It Is Time to Revamp Approaches to Managing Dysphagia in Nursing Homes

Levenson, Steven A.; Walker, Victoria

doi:10.1016/j.jamda.2019.06.005

Cited by 9 publications

(14 citation statements)

References 18 publications

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“…Observational design was used in one study [ 27 ]. Of the six reviews, four were literature reviews and the other were systematic reviews [ 13 , 32 , 33 , 35 , 36 , 38 ]. A further two studies utilized case series approaches and one was case report [ 26 , 28 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…Such modification usually involved the use of thickening agents to change the consistency of food or fluids. Of these studies, seven used this intervention as a part of an interdisciplinary prevention plan [ 13 , 33 , 34 , 37 , 38 , 40 , 41 ]; the others focused on it to explore its independent effects [ 30 , 32 , 35 , 36 , 39 ]. Most of studies concluded that texture-modified food and liquids reduced the risk of aspiration, and that this was helpful in maintaining adequate fluid intake for residents with dysphagia.…”

Section: Resultsmentioning

confidence: 99%

“…Most of studies concluded that texture-modified food and liquids reduced the risk of aspiration, and that this was helpful in maintaining adequate fluid intake for residents with dysphagia. However, Levenson reported that no clear correlation was found between viscosity and successful prevention of aspiration pneumonia [ 32 ]. Painter also reported that food consistency change was useful in reducing the risk of aspiration seen on video fluoroscopy, but little evidence supported the use of texture-modified food to improve the clinical consequence of aspiration pneumonia [ 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…As Table 1 shows, of the nineteen studies [13,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], six were conducted in the USA, three were conducted in Japan, two were conducted in Australia, and one was conducted in the UK, France, Sweden, Brazil, South Korea, Mainland China, Hongkong and Taiwan, respectively. Most were conducted in developed countries or regions (89.5%).…”

Section: Country or Region For Publicationmentioning

confidence: 99%

“…Twelve studies reported that modification of dietary consistency or texture was a commonly used method in nursing homes to prevent or reduce aspiration [13,30,[32][33][34][35][36][37][38][39][40][41]. Such modification usually involved the use of thickening agents to change the consistency of food or fluids.…”

Section: Modification Of Dietarymentioning

confidence: 99%

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

2021

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Country or Region For Publicationmentioning

confidence: 99%

Section: Modification Of Dietarymentioning

confidence: 99%

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

2021

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Management of Dysphagia in Nursing Homes: A National Survey

Engh

Speyer

2021

Dysphagia

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The management of dysphagia may differ by country and clinical setting. The purpose of this study was to describe the management and care pathways for elderly people with dysphagia in nursing homes across Norway using an online survey. A national survey was developed that consisted of 23 questions covering various areas related to dysphagia care in nursing homes: background information of respondents, nursing homes, and residents and staff; screening and assessment of dysphagia including use of specialist consultation; management, practice patterns, and interventions targeting residents with dysphagia; training of staff; and perceived quality of current clinical practices in their nursing home. A total of 121 respondents completed the online survey, resulting in an overall response rate of 23.2%. Substantial discrepancies in dysphagia management were identified between nursing homes. In approximately 75% of nursing homes, residents were not routinely screened or assessed for swallowing problems. Although nursing homes used a broad range of strategies and routines for people with eating and swallowing difficulties, bolus modification seemed standard practice. Oral hygiene strategies were lacking in over 80% of nursing homes, and almost 50% did not have access to external experts, including speech therapists. Although nursing home staff rated the overall quality of care for people with eating and swallowing problems as high, their rating seemed mainly based on care for malnutrition and not directly aimed at dysphagia. The survey identified an evident need for training and upskilling staff in Norwegian nursing homes and raising awareness of the serious consequences and comorbidities that can result from dysphagia.

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