{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T18:28:32Z","timestamp":1785868112642,"version":"3.56.0"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"am","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["JPMJFS2102"],"award-info":[{"award-number":["JPMJFS2102"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["JPMJSC2308"],"award-info":[{"award-number":["JPMJSC2308"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["25zf0127001h0005"],"award-info":[{"award-number":["25zf0127001h0005"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["22K19760"],"award-info":[{"award-number":["22K19760"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24K02778"],"award-info":[{"award-number":["24K02778"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["25K22899"],"award-info":[{"award-number":["25K22899"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Aspiration pneumonia (AP) is a leading cause of morbidity and mortality in older adults. Facility\u2010level determinants of AP in long\u2010term care settings remain poorly understood. In Japan's long\u2010term care insurance system, geriatric health service facilities differ in their staff composition, care processes, and swallowing support systems, which may influence AP incidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a nationwide, facility\u2010level cross\u2010sectional 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\u2010enhanced, enhanced, add\u2010on, or basic. Facility characteristics, staffing composition, nutritional and swallowing management practices, and reimbursement\u2010based care add\u2010ons were compared across facility types. Multivariate logistic regression was used to identify the risk factors associated with AP occurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Facility type, staff composition, and care resources varied significantly. The multivariable model revealed that a history of AP (OR\u2009=\u200945.138, 95% CI 16.937\u2013120.292;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and aspiration events (OR\u2009=\u20099.280, 95% CI 4.215\u201320.116;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) were strongly associated with AP. Facilities lacking occupational therapists had a higher risk of AP (OR\u2009=\u20094.875, 95% CI 1.708\u201313.909;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2010level risk of AP, suggesting that organizational differences in care management may influence AP in long\u2010term care settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ggi.70410","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T09:11:57Z","timestamp":1771492317000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Facility\u2010Level Factors Associated With Aspiration Pneumonia in Japanese Geriatric Health Service Settings: A Nationwide Cross\u2010Sectional Study"],"prefix":"10.1111","volume":"26","author":[{"given":"Xinze","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuma","family":"Okazaki","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiro","family":"Okochi","sequence":"additional","affiliation":[{"name":"Geriatric Health Services Faculty Tatsumanosato  Daito Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3574-649X","authenticated-orcid":false,"given":"Satoru","family":"Ebihara","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2025.105820"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idnow.2025.105102"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-024-03015-8"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiac.2014.04.002"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep38097"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1714562"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2021.106485"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S97481"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.31662\/jmaj.2018-0015"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaa102"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0254261"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-023-02641-y"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ggi.13164"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.01597.x"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resinv.2025.06.014"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201410-1876PP"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43163-025-00812-8"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000462"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.2169\/naika.109.2142"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pupt.2010.10.003"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.3389\/fstro.2024.1410657"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-86011-w"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0213825"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13728-015-0036-7"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11185323"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2013.07.012"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.4103\/jdmimsu.jdmimsu_194_22"},{"key":"e_1_2_11_29_1","unstructured":"Ministry of Health \u201cReimbursement and Regulatory Standards for Long\u2010Term Care Health Facilities [in Japanese] \u201dassessed November 6 2020 https:\/\/www.mhlw.go.jp\/content\/12300000\/000698290.pdf."},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31820fbca9"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2022.104311"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/47.5.672"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2006.01.024"}],"container-title":["Geriatrics &amp; 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