Abstract
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.
Highlights
Oropharyngeal dysphagia (OD) presents a serious health threat
Oropharyngeal dysphagia affects people all over the world, with prevalence data in the general population that vary between 2.3 and 16% [6], depending on definitions of swallowing problems and methods used for screening and assessment [6,7,8]
Substantial discrepancies in dysphagia management were identified between nursing homes across Norway
Summary
Oropharyngeal dysphagia (OD) presents a serious health threat. It may result in failure to maintain hydration and nutrition and pose a risk of choking and aspiration, with devastating consequences [1, 2]. Oropharyngeal dysphagia affects people all over the world, with prevalence data in the general population that vary between 2.3 and 16% [6], depending on definitions of swallowing problems and methods used for screening and assessment [6,7,8]. The condition is especially common in elderly, stroke patients, and in those with neurological diseases [4] and is considered a major health care problem in nursing home residents [2]. The high prevalence of dysphagia among the elderly in an aging population has a major impact on health economics and the health care system [9]. OD is considered a geriatric syndrome, as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated [9]
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