aid in the healing process. prognosis dysphagia clinicians often recommend alteration of dietary regimens, altered head positioning, or removal of all oral intake. while studies have suggested that thickening liquids can decrease aspiration through slowed pharyngeal transit time, they have also demonstrated increased pharyngeal residues with risk for delayed aspiration. the ability of clinical interventions to reduce pneumonia incidence is relatively unknown. dietary modifications or nothing-by-mouth status also have no effect on a patient's ability to handle their own secretions. a patient's individual vigor may impact the development of pulmonary infections more than aspiration. also increased pneumonia risk exists in patients with esophageal dysphagia when compared to stroke patients because patients with stroke will improve as they recover from their acute injury, whereas esophageal dysphagia is likely to worsen with time. in one cohort of aspiration pneumonia patients, overall three-year mortality was 40%. studies have shown that aspiration pneumonia has been associated with an overall increased in-hospital mortality as compared with other forms of pneumonia. further studies investigating differing time spans including 30-day mortality, 90-day mortality, and 1-year mortality. individuals diagnosed with aspiration pneumonia were also at increased risk of developing future episodes of pneumonia. in fact, these individuals were also found to be at higher risk for readmission after being discharged from the hospital. lastly, one study found that individuals diagnosed with aspiration pneumonia were more likely to fail treatment compared to other types of pneumonia. elderly aging increases the risk of dysphagia. the prevalence of dysphagia in nursing homes is approximately 50%, and 30% of the elderly with dysphagia develop aspiration. for individuals older than 75, the risk of pneumonia due to dysphagia, is six times greater than those 65. owing to multiple factors, such as frailty, impaired efficacy of swallowing, decreased cough reflex and neurological complications, dysphagia can be considered as a geriatric syndrome. atypical presentation is common in the elderly. older patients may have impaired t cell function and hence, they may be unable to mount a febrile response. the mucociliary clearance of older people is also impaired, resulting in diminished sputum production and cough. therefore, they can present non-specifically with different geriatric syndromes. microaspirations in the elderly, dysphagia is a significant risk factor for the development of aspiration pneumonia. aspiration pneumonia most often develops due to micro-aspiration of saliva, or bacteria carried on food and liquids, in combination with impaired host immune function. chronic inflammation of the lungs is a key feature in aspiration pneumonia in elderly nursing home residents and presents as a sporadic fever (one day per week for several months). radiological review shows chronic inflammation in the consolidated lung tissue, linking chronic micro-aspiration and chronic lung inflammation. choking after falls, choking on food presents as the second highest cause of preventable death in aged care. although food choking risk is commonly associated with young children, data shows that individuals over 65 years of age have a choking incidence that is seven times higher than children aged 1–4 years. parkinson's disease the reported prevalence of dysphagia in patients with parkinson's disease ranges from 20% to 100% due to variations in the methods of assessing the swallowing function. unlike some medical problems, such as stroke, dysphagia in parkinson's disease degenerates with disease progression. aspiration pneumonia was the most common reason for the emergency admission of patients with parkinson's disease whose disease duration was >5 years and pneumonia was one of the main causes of death. dementia the familiar model of care for people with advanced dementia and dysphagia is the revolving door of recurrent chest infections, frequently associated with aspiration and related readmissions. many individuals with dementia resist or are indifferent to food and fail to manage the food bolus. there are also many contributory factors such as poor oral hygiene, high dependency levels for being positioned and fed, as well as the need for oral suctioning. while tube feeding might therefore be considered a safer option, tube feeding has not been shown to be beneficial in people with advanced dementia. the preferred option therefore is to continue eating and drinking orally despite the risk of developing chest infections.