Table 3.

The clinical competencies in managing older adults with aspiration

Competency	Content
Diagnosis	Knowing the characteristics of AP and differences from CAP, HAP, HCAP, NHCAP, aspiration pneumonitis Detecting pathogens, assessing risk of resistant bacteria Evaluating X-ray and CT images Diagnosing the underlying condition causing the dysphagia or aspiration Recording and coding correctly on medical records
Treatment	Appropriate antibiotic treatment Fluid and electrolyte management Airway and breathing, and sputum management
Swallow assessment	Early consultation to a speech therapist Observation of eating and drinking habits Assessment with videofluoroscopy, videoendoscopy Assessment of silent aspiration and cough effectiveness Appropriate diet and liquid modification and feeding techniques
Underlying condition management	Management of dysphagia and aspiration related with the underlying condition Drug review
Nutrition	Early initiation of oral intake (avoiding unnecessary fasting) Modification of diet and liquids according to swallow function Evaluation of nutritional status and intake Supplementation of inadequate oral intake Appropriate usage of tube feeding and prevention of complications
Oral management	Evaluation of oral status (OHAT, ROAG) Frequent oral care Availability of guidance and resources for oral care on the ward Appropriate use and cleaning of dentures Dental treatment
Rehabilitation	Early initiation of physiotherapy and swallow training Maintenance of daily activities Utilisation of devices (TESS)
Multidisciplinary team	Discussions regarding difficult decision making Developing protocols for AP management, risk feeding Comprehensive team intervention Providing efficient training for healthcare professionals
Decision making	Acknowledging the complexity of decision making Decisions on administering, withholding, or withdrawing antibiotics, hydration, risk feeding, hospitalisation, and resuscitation Accepting AP as a natural course of decline in terminal cases Understanding the ethical challenges and dilemmas of difficult decision making
Prevention	Oral Care Vaccination Drug review (discontinuation of risky drugs, appropriate use of preventative drugs)
Prognosis	Awareness of poor prognosis compared to non-AP Evaluation of severity, prognosis and survival rate utilisation of prognostic factors Communicating the perceived prognosis to patients and families
Palliative care	Subjective and objective symptom assessments Symptom control (Discomfort, pain, dyspnoea, cough, rattling breath)

AP aspiration pneumonia, CAP community acquired pneumonia, HAP hospital acquired pneumonia, HCAP healthcare-associated pneumonia, NHCAP nursing and healthcare-associated pneumonia, CT computed tomography, OHAT oral health assessment tool, ROAG Revised Oral Assessment Guide, TESS transcutaneous electrical sensory stimulation