of this moment. It's okay to need help. And it's okay to prioritize both your loved ones well-being and your own peace of mind.Let us be a trusted partner in this journeyso you dont have to walk it alone.Contact us today at pghassistedliving.com or (724) 972 -3202 to take the first step. Were here to help with heart, knowledge, and unwavering support. 

Everyday Digital Tech Is Protecting Seniors' Brain Health, Study Says

A new study published on April 15, 2025, reveals that using everyday digital technologylike smartphones, computers, and tabletsmay actually protect brain health in older adults rather than harm it. Contrary to longstanding fears that reliance on digital devices contributes to cognitive decline, researchers found that these technologies may play a positive role in preserving memory and thinking skills. The study, conducted by scientists from the University of Texas at Austin and Baylor University, analyzed data from 57 prior studies, covering more than 411,000 adults with an average age of 69. It showed that those who regularly used digital technology had a 58% lower risk of developing cognitive impairments compared to those who did not. The researchers argue that using digital devices can challenge the brain in meaningful ways. Tasks like reading news online, sending emails, using GPS, or managing a calendar require mental engagement and memory, helping to keep the brain active. These actions involve navigating apps, understanding icons, recalling passwords, and making decisionscognitive processes that mirror many of the brains executive functions. In other words, regular interaction with technology may act like mental exercise, reinforcing cognitive skills much like physical activity helps maintain muscle strength. One of the most notable aspects of the findings is how they contradict popular concerns about digital dementia, a term used in recent years to describe the belief that technology use causes memory problems by making people too reliant on external tools. Instead of supporting this idea, the researchers found the opposite: older adults who stayed digitally engaged were less likely to show signs of cognitive decline. This suggests that fears around the negative effects of digital tools on the aging brain may be overstated or even unfounded. The researchers proposed three main reasons why digital technology may be beneficial: complexity, connection, and compensation. Complexity refers to the mental challenges posed by using technology, which can stimulate cognitive functions. Connection refers to the social aspectstaying in touch with family and friends through messaging, video calls, or social mediawhich has long been linked to better brain health. Compensation describes how digital tools can help older adults cope with minor memory issues, such as by setting reminders or keeping track of important information, reducing stress and promoting independence. Experts outside the study also praised the results. Dr. Leah Mursaleen from Alzheimers Research UK said the findings were encouraging and aligned with what is already known about mental stimulation and brain health. Caroline Abrahams of Age UK emphasized that while the benefits of digital engagement are clear, some older adults still struggle with access or confidence using these tools. This underlines the importance of digital inclusionensuring all seniors have the opportunity, training, and support needed to benefit from the digital world. The research carries significant implications as global populations continue to age and technology becomes further embedded in daily life. As more adults over 50 begin to age into their 70s and 80s with a lifetime of digital experience, understanding how to harness technology to support mental health will be increasingly important. While the study does not suggest that tech use alone is a magic bullet against dementia, it does point to a relatively simple, low-cost, and accessible way to help preserve cognitive function over time. In summary, the study challenges outdated assumptions that technology is harmful to older minds and instead presents a hopeful narrative: when used actively and meaningfully, digital technology can support brain health, improve quality of life, and help older adults stay mentally sharp. As researchers continue to explore the intersection of aging and technology, these findings offer strong evidence that staying digitally engaged may be one of the easiest and most effective tools for protecting cognitive function later in life.

Local Services By This Author

Carson Eldercare Consulting & Management

Geriatric Care Management Sewickley Heights, , Pennsylvania, 15143

Are you feeling overwhelmed by the complexities and difficulties associated with aging? Have the responsibilities in caring for your loved one become unmanageable? Do you live far away and are unable to provide reliable senior care management? If you answered yes to any of the above questions, you may want to consider hiring an eldercare manager. Hi, my name is Laura. I have been a Registered Nurse (RN) for over 20 years and have witnessed firsthand the challenges and complications that aging presents. It affects not only the aging themselves but also their families and loved ones. Health care is complex, and in this increasingly fragmented and overburdened system, it can be extremely helpful to have a professional oversee all aspects of care. As your eldercare manager, I will comprehensively assess the needs of your loved one and we will work together in establishing a care plan. I will assist you and your family with difficult decisions and help promote healthy communication on issues that are often difficult to address and navigate. An expanded version of my core services are summarized below: MANAGE health care needs, chronic conditions, illnesses, and coordination of careOPTIMIZE health outcomes via my extensive knowledge and experience in the healthcare system. I provide necessary education on chronic diseases and treatment plans, promote collaboration and communication amongst the health care team, ask the right questions of health care personnel, and any other needed activities in order to promote the safety and wellness of my clientsNAVIGATE the complex health system ADVOCATE for individuals to receive high quality care. I do this by such actions as asking the right questions of health care personnel, requesting a referral, second opinion, or further resources when appropriate, and anticipating/ planning for future health care needsTRANSITION clients to appropriate living conditions and proper levels of care. This may be from out of a private home into independent or residential living. It can also entail transition to a skilled nursing facility, assisted living, long term acute care, and hospice. There are many factors and variables to be considered when making these changes, and I provide assistance and support.  The above services represent the bulk of my client/family needs. Some other services provided are:Comprehensive health status assessmentAssistance with medication complianceAssessing safety of the home and providing measures to reduce falls  Helping clients/ families make difficult health decisions while navigating familydynamics and promoting effective communicationBeing present with client during doctor appointments etc. to ask the rightquestions and help assimilate health informationVisiting and interacting with clients at hospitals and facilities to assess healthstatus, monitor progress, and assist with any needs upon discharge or transfer Contact me today for a free 20-minute consultation!

Carson Eldercare Consulting & Management

Elder Care Planning & Consulting Sewickley Heights, , Pennsylvania, 15143

Are you feeling overwhelmed by the complexities and difficulties associated with aging? Have the responsibilities in caring for your loved one become unmanageable? Do you live far away and are unable to provide reliable senior care management? If you answered yes to any of the above questions, you may want to consider hiring an eldercare manager. Hi, my name is Laura. I have been a Registered Nurse (RN) for over 20 years and have witnessed firsthand the challenges and complications that aging presents. It affects not only the aging themselves but also their families and loved ones. Health care is complex, and in this increasingly fragmented and overburdened system, it can be extremely helpful to have a professional oversee all aspects of care. As your eldercare manager, I will comprehensively assess the needs of your loved one and we will work together in establishing a care plan. I will assist you and your family with difficult decisions and help promote healthy communication on issues that are often difficult to address and navigate. An expanded version of my core services are summarized below: MANAGE health care needs, chronic conditions, illnesses, and coordination of careOPTIMIZE health outcomes via my extensive knowledge and experience in the healthcare system. I provide necessary education on chronic diseases and treatment plans, promote collaboration and communication amongst the health care team, ask the right questions of health care personnel, and any other needed activities in order to promote the safety and wellness of my clientsNAVIGATE the complex health system ADVOCATE for individuals to receive high quality care. I do this by such actions as asking the right questions of health care personnel, requesting a referral, second opinion, or further resources when appropriate, and anticipating/ planning for future health care needsTRANSITION clients to appropriate living conditions and proper levels of care. This may be from out of a private home into independent or residential living. It can also entail transition to a skilled nursing facility, assisted living, long term acute care, and hospice. There are many factors and variables to be considered when making these changes, and I provide assistance and support.  The above services represent the bulk of my client/family needs. Some other services provided are:Comprehensive health status assessmentAssistance with medication complianceAssessing safety of the home and providing measures to reduce falls  Helping clients/ families make difficult health decisions while navigating familydynamics and promoting effective communicationBeing present with client during doctor appointments etc. to ask the rightquestions and help assimilate health informationVisiting and interacting with clients at hospitals and facilities to assess healthstatus, monitor progress, and assist with any needs upon discharge or transfer Contact me today for a free 20-minute consultation!