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

Abstract

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.

Association between a malnutrition screening tool and mealtime observation checklist items in older people receiving oral intake support: A cross‐sectional study of four long‐term care facilities

“…this study. In addition, 'Has fatigue due to extended mealtime' and 'Assisted feeding is required' have been associated with aspiration pneumonia in the previous study (Nishioka et al, 2023), so these are considered important for the prevention of both malnutrition and aspiration pneumonia. Therefore, these two items warrant attention during daily care.…”

“…The swallowing ability of participants was assessed using the MWST (Tohara et al, 2003). The method and score classification of the MWST have been previously described in detail (Nishioka et al, 2023). The participants were divided into two groups based on their scores: those with a score of 4 or 5 and those with a score of 1-3 (dysphagia).…”

“…We used the Japanese Dysphagia Diet 2013 (JDD2013) by the Japanese Society of Dysphagia Rehabilitation (JSDR) dysphagia diet committee (The Dysphagia Diet Committee of the Japanese Society of Dysphagia Rehabilitation, 2013) to assess the food texture level of the meals served to the participants, assigning codes 1-4 or as normal. The definitions of each code were previously explained in detail (Nishioka et al, 2023). Because it has been reported that pureed menus have a lower nutrient content than regular texture menus do and are more likely to contribute to malnutrition among individuals who consume them (Vucea et al, 2017(Vucea et al, , 2018, we categorized the participants into two groups: those with code 2 or lower and those with code 3 or higher.…”

“…MOCL and aspiration pneumonia, indicating the potential of the checklist as a valid assessment tool for evaluating food intake capacity (Nishioka et al, 2023). Against this background, the MOCL may serve as an early indicator of potential eating problems that can lead to malnutrition.…”

“…This cross-sectional study was conducted from July 2016 to July 2017 using data from a retrospective cohort study that gathered medical information from four LTC facilities in Japan. A total of 199 older people were enrolled in the study (Nishioka et al, 2023).…”