Aspiration Pneumonia in Nursing Homes

Attorneys for Nursing Home Residents Injured By Choking

Aspiration pneumonia is a common, serious, and often preventable cause of illness, hospitalization, and death among nursing home residents. When food, liquids, saliva, or gastric contents enter the lungs instead of the stomach, bacteria can be carried into the lower airways and cause infection. Older adults living in long-term care settings are at especially high risk because of swallowing problems (dysphagia), impaired cough reflex, neurological disease (stroke, dementia, Parkinson’s), poor oral hygiene, and certain medications that depress alertness.

At John J. Malm & Associates, our Illinois nursing home negligence attorneys are known for delivering compassionate, strategic, and results-driven representation for injured individuals and their families across Illinois. With over 90 years of combined experience, our attorneys have built a reputation for meticulous investigation, powerful advocacy, and a relentless commitment to holding negligent nursing homes, nurses, medical providers, and corporations accountable. Clients turn to us because we stand by them in their most difficult moments: offering clear guidance, personalized attention, and the proven legal skill needed to secure justice and meaningful compensation.

“When nursing homes fail to identify swallowing problems, supervise risky feedings, or maintain basic oral care, residents pay with preventable infections and loss of life. We investigate those lapses and hold facilities accountable so families get answers and compensation.”— John J. Malm, Naperville nursing home neglect attorney

Why Aspiration Pneumonia Matters in Nursing Homes

Pneumonia is a leading cause of morbidity and mortality in older adults, and aspiration accounts for a large share of pneumonia cases in the elderly. Studies and clinical reviews report that aspiration pneumonia is associated with higher mortality, longer hospital stays, and poorer outcomes compared with non-aspiration pneumonia. In one recent review, a majority of aspiration-related pneumonia deaths occurred in people age 75 and older, and aspiration pneumonia carried a substantially worse short-term survival than non-aspiration cases.

Because many nursing home residents have multiple risk factors (dysphagia, cognitive impairment, tube feeding, reduced mobility), nursing homes must actively screen for aspiration risk, implement evidence-based prevention strategies, and promptly treat suspected cases. Failure to do so can lead to preventable harm.

How Aspiration Pneumonia Happens

Aspiration can occur in residents both quietly or dramatically. In nursing homes, common mechanisms include:

• Oropharyngeal aspiration during eating or drinking because of impaired swallowing (dysphagia).
• Silent aspiration: where residents do not cough or show overt signs when material enters the airway.
• Gastroesophageal reflux with microaspiration of gastric contents into the lungs.
• Vomiting with large-volume aspiration.
• Tube feeding (enteral feeding) that is poorly managed or when residents have compromised airway protection.

These mechanisms are often compounded by poor oral hygiene (increasing pathogenic bacteria in saliva), sedating medications that blunt cough and swallow reflexes, and neurological disease that impairs coordination of swallowing and airway protection.

Who is at Highest Risk of Aspiration Pneumonia?

A number of resident characteristics increase aspiration pneumonia risk. Common, well documented risk factors include:

• Dysphagia (swallowing difficulty): highly prevalent in institutionalized older adults (estimates commonly range from roughly 40–60% in nursing homes).
• Cognitive impairment and dementia: progressive dementia commonly leads to deterioration in safe swallowing and coughing reflexes.
• Recent stroke or neurodegenerative disease (Parkinson’s, ALS): neurologic deficits often lead to impaired swallow.
• Advanced age (especially 75+ and 85+): studies show markedly higher mortality from aspiration pneumonia in the oldest age groups.
• Tube feeding/enteral nutrition without appropriate monitoring or aspiration precautions.
• Poor oral care and dental disease: increased oral pathogens raise infectious risk if aspirated.
• Medications that sedate, reduce cough response, or impair coordination (antipsychotics, benzodiazepines, opioids).

Because many nursing home residents have multiple overlapping risk factors, nursing home clinicians must assess and manage each resident’s aspiration risk proactively to prevent serious aspiration pneumonia.

The Signs of Aspiration Pneumonia

Aspiration pneumonia can present in typical or atypical ways in older adults. Common features include:

• New or worsening cough, often productive.
• Fever, though elderly residents may have blunted febrile responses.
• Increased respiratory rate, shortness of breath, or oxygen desaturation.
• Change in mental status, increased confusion or lethargy.
• New or increased difficulty swallowing, choking during meals, drooling.
• New onset of abnormal lung findings (crackles) on exam; chest x-ray showing infiltrates, often in dependent lung zones (posterior segments, right lower lobe).

Importantly, silent aspiration is common. Some residents will develop pneumonia without an identifiable choking event. Because standard tests cannot always distinguish aspiration pneumonia from other pneumonia causes, clinicians need careful history (swallowing assessments), imaging, and consideration of risk factors.

Diagnosis of Aspiration Pneumonia

The clinical workup of aspiration pneumonia in nursing home residents typically involves:

• Clinical assessment including vital signs and oxygenation.
• Focused swallowing evaluation: bedside screening and formal evaluation by a speech-language pathologist (SLP) when indicated.
• Chest radiography to identify infiltrates and distribution.
• Laboratory tests (CBC, markers of infection) and pulse oximetry/arterial blood gas if hypoxic.
• Microbiologic testing (sputum cultures) when appropriate; however, empiric antibiotics are often started based on clinical judgment because cultures may be insensitive.
• Consideration of aspiration risk contributors: medication list review, dental/oral health exam, review of enteral feeding protocols.

Because there is no single definitive diagnostic test for aspiration pneumonia, multi-disciplinary assessment and documentation are essential.

Treatment of Aspiration Pneumonia

Treatment strategies for aspiration pneumonia include:

• Prompt empiric antibiotic therapy targeting typical oropharyngeal organisms and, when indicated, anaerobic coverage. Local antibiograms and severity guide selection.
• Supportive care: oxygen, intravenous fluids if needed, and monitoring for respiratory failure.
• Swallowing interventions: speech-language pathologist-guided therapy, diet texture modification (thickened liquids, pureed foods) or supervised feeding.
• Oral hygiene improvement and decontamination strategies to reduce bacterial load.
• Medication review to reduce sedating or anticholinergic drugs where possible.
• Consideration of enteral feeding options and placement/management if the resident cannot safely take oral nutrition, recognizing tube feeding itself changes aspiration risk and requires careful protocols.
• Advance care planning and goals-of-care discussions when appropriate, particularly for frail residents with poor prognosis.

Early involvement of the care team, including nursing, speech-language pathologists (SLPs), physicians, and families, improves outcomes and ensures treatments align with resident preferences.

When a Nursing Home May Be at Fault For a Resident’s Aspiration Pneumonia

Aspiration pneumonia can result from natural disease progression, but it is often linked to preventable care deficiencies. Situations that may signal facility responsibility include:

• Failure to screen for or identify dysphagia after a stroke, progressive dementia, or change in condition.
• Lack of timely SLP evaluation when swallowing problems are suspected.
• Inadequate feeding supervision, unsafe positioning, or failure to provide prescribed diet textures.
• Poor or inconsistent oral hygiene and failure to follow infection-prevention protocols.
• Inappropriate medication use (sedation) and failure to review medications that increase aspiration risk.
• Failure to implement or follow safe enteral feeding policies (e.g., not elevating head of bed, not monitoring tube placement).
• Poor documentation that masks whether appropriate prevention steps were taken.

Careful review of medical records, staffing logs, shift notes, medication lists, SLP and nursing assessments, and incident reports is necessary to determine whether facility negligence contributed to the aspiration event. Expert review (nursing, SLP, and medical) is often required.

Documenting and Preserving Evidence After an Aspiration Event

If you suspect negligence contributed to aspiration pneumonia, take these steps promptly:

• Request and preserve medical records, care plans, SLP evaluations, medication administration records, and incident reports.
• Photographs or videos of feeding conditions or equipment (if relevant).
• Obtain witness statements from staff or other residents if possible.
• Keep copies of physician orders, dietary prescriptions, and any nursing notes on feeding supervision.
• Ask the facility for infection control logs and oral care/dental appointment records.

Legal counsel can issue preservation letters and subpoenas to ensure crucial evidence (which may be altered or discarded) is retained.

Frequently Asked Questions About Aspiration Pneumonia in Nursing Home Residents

Q: Is aspiration pneumonia the same as regular pneumonia?
A: Not exactly. Aspiration pneumonia results when material from the mouth or stomach enters the lungs and causes infection; the organisms and clinical course can differ from community-acquired pneumonia, and aspiration is often tied to swallowing problems and care practices.

Q: Can aspiration pneumonia be prevented?
A: Many cases can be reduced or prevented through proper screening for dysphagia, supervised feeding, oral care, medication review, and safe enteral feeding protocols. Prevention requires active nursing home policies and staff training.

Q: My loved one has dementia and chokes sometimes, is that normal?
A: Dementia commonly impairs swallowing reflexes over time. Choking episodes should prompt a formal swallowing assessment by a speech-language pathologist and a review of diet and feeding supervision to reduce aspiration risk.

Q: Are feeding tubes safe to prevent aspiration?
A: Feeding tubes can help provide nutrition but do not eliminate aspiration risk and in some cases are associated with aspiration of gastric contents. Tube feeding requires careful protocols and is not a guaranteed prevention strategy. Decisions about tube feeding should be individualized and documented.

Q: When should I involve an Illinois nursing home abuse attorney?
A: If documentation or staff accounts suggest missed assessments, failure to follow prescribed diet or precautions, poor oral care, or lack of timely treatment that may have caused or worsened aspiration pneumonia, consult an attorney experienced in nursing home care. Prompt review helps preserve time-sensitive records and expert testimony.

Contact the Top-Rated Illinois Pneumonia Nursing Home Lawyers at John J. Malm & Associates

Aspiration pneumonia in nursing homes is common and often preventable when facilities follow evidence-based screening, care, and prevention protocols. Because the condition can progress rapidly and exceed the body’s ability to recover in frail residents, early recognition, multidisciplinary management, and clear documentation are essential.

If your family member developed aspiration pneumonia in a nursing home and you have concerns about the care provided, contact John J. Malm & Associates for a free consultation. Our Illinois nursing home lawyers will review medical records and care plans, consult with clinical and swallowing experts, and investigate whether failures in assessment, feeding supervision, oral care, medication management, or enteral feeding protocols contributed to harm. Our goal is to obtain answers, protect your loved one from further harm, and pursue compensation when facility negligence caused preventable illness or death.

Contact our firm today for a free, no-obligation consultation. We will explain your rights, preserve critical evidence, and advocate for recovery of medical expenses, pain and suffering, and other damages. We handle these cases with the sensitivity and experience they require.