Instrumental swallowing assessment in adults in residential aged care homes: Practice patterns and opportunities

Abstract

Objective: To describe practice patterns in the use of instrumental swallowing assessment (ISA) for older adults in residential aged care homes (RACHs). Methods:A retrospective audit of medical records of residents living in RACHs in Melbourne, Australia to extract data on speech-language pathologist (SLP) involvement, indications for ISA and ISA practice patterns.Results: Medical files of 323 residents across four Melbourne facilities were reviewed. 36% (n = 115) of residents were referred to SLP for swallowing assessment.Referral to SLP was related to length of stay (U = 7393.00, p < 0.001), dementia status (χ 2 [1] = 7.06, p = 0.008), texture modification (χ 2 [1] = 93.34, p < 0.001) and an existing dysphagia diagnosis (χ 2 [1] = 112.89, p < 0.001). There were no referrals for ISA and no instances of ISA being used. Among 115 residents who were referred to SLP for swallowing assessment, there were 33 instances where ISA might be clinically relevant according to ISA indicators.Conclusions: Instrumental swallowing assessment is not being used for the management of swallowing in RACHs in Australia despite a clinical need for ISA and a potential role for ISA to improve swallowing care quality. Lack of timely ISA may fail to meet the complex health-care needs of older adults living with

The Prevalence of Dysphagia in Individuals Living in Residential Aged Care Facilities: A Systematic Review and Meta-Analysis

“…This may be due to the requirement of specialized training and equipment that is often only available at hospitals, increased costs, travel, staff availability, and feasibility of completion for residents with additional comorbidities [ 82 ]. For example, in aged care facilities in Australia, instrumental assessment requires referral of the resident by a Doctor or an SLP to an outpatient clinic such as a hospital [ 48 ]. On the other hand, all studies in this review utilized a CSE, likely due to being non-invasive, cost-effective, and time-efficient, making it the preferred method of choice in this population.…”

“…Despite the availability of valid and reliable methods, dysphagia remains underrecognized and undertreated in aged care settings [ 41 ]. This is due to the paucity of clinical governance for routine screening and assessment; infrequent referral to, reimbursement of, and involvement of allied health professionals including dietitians and speech-language pathologists; the inconsistent use of validated screening tools for risk assessment due to the unavailability of an internationally standardized tool [ 48 ]; the increased cost and actions associated with instrumental assessment and lack of awareness among residential aged care staff to detect signs of dysphagia and conduct accurate screening [ 49 ].…”

Malnutrition in aged care: interplay between dysphagia and diet

“…Birchall et al [23 ▪ ] report on access to instrumental swallowing assessment in aged care in Australia. In view of the prevalence of swallowing difficulties in aged care residents, we would expect to see a high frequency of referrals for instrumental swallow assessment to support informed dysphagia management.…”