Our clinical experience points to a critical gap in the care of hospitalized older adults: oral hygiene. We have seen firsthand how this gap in preventive care increases the risk of aspiration pneumonia, a dangerous complication for which risk might be reduced. This is why the discussion around strengthening nurse-led geriatric models, such as the INTERCARE protocol by Zúñiga et al. 1, is so important. While their initiative is a vital step toward better care, we contend it will not be complete without making systematic oral hygiene a core component for preventing these hospital-acquired harms. The debate over oral hygiene's role in pneumonia prevention, previously aired in this journal by Mylotte 2, can now be settled by a wealth of evidence. For instance, a pivotal early study from Bassim et al. 3 established that a dedicated oral hygiene aide could materially impact pneumonia-related mortality. This finding is powerfully reinforced by Sjögren et al. 4, whose comprehensive systematic review and meta-analysis—also in JAGS—connected oral care to a reduced risk of death from pneumonia across both hospital and nursing home settings. This link is not static; it is continually strengthened by new, high-quality research. A quasi-experimental study showed that structured training for nursing assistants slashed non-ventilator hospital-acquired pneumonia by 66% 5. Another RCT confirmed that daily 0.2% chlorhexidine care significantly cuts oral bacterial colonization 6. Crucially, novel approaches are also emerging. We can now use low swallowing tongue pressure to identify high-risk individuals 7 and promote effective post-discharge self-care through proven brushing techniques 8. Yet, for all this evidence, a significant implementation gap persists. It is characterized by inadequate staff training and inconsistent adherence to protocols 9, 10—precisely the challenges that implementation models like INTERCARE aim to solve. Therefore, we propose a clear path forward. Nurse-led models designed to enhance geriatric care quality, such as INTERCARE, must explicitly integrate standardized, evidence-based oral care protocols as a core element. This means embedding risk assessment, staff training on techniques and tools, and clear care pathways into daily practice. Furthermore, future work should examine how critical variables—such as length of stay, functional dependency, cognitive status, and comorbidities—influence both pneumonia risk and the practical application of these oral care interventions. By weaving oral hygiene into these broader quality improvement frameworks, we can translate robust evidence into meaningful reductions in pneumonia incidence and mortality for our most vulnerable patients. Jing Yang: writing and editing, investigation. Yuanyan Bai: writing – review and supervision. The authors have nothing to report. The authors declare no conflicts of interest. This publication is linked to a related reply by Zúñiga and Siqeca. To view this article, visit https://doi.org/10.1111/jgs.70304.
Yang et al. (Tue,) studied this question.