Validation of the applicability of the mealtime observation checklist in predicting the risk of aspiration pneumonia in older adults receiving oral intake support: A retrospective cohort study of four long-term care facilities.

Aim: In Japan, a 24-item mealtime observation checklist (MOCL) was developed in 2015 to support oral intake and prevent aspiration in older adults. The MOCL consists of signs/symptoms/conditions that reflect eating and swallowing functions and oral conditions. This study aimed to examine the association between each MOCL item and the onset of aspiration pneumonia (AP).

Methods: This retrospective cohort study included 199 older adults with difficulties in oral intake residing in four long-term care facilities. The association between the time to the onset of AP (6 months follow-up) and each MOCL item was examined using Cox proportional hazards models.

Results: The median (25th, 75th percentiles) age of the participants was 87 (82, 91.5) years; 131 (65.8%) were women; and 24 developed AP during the study period. After adjusting for the characteristics of participants, six items were significantly associated with the onset of AP: "Has difficulty maintaining a sitting position" (hazard ratio [HR] = 3.29, 95% confidence interval [CI]: 1.37-7.88), "Sleep while eating" (HR = 3.45, 95% CI: 1.12-10.59), "Has difficulty starting to eat, frequently interrupts eating even after starting to eat, and has difficulty concentrating on eating" (HR = 2.51, 95% CI: 1.10-5.72), "Has fatigue because additional time is needed to eat" (HR = 3.08, 95% CI: 1.32-7.20), "Dry mouth" (HR = 2.84, 95% CI: 1.21-6.67), and "Assisted feeding is required" (HR = 2.90, 95% CI: 1.21-6.93).

Conclusions: Of the 24 items on the MOCL, we found six items that might contribute to screening older adults at a high risk of AP onset. Geriatr Gerontol Int 2023; 23: 376-382.