Interventions for Feeding and Swallowing Disorders in Adults with Intellectual Disability: A Systematic Review of the Evidence

Abstract

Feeding and swallowing disorders are prevalent in adults with Intellectual Disability (ID) and can potentially lead to discomfort, malnutrition, dehydration, aspiration, and choking. Most common interventions include: diet modification, compensatory strategies, swallowing therapy, and non-oral feeding. Despite their common use, the research evidence for these interventions is lacking. The current study aimed to systematically review the evidence for the safety and the effectiveness of interventions for feeding and swallowing disorders in adults with ID. Seven electronic databases, conference proceedings, and reference lists of relevant studies were reviewed from online availability to March 2019, with no language restrictions. Eligibility criteria encompassed experimental or non-experimental study design, adults (> 18 years) with ID and feeding and/or swallowing disorders (any etiology and severity) and any intervention for feeding and/or swallowing disorders. Methodological quality was assessed by two independent reviewers using the Downs and Black checklist. Four articles met the inclusion criteria. All included studies considered enteral feeding as an intervention strategy and had a retrospective observational design. Overall, included studies reported positive change in nutritional status and a high incidence of adverse events following enteral feeding initiation. Risk of bias was high with variability in methodological quality. The safety and effectiveness of interventions for feeding and swallowing in adults with ID is unclear. This review highlights the lack of evidence-based practice in this area. Directions for further research are provided. Before enteral feeding initiation, risks and benefits should be appropriately balanced on an individual basis, and caregivers should be involved in the decision-making process.

Methodology for design of suitable dishes for dysphagic people

“…Untreated dysphagia can severely compromise the normal feeding and hydration. People who suffer dysphagia have a higher risk of malnutrition and dehydration (Manduchi et al, 2019). In general population, the prevalence of oropharyngeal dysphagia varies (depending on the participant selection, screening or assessment tools) between 2.3 % and 16.0 %, and it rises with age, up to 26.7 % for people older than 76 years (Baijens et al, 2016).…”

Development and validation of a functional screening tool for adults with intellectual disabilities

“…The great challenge of developing a new instrument is ensuring its accessibility for primary care providers (Ben Dor et al, 2016;Manduchi et al, 2020;Mendler & Kurazim, 2005).…”

Evaluating the effectiveness of stepwise swallowing training on dysphagia in patients with Alzheimer’s disease: study protocol for a randomized controlled trial

“…Overall, fewer participants aspirated on nectar- ( p < 0.01) and honey-thickened liquids ( p < 0.01) [ 10 ]. While previous studies are conflicted about these strategies and some data suggest that postural adjustments are inferior to active rehabilitation, other approaches include chemo-denervation, pharmacological treatment, neuromuscular electrical stimulation, and non-invasive brain stimulation [ 11 , 12 ]. Chemical myotomy and drug application are not highly recommended as first-line treatment in older adults with dysphagia due to the potential risks and side effects.…”