Facility‐Level Factors Associated With Aspiration Pneumonia in Japanese Geriatric Health Service Settings: A Nationwide Cross‐Sectional Study

BACKGROUND: Aspiration pneumonia (AP) is a leading cause of morbidity and mortality in older adults. Facility-level determinants of AP in long-term care settings remain poorly understood. In Japan's long-term care insurance system, geriatric health service facilities differ in their staff composition, care processes, and swallowing support systems, which may influence AP incidence. METHODS: We conducted a nationwide, facility-level cross-sectional study using data from the 2024 Survey on Eating and Swallowing Support conducted by the Japan Association of Geriatric Health Service Facilities. Of the 454 respondents, 445 facilities were included. The facilities were categorized as super-enhanced, enhanced, add-on, or basic. Facility characteristics, staffing composition, nutritional and swallowing management practices, and reimbursement-based care add-ons were compared across facility types. Multivariate logistic regression was used to identify the risk factors associated with AP occurrence. RESULTS: Facility type, staff composition, and care resources varied significantly. The multivariable model revealed that a history of AP (OR = 45.138, 95% CI 16.937-120.292; p < 0.001) and aspiration events (OR = 9.280, 95% CI 4.215-20.116; p < 0.001) were strongly associated with AP. Facilities lacking occupational therapists had a higher risk of AP (OR = 4.875, 95% CI 1.708-13.909; p = 0.003). CONCLUSIONS: Facilities characterized by frequent aspiration events or a history of AP tended to have a higher incidence of AP. The absence of occupational therapists was associated with an increased facility-level risk of AP, suggesting that organizational differences in care management may influence AP in long-term care settings.