“Meet my patient. His name is MM, he is 90 years old, and three months ago he was walking. I know he looks like an inactive elderly man lying on this stretcher, but a decline this fast is not normal. We need to help him, and we need to find the cause.”
My name is Deedee, and I am a home care nurse. This is the story of how recurrent aspiration pneumonia kept sending one of my patients back to hospital, and why treating the cause matters as much as treating the infection.
Three Hospital Admissions in Two Months
My company was hired to care for MM at home after his third discharge from hospital. He had no significant medical history and none of the main geriatric syndromes. Yet when I met him, he was weak, barely moving, bed-bound most of the time, and fully dependent on others for his care.
Something was not right. He had been in and out of hospital three times in just two months.
The hospital diagnosis was aspiration pneumonia. Swallowing difficulties at mealtimes had allowed food particles to enter his lungs, which led to a chest infection. During his first admission, the doctors inserted a G tube (a feeding tube into the stomach) because a swallowing assessment showed that eating by mouth was no longer safe. That hospital stay lasted three weeks, and the long period in bed weakened his leg muscles until he could no longer use them.
He was sent home with the G tube. The aspiration pneumonia came back twice more. Each time he received IV antibiotics and was sent home again.
Getting to Know the Patient
On my first day, I was determined to get to know MM as a person, not just as a diagnosis. I wanted to know:
- What work he used to do
- What his daily routine looked like
- What foods he ate
- Whether he slept at night or during the day
- Whether he was talkative or reserved
I gathered this information from his private carer, the domestic staff, his daughters, and his son. Each person knew something the others did not. Together, their information gave me a much fuller picture of my patient.
I learned that three months earlier, MM was walking around the house with support from his carer. He had been a successful businessman who spoke several languages and led an active life. When I asked more about his eating habits, the family told me he had a long history of indigestion, a sensitive stomach, acid reflux, and frequent burping.
Why Reflux Increases the Risk of Aspiration Pneumonia
When stomach contents enter the lungs, the risk of a chest infection is high. Stomach contents are liquid and acidic, so they are easy to aspirate and irritating to the lungs.
People at higher risk of aspiration pneumonia include those who:
- Are bed-bound
- Have a history of acid reflux (GERD) or indigestion
- Have slow gastric emptying
- Have chronic constipation
As we age, the body’s ability to sense acid reflux also weakens, which leaves the airway less protected. Learn more about swallowing difficulties in older adults.
What the Nursing Assessment Showed
The lining of MM’s mouth showed signs of repeated acid exposure. The back of his tongue, which is hidden and hard to reach, was coated with a brown film, even though he was not eating anything by mouth.
Everything else was being managed correctly:
- His positioning in bed was appropriate.
- His feeding volumes were controlled with residual volume checks.
- His medications to reduce acid and help stomach emptying were given as prescribed.
Even so, MM began to cough, and a small amount of aspirated material came from his mouth. Another episode of regurgitation followed. His heart rate rose, he developed a fever, and his oxygen levels dropped. We informed the family that he needed to go to hospital.
Becoming the Patient’s Voice
We arrived at the Emergency Department by ambulance. MM was stable and on oxygen. He could not speak, so I had to tell his story for him. With his family beside him, I summarised the facts so they could add anything I had missed.
As I looked at him on the stretcher, wrapped in blue blankets with the heart monitor beeping, he looked like a tired elderly man. That was completely different from the man his family had described to me. So I spoke for him:
“Meet Mr MM. He is 90 years old, and three months ago he was walking. He has been in and out of hospital over the last three months. He keeps regurgitating his feeds despite correct positioning and volume control. His vital signs have been stable throughout. He has no previous medical history, he is receiving all his prescribed medications, he is not constipated, there are no signs of infection at his G tube site, and his skin condition is excellent. His family reports a history of indigestion, and you may wish to check whether this was recorded at his first admission. Three different types of feed have been trialled. I am his nurse, and I am speaking for my patient. I know he looks elderly to you, but he was an active man three months ago, and such a rapid decline is concerning. We need to find the cause so this does not happen again.”
Why Treating the Cause Matters
Treating aspiration pneumonia with antibiotics clears the infection, but it does not stop the next one. Recurrent aspiration pneumonia needs a clear answer to one question: why is the patient aspirating? Only then can the care plan prevent another admission.
For families caring for a loved one with a feeding tube, read our guide on PEG tube and tracheostomy care at home.
Leaders in Home Nursing
Enayati Home Nursing is committed to delivering safe patient care. Enayati nurses are ranked among the top nursing teams in the country through the adoption of Canadian Best Practice Guidelines. We follow the RNAO Best Practice Guidelines, including caregiving strategies for older adults with delirium, dementia, and depression.
