Skip to main content

Advertisement

SpringerLink
Log in

The Role of Instrumental Swallowing Assessment in Adults in Residential Aged Care Homes: A National Modified Delphi Survey Examining Beliefs and Practices

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Many adults in residential aged care homes (RACHs) live with oropharyngeal dysphagia (OD) and its physiological, psychosocial, and economic sequalae. Timely, evidence-based assessment of OD can help healthcare teams to create OD management plans that optimize consumer health and minimize healthcare costs. Instrumental swallowing assessment (ISA), specifically flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing studies (VFSS), is generally accepted to be an important component of dysphagia assessment and management in older adults. However, its role in RACHs has not been empirically examined. This study aimed to explore the role and use of ISA in adults in RACHs from the perspective of speech–language-pathologists (SLPs) experienced in a RACH setting and/or FEES and VFSS. A three-round electronic Delphi study was conducted to guide 58 SLPs in Australia towards consensus using a combination of multiple-choice questions, statements with five-point Likert scale agreement options, and open-ended questions. Participants’ responses were analyzed using descriptive statistics and content analysis after each survey round. Feedback about group responses was provided before subsequent surveys. Consensus was defined as 70% or greater agreement. Participants reached consensus about obstacles and facilitators to the use of ISA in RACHs. Participants agreed that FEES was a valuable tool in RACHs and that a mobile service model may have advantages over standard off-site assessment. SLPs believed that appropriate governance processes, infrastructure and education were necessary to develop a safe, high-quality service. These views support equitable access to ISA across settings, aligning with person-centered care, re-ablement, and care-in-place.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Steele CM, Greenwood C, Ens I, Robertson C, Seidman Carlson R. Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia. 1997;12(1):43–50.

    Article  CAS  Google Scholar 

  2. Li-Chan L, Shiao-Chi W, Shen CH, Tyng-Guy W, Miao-Yen C. Prevalence of impaired swallowing in institutionalized older people in Taiwan. J Am Geriatr Soc. 2002;50:1118–23.

    Article  Google Scholar 

  3. Park YH, Han HR, Oh BM, Lee J, Park JA, Yu SJ, Chang H. Prevalence and associated factors of dysphagia in nursing home residents. Geriatr Nurs. 2013;34:212–7.

    Article  Google Scholar 

  4. Nogueira D, Reis E. Swallowing disorders in nursing home residents: how can the problem be explained? Clin Interv Aging. 2013;8:221–7.

    Article  Google Scholar 

  5. Kayser-Jones J, Pengilly K. Dysphagia among nursing home residents. Geriatr Nurs. 1999;20:77–84.

    Article  CAS  Google Scholar 

  6. Attrill S, White S, Murray J, Hammond S, Doeltgen S. Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC Health Serv Res. 2018;18:594.

    Article  Google Scholar 

  7. Langmore SE. History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia changes over the years. Dysphagia. 2017;32:27–38.

    Article  Google Scholar 

  8. Birchall O, Bennett M, Lawson N, Cotton S, Vogel AP. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopy swallowing assessment of adults in residential care facilities: a scoping review protocol. JBI Evid Synth. 2020;18(3):599–609. https://doi.org/10.11124/JBISRIR-D-19-00015.

    Article  PubMed  Google Scholar 

  9. Barczi SR, Sullivan PA, Robbins JA. How should dysphagia care of older adults differ? Establishing optimal practice patterns. Semin Speech Lang. 2020;21:0347–64.

    Article  Google Scholar 

  10. Birchall O, Bennett M, Lawson N, Cotton SM, Vogel AP. Instrumental swallowing assessment in adults in residential aged care homes: a scoping review. J Am Med Dir Assoc. 2021;22(2):372-379.e376.

    Article  Google Scholar 

  11. DeFabrizio ME, Rajappa A. Contemporary approaches to dysphagia management. J Nurse Pract. 2010;6:622–30.

    Article  Google Scholar 

  12. Takahashi N, Kikutani T, Tamura F, Groher M, Kuboki T. Videoendoscopic assessment of swallowing function to predict the future incidence of pneumonia of the elderly. J Oral Rehabil. 2012;39:429–37.

    Article  CAS  Google Scholar 

  13. Casper ML. Ethically navigating the maze of billing, documentation, and reimbursement for dysphagia services in long-term care. Perspect Swallowing Swallowing Disord (Dysphagia). 2014;23:58–64.

    Article  Google Scholar 

  14. Tejima C, Kikutani T, Takahashi N, Tamura F, Yoshida M. Application of simple swallowing provocation test with fiberoptic endoscopic evaluation of swallowing in a cross-sectional study. BMC Geriatr. 2015;15:48.

    Article  Google Scholar 

  15. Hase T, Miura Y, Nakagami G, Okamoto S, Sanada H, Sugama J. Food bolus-forming ability predicts incidence of aspiration pneumonia in nursing home older adults: a prospective observational study. J Oral Rehabil. 2020;47(1):53–60.

    Article  Google Scholar 

  16. OECD. Health at a Glance 2013: OECD indicators. OECD Publishing; 2013. https://doi.org/10.1787/health_glance-2013-en. Accessed 1 April 2020.

  17. Australian Commission on Safety and Quality in Health Care (ACSQHC) (2015) Vital signs 2015: the state of safety and quality in Australian health care. ACSQHC; 2015.

  18. Australian Commission on Safety and Quality in Healthcare. National Model Clinical Governance Framework. Australian Commission on Safety and Quality in Healthcare; 2019. https://www.safetyandquality.gov.au/topic/national-model-clinical-governance-framework. Accessed 29 May 2020.

  19. Ibrahim J. Nature and extent of external-cause deaths of nursing home residents in Victoria, Australia. J Am Geriatr Soc. 2015;63:954–62.

    Article  Google Scholar 

  20. State of Victoria Department of Health and Human Services. Services SoVDoHaH: supporting the delivery of quality healthcare for aged care residents: residential aged care services, general practitioners and health services. State of Victoria Department of Health and Human Services; 2016. https://www2.health.vic.gov.au/about/publications/policiesandguidelines/supporting-the-delivery-of-quality-healthcare-for-aged-care-residents. Accessed 1 April 2020.

  21. Dyer SM, van den Berg M, Barnett K, Brown A, Johnstone G, Laver K, Lowthian J, Maeder AJ, Meyer C, Moores C, Ogrin R, Parrella A, Ross T, Shulver W, Winsall M, Crotty M. Review of innovative models of aged care for the The Royal Commission into Aged Care Quality and Safety. 2019. https://agedcare.royalcommission.gov.au/publications/Documents/research-paper-3-review-innovative-models-of-aged-care.pdf. Accessed 1 April 2020.

  22. Keeney S, Hasson F, McKenna H. Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs. 2006;53:205–12.

    Article  Google Scholar 

  23. Stewart D, Gibson-Smith K, MacLure K, Mair A, Alonso A, Codina C, Cittadini A, Fernandez-Llimos F, Fleming G, Gennimata D, Gillespie U, Harrison C, Junius-Walker U, Kardas P, Kempen T, Kinnear M, Lewek P, Malva J, McIntosh J, Scullin C, Wiese B. A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people. PLoS ONE. 2017;12(11):e0188348. https://doi.org/10.1371/journal.pone.0188348.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Hollaar V, van der Maarel-Wierink C, van der Putten G-J, van der Sanden W, de Swart B, de Baat C. Defining characteristics and risk indicators for diagnosing nursing home-acquired pneumonia and aspiration pneumonia in nursing home residents, using the electronically-modified Delphi Method. BMC Geriatr. 2016;16:60.

    Article  Google Scholar 

  25. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(1008–1015):26.

    Google Scholar 

  26. Williams PL, Web G. The Delphi technique: an adaptive research tool. Br J Occup Ther. 1994;61(4):153–6.

    Google Scholar 

  27. Parliament of Australia (2014) Prevalence of different types of speech, language and communication disorders and speech pathology services in Australia. Chapter 5: The availability and adequacy of speech pathology services in Australia https://www.aph.gov.au/-/media/Committees/Senate/committee/clac_ctte/speech_pathology/report/c05.pdf?la=en&hash=55F948C66C179D97722D839F34D8332B8BA9A6E4. Accessed 1 April 2020.

  28. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.

    Article  Google Scholar 

  29. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN. The REDCap Consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

    Article  Google Scholar 

  30. Gephart SM, Effken JA, McGrath JM, Reed PG. Expert consensus building using e-Delphi for necrotizing enterocolitis risk assessment. J Obstet Gynecol Neonatal Nurs. 2013;42(3):332–47.

    Article  Google Scholar 

  31. Vogel C, Zwolinsky S, Griffiths C, Hobbs M, Henderson E, Wilkins E. A Delphi study to build consensus on the definition and use of big data in obesity research. Int J Obes. 2019;43(12):2573–86.

    Article  Google Scholar 

  32. Slade SC, Dionne CE, Underwood M, Buchbinder R. Standardised method for reporting exercise programmes: protocol for a modified Delphi study. BMJ Open. 2014;4(12):e006682.

    Article  Google Scholar 

  33. Veugelers R, Gaakeer MI, Patka P, Huijsman R. Improving design choices in Delphi studies in medicine: the case of an exemplary physician multi-round panel study with 100% response. BMC Med Res Methodol. 2020;20(1):156.

    Article  Google Scholar 

  34. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.

    Article  Google Scholar 

  35. Australian Bureau of Statistics. Remoteness structure: the Australian Statistical Geography Standard remoteness structure. Australian Bureau of Statistics; 2017. https://www.abs.gov.au/websitedbs/D3310114.nsf/home/remoteness+structure. Accessed 1 April 2020.

  36. Luxon L. Infrastructure—the key to healthcare improvement. Future Hosp J. 2015;2:4–7.

    Article  Google Scholar 

  37. Ouslander JG, Lamb G, Tappen R, Herndon L, Diaz S, Roos BA, Grabowski DC, Bonner A. Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II Collaborative Quality Improvement Project. J Am Geriatr Soc. 2011;59:745–53.

    Article  Google Scholar 

  38. Ibrahim J. Recommendations for prevention of injury-related deaths in residential aged care services. Southbank: Monash University; 2017. https://www.aph.gov.au/DocumentStore.ashx?id=525f03d1-245d-4da2-9482-df2948748824. Accessed 1 March 2020.

  39. Yeon-Hwan P, Hwal Lan B, Hae-Ra H, Hee-Kyung C. Dysphagia screening measures for use in nursing homes: a systematic review. J Korean Acad Nurs. 2015;45:1–13.

    Article  Google Scholar 

  40. Giammarino C. Safety concerns and multidisciplinary management of the dysphagic patient. Phys Med Rehabil Clin N Am. 2012;23:335.

    Article  Google Scholar 

  41. Rosen MA, DiazGranados D, Dietz AS, Benishek LE, Thompson D, Pronovost PJ, Weaver SJ. Teamwork in healthcare: key discoveries enabling safer, high-quality care. Am Psychol. 2018;73:433–50.

    Article  Google Scholar 

  42. Victoria State Government (2017) An interdisciplinary approach to caring. Victoria State Government; 2017. https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/resources/improving-access/ia-interdisciplinary. Accessed 2 Dec 2020.

  43. Permpongkosol S. Iatrogenic disease in the elderly: risk factors, consequences, and prevention. Clin Interv Aging. 2011;6:77–82.

    Article  Google Scholar 

  44. McGinnis CM, Homan K, Solomon M, Taylor J, Staebell K, Erger D, Raut N. Dysphagia: interprofessional management, impact, and patient-centered care. Nutr Clin Pract. 2019;34:80–95.

    Article  Google Scholar 

  45. Cichero JA, Cichero JAY. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J. 2013;12:54.

    Article  Google Scholar 

  46. Murray J, Miller M, Doeltgen S, Scholten I. Intake of thickened liquids by hospitalized adults with dysphagia after stroke. Int J Speech Lang Pathol. 2014;16:486–94.

    Article  Google Scholar 

  47. Crary MA, Humphrey JL, Carnaby-Mann G, Sambandam R, Miller L, Silliman S. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care. Dysphagia. 2013;28:69–76.

    Article  Google Scholar 

  48. Leong LJP, Crawford GB. Residential aged care residents and components of end of life care in an Australian hospital. BMC Palliat Care. 2018;17:84. https://doi.org/10.1186/s12904-018-0337-x.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kjelle E, Lysdahl KB. Mobile radiography services in nursing homes: a systematic review of residents’ and societal outcomes. BMC Health Serv Res. 2017;17:1–8.

    Article  Google Scholar 

  50. Kjelle E, Lysdahl KB, Olerud HM. Impact of mobile radiography services in nursing homes on the utilisation of diagnostic imaging procedures. BMC Health Serv Res. 2019;19(1):428.

    Article  Google Scholar 

  51. Australian Medical Association. AMA submission to the Medical Services Advisory Committee—new mobile imaging services for residential aged care facilities. Australian Medical Association; 2018. https://ama.com.au/sites/default/files/documents/AMA_submission_to_MSAC_new_mobile_imaging_services_for_residential_aged_care_facilities.pdf. Accessed 2 Dec 2020.

  52. Kjelle E, Lysdahl KB, Olerud HM, Myklebust AM. Managers’ experience of success criteria and barriers to implementing mobile radiography services in nursing homes in Norway: a qualitative study. BMC Health Serv Res. 2018;18(1):301.

    Article  Google Scholar 

  53. The Speech Pathology Association of Australia. Submission to the senate community affairs references committee future of Australia’s aged care sector workforce. The Speech Pathology Association of Australia; 2016. https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Advocacy/Submissions_prior_2018.aspx. Accessed 31 May 2020.

Download references

Funding

This study was conducted as part of a PhD research program. This work was supported by the following sources of funding: OB is receiving the Australian Government Research Training Scholarship funding through the University of Melbourne to participate in this research program; AV holds a Fellowship from the National Health and Medical Research Council, Australia (#1135683); and SC is supported by a National Health and Medical Council Senior Research Fellowship (SRF, # APP1136344).

Author information

Author notes

  1. Susan M. Cotton and Adam P. Vogel: contributed equally as senior authors.

Authors and Affiliations

  1. Centre for Neurosciences of Speech, The University of Melbourne, Melbourne, Australia

    Olga Birchall & Adam P. Vogel

  2. Department of Audiology and Speech Pathology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia

    Olga Birchall

  3. School of Allied Health, Australian Catholic University, North Sydney, Sydney, Australia

    Michelle Bennett

  4. Speech Pathology Department, Cabrini Hospital, Malvern, Australia

    Nadine Lawson

  5. The National Centre of Excellence in Youth Mental Health, Melbourne, Australia

    Susan M. Cotton

  6. Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    Susan M. Cotton

  7. Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany

    Adam P. Vogel

  8. Redenlab, Melbourne, Australia

    Adam P. Vogel

Authors
  1. Olga Birchall
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michelle Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nadine Lawson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan M. Cotton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adam P. Vogel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, survey distribution and data collection were performed by OB, MB and NL. Data analysis was performed by OB and MB. The first draft of the manuscript was written by OB. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Olga Birchall.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article. The authors declare that they have no conflict of interest.

Ethical Approval

Ethical approval was granted by The University of Melbourne Human Research and Ethics Committee (#1853221, 13/03/2019–31/12/2019).

Informed Consent

Consent was provided electronically by study participants after reading an online plain language statement.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Birchall, O., Bennett, M., Lawson, N. et al. The Role of Instrumental Swallowing Assessment in Adults in Residential Aged Care Homes: A National Modified Delphi Survey Examining Beliefs and Practices. Dysphagia 37, 510–522 (2022). https://doi.org/10.1007/s00455-021-10296-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-021-10296-2

Keywords

Search

Navigation