When visibility and priming have an inverse relationship: A successful replication of Vorberg et al., 2003.

Pneumonia remains a major public health concern and one of the leading causes of death among older adults []. Among its subtypes, aspiration pneumonia (AP) represents a major challenge in long‐term care settings [, ]. It is the leading cause of pneumonia among older adults with frailty receiving long‐term care and is associated with substantial morbidity and care burden [, ], particularly among residents who require daily assistance with feeding and oral care []. This burden may be greater in nutritionally vulnerable residents. Residents at high risk of malnutrition in long‐term care often have compromised oral function, reduced swallowing efficiency, and limited physiological reserve, which may increase susceptibility to AP [, ]. Previous studies have reported associations between oral frailty‐related conditions and AP [, , ], primarily through the colonization of the oral cavity by pathogenic microorganisms. Poor oral hygiene leads to colonization of the oral cavity by pathogenic microorganisms, which may serve as a reservoir for bacteria that can be aspirated into the lower respiratory tract []. Colonization of dental plaque by respiratory pathogens and subsequent aspiration of oropharyngeal bacteria have been consistently implicated in the pathogenesis of AP []. However, most existing studies have focused on oral frailty‐related conditions examined in isolation, often within limited clinical settings among residents with nutritional vulnerability [, ]. Evidence on the relationship of AP with the coexistence and overall burden of multiple oral frailty‐related conditions encountered in routine care environments in long‐term care populations remains limited. In addition to oral frailty‐related conditions, feeding‐related factors have also been investigated in relation to AP []. Body position during meals may influence swallowing safety, with upright sitting generally associated with less difficulty than supine postures []. A semi‐recumbent position of approximately 30° may represent the optimal position for swallowing, as it facilitates bolus transit while maintaining airway protection and potentially reducing AP occurrence []. However, a study has reported that swallowing performance varies across positions, with subjective swallowing difficulty at 30° lower than that in the supine position but greater ease observed at more upright or 60° semi‐recumbent positions []. The observational findings in care settings regarding meal position and AP remain inconsistent []. These considerations may be relevant for long‐term care residents with greater functional and nutritional vulnerabilities in whom both oral function and postural control during feeding are often compromised. Given that meal‐related positioning is routinely adjusted in long‐term care facilities and is a potentially modifiable factor in daily care, further investigations are warranted.