Barriers and improvements of respiratory aspiration risk management in older patients from multiple perspectives: a qualitative study.

Background: Aspiration, the entry of food, fluids, saliva or gastric contents into the airway, is common in older adults and may lead to pneumonia or even death. Multidisciplinary management has the opportunity to help prevent aspiration in older patients. However, implementation in clinical practice remains problematic. By investigating the perspectives of stakeholders, comprehensive barriers and improvements measures can be identified to help manage aspiration risk.

Method: Doctors, therapists, nurses, patients and their caregivers were recruited from wards in three tertiary hospitals. Semi-structured interviews were conducted to explore participants' views and experiences on the implementation of aspiration risk management. Data were analysed using content analysis.

Results: Data from 62 participants revealed barriers and improvements measures in aspiration risk management in older patients: Barriers: (i) Patient-related barriers, related to cognition, physical condition, compliance and caregiver burden; (ii) Healthcare-related barriers, including insufficient professional competence, lack of personalised guidance and education and limited communication; (iii) Support system and environmental barriers, including insufficient collaboration, limited processes, insufficient technical support and uneven hospital management attention. Improvements measures: (i) Hybrid management model of online and offline integration; (ii) Clear role definition across multiple roles; (iii) Visualization or quantification of aspiration display; (iv) Personalised and dynamic aspiration management strategies; (v) Strengthening communication and trust to improve adherence; (vi) Emotional support and supervision by caregivers.

Conclusion: All major stakeholders faced some challenges, and it was necessary to strengthen teamwork, make good use of new technology support and enhance humanistic care to help stakeholders manage aspiration risk in older patients.