Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review

Abstract

Background Dysphagia is highly prevalent condition in older adults living in nursing homes. There is also evidence indicating that aspiration is one of the major health risks for these older adults, which is more likely to result in respiratory infections, aspiration pneumonia and sudden bolus death. Evidence syntheses have demonstrated the effectiveness of interventions for prevention of aspiration among hospitalized older people. The aim of this scoping review is to describe the current spread of interventions to prevent or reduce aspiration in older adults with dysphagia with a specific focus on those who reside in nursing homes. Methods The Joanna Briggs Institute methods and PRISMA-ScR guidelines were used to inform this review. MEDLINE, CINAHL, EMBASE, Cochrane Library, Joanna Briggs Institute EBP Database and Web of Science were searched for related articles from 2010 to 2020 as well as Chinese databases (CNKI, WANFANG DATA and VIP) and databases for unpublished material. A three-step search strategy was utilized, including the use of citation software to manage search results and de-duplication, abstract review and full-text review by two reviewers. Details of included studies were then extracted using a prepared data extraction tool. The resulting map was displayed in tabular form along with a narrative summary. Results Although 637 articles were located, 19 papers were included in the final analysis. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes included: more bedside evaluation, modification of dietary, creating an appropriate environment for swallowing, providing appropriate feeding assistance, appropriate posture or maneuver for swallowing, appropriate rehabilitation program, medication treatment, and stimulation treatment. Conclusion Nursing homes, particularly those in developing countries, require more support for staff training and necessary equipment. Professional interventions provided by speech and language therapists are still limited in the setting of nursing homes. Modification of dietary was the most frequently used intervention to prevent or reduce aspiration. Multi-disciplinary interventions had the best results for aspiration management, but for many nursing homes, access to such teams is limited. Nursing home residents respond well to person-centered interventions that have a comprehensive consideration of their degree of aspiration risk, health condition, individual feelings and cognitive state.

Prevalence and management of dysphagia in nursing home residents in Europe and Israel: the SHELTER Project

“…Concerning the management of dysphagia, some studies suggest that the feeding practice and assistance might be very helpful in preventing the aspiration pneumonia in subjects with dysphagia [ 48 ]. But despite the evidence supporting the effectiveness of texture modified diets in improving the nutritional status and preventing aspiration pneumonia is scant, diet modification is the most common intervention used to manage dysphagia in NHRs, as also observed in our study [ 34 , 49 – 53 ].…”

Health Value of China’s Long-term Care Insurance in Older Disabled People: Role of Institutional Care

“…High-quality airway management is a fundamental and vital skill in the care of disabled patients [25]. Repeated episodes of pneumonia can be avoided by prevention of aspiration, timely sputum suction, suitable oral health care, gastroesophageal re ux management, and a head-up position during the night [26, 27,28]. Pressure ulcers are frequent complications of disabled patients and are generally connected with poor prognosis [29,30].…”

Research progress in the risk factors and screening assessment of dysphagia in the elderly

“…Interventions to prevent dysphagia in older adults living in nursing homes included more bedside evaluation, modification of dietary, creating an appropriate environment for swallowing, providing appropriate feeding assistance, appropriate posture or maneuver for swallowing, appropriate rehabilitation program, medication treatment, and stimulation treatment. Among them, modification of dietary was the most frequently used intervention to prevent or reduce aspiration ( 37 ). Saliva aspiration prevention like oral anticholinergics, transdermal anticholinergics, intravenous anticholinergics, and salivary gland irradiation, as well as active dysphagia revalidation including bedside swallow exercises, swallow training with electrical stimulation and swallow training with surface electromyographic biofeedback were proven to be effective preventive measures for dysphagia ( 38 ).…”