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Nagshabandi BS, Zinnershine L, Shune SE. A Review of Factors Contributing to Adults' Adherence to Dysphagia Dietary Recommendations Through an Ecological Lens. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:341-357. [PMID: 36450148 DOI: 10.1044/2022_ajslp-21-00351] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this review was to identify the factors affecting adherence to dysphagia dietary recommendations, a necessary contributor to the effectiveness of this compensatory strategy. METHOD A rapid review of two electronic databases was conducted in April 2021. Studies were included based on the following criteria: (a) were empirical studies published in English, (b) included data from the adult population, and (c) measured adherence to dietary recommendations. The ecological model and the health belief model were used as frameworks during the analysis process. RESULTS The literature search resulted in 930 unique abstracts, of which 14 articles were included based on the final criteria. Across the literature, multiple factors were identified as having an influence on adherence, classified according to three unique levels: the individual (e.g., dissatisfaction), the caregiver (e.g., knowledge), and the environment (e.g., institutional policies and values). CONCLUSIONS Improving adherence to dysphagia dietary recommendations is crucial for the effectiveness of those recommendations. As suggested by the current review, increased adherence will require careful attention to the multiple levels of factors that likely play a role, acknowledging the multifaceted nature of this complex behavior. Furthermore, characterizing the multilevel factors that influence adherence can contribute to future theoretical models, which could help guide speech-language pathologists in their clinical practices.
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Affiliation(s)
| | - Lauren Zinnershine
- Communication Disorders and Sciences Program, University of Oregon, Eugene
| | - Samantha E Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene
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2
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Noë S, Goeleven A, Brouwers H, Meurrens T, De Cock A, Kos D, Vanhaecht K. Training for Caregivers and Compliance with Dysphagia Recommendations in a Tertiary Multiple Sclerosis Rehabilitation Center. Int J MS Care 2021; 23:223-228. [PMID: 34720762 DOI: 10.7224/1537-2073.2020-019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Dysphagia is common in persons with multiple sclerosis (MS). Speech and language therapists give dysphagia recommendations to persons with MS and caregivers. Nonadherence to these recommendations can increase the risk of aspiration. We investigated current compliance with dysphagia recommendations among caregivers and kitchen staff and assessed improvement in compliance by increasing knowledge through tailored training. Methods An observational cohort study was conducted over 4 weeks during which the compliance of the caregivers and kitchen staff in a rehabilitation center was monitored. A questionnaire was used to assess reasons for noncompliance. A 2-hour training session was provided for all caregivers and kitchen staff to improve their knowledge and skills. The compliance rate was observed again 1 and 6 months after the training. Compliance was defined by whether recommendations were followed. Results Results showed a significant improvement after training for overall compliance by caregivers (from 58% to >81%, P < .001). This improvement was still observed 6 months later (80%). After training, significant differences were found in compliance with the following recommendations (P ≤ .001): consistency of soup, consistency of liquids, food preparation, alertness, speed, amount, posture, and supervision. Recommendation for utensils did not improve (P = .44). Compliance with diet modifications made by the kitchen staff improved significantly (from 74% to >86%, P = .002), and even more during follow-up (to >95%, P = .009). Conclusions Dysphagia training tailored to the needs of caregivers to improve knowledge significantly improves compliance with dysphagia recommendations and the quality of care.
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Affiliation(s)
- Sofie Noë
- Speech and Language Department (SN), Melsbroek, Belgium
| | - Ann Goeleven
- Department of ENT-Head and Neck Surgery (AG), University Hospitals Leuven, Leuven, Belgium
| | | | | | - Alexander De Cock
- National MS Center Melsbroek (AD, DK), Melsbroek, Belgium.,Neurology, Center of Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium (AD)
| | - Daphne Kos
- National MS Center Melsbroek (AD, DK), Melsbroek, Belgium.,Department of Rehabilitation Sciences (DK), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Department of Quality Management (KV), University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy (KV), Katholieke Universiteit Leuven, Leuven, Belgium
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Waldron C, MacGiolla Phadraig C, Nunn J. What is it about carer-led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review. Community Dent Oral Epidemiol 2020; 48:522-532. [PMID: 33145831 DOI: 10.1111/cdoe.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To undertake a realist review of carer-led oral hygiene interventions for people with intellectual disabilities. This was run parallel with a Cochrane Review. METHODS Realist review methods were followed. This was characterized by an iterative process of developing and refining theories of how interventions might work, expressed as context-mechanism-outcome configurations. The steps included identifying candidate theories with local and international expert consultation before applying an iterative search strategy. Selection criteria were applied for screening of the abstracts and 10% of the included full texts were screened by the three review members, independently, to ensure adherence to the criteria. Data were extracted in NVivo and synthesized qualitatively to confirm, refute or refine theories about what works, why, in what circumstances and for whom. RESULTS Of the 697 potential sources, 112 studies progressed to full-text screening, and 58 of those were included in the review. These 58 studies found evidence to support six theories about carer-led oral hygiene interventions for people with intellectual disabilities, from a starting point of ten candidate theories. This realist review found evidence to support the contention that, in order for carer-led oral hygiene interventions for people with ID to succeed, there is a need for adequate resources and a system-level approach; involving carers in design and implementation; tailoring of training to suit carers' needs and work environments; clearly stating how interventions are expected to work; specifying goals with achievable steps for carers to follow; providing carers with support and feedback on their efforts; acknowledging the physical and emotional toll caring for people with intellectual disabilities has on the well-being of carers; and repeating training. CONCLUSIONS The theories from this realist review will direct future interventions by suggesting the mechanisms and contexts that are important to achieve the intended outcome of improved oral health for people with intellectual disabilities. These are, of course, propositions intended for testing, rather than proven. The parallel use of Cochrane and realist methods provides a unique richness to our hypothesis of what works, for whom, when and how.
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Affiliation(s)
| | | | - June Nunn
- Dublin Dental University Hospital, Dublin 2, Ireland
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Krekeler BN, Vitale K, Yee J, Powell R, Rogus-Pulia N. Adherence to Dysphagia Treatment Recommendations: A Conceptual Model. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1641-1657. [PMID: 32432958 PMCID: PMC7839030 DOI: 10.1044/2020_jslhr-19-00270] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 05/14/2023]
Abstract
Purpose Conceptual models of complex health problems are useful when designing targeted clinical interventions and focused research studies. Understanding and studying patient adherence often involves interplay among many factors that influence whether a patient successfully follows recommendations or completes a therapy program. Functional frameworks serve to arrange these factors visually, increasing interpretability and allowing for empirical testing of relationships among concepts. The purpose of this article is to integrate relevant factors from the literature into a comprehensive framework that describes adherence to dysphagia treatment. Method Using peer-reviewed, published guidelines regarding conceptual model construction, the authors created a list of potential factors that influence patient adherence to dysphagia-related treatment recommendations. During model construction, following extensive review of the literature and existing theories that have been applied in other areas of health care, factors were identified and grouped into conceptually similar domains (clusters). Clusters were arranged into larger categories that emerged during model optimization. Ultimately, two models were created: one that illustrates the interrelated factors of patient adherence and another that illustrates a subset of modifiable risk factors that a clinical speech-language pathologist may influence when developing a dysphagia treatment plan. Results Three general categories from 14 factors emerged based on relationships between factors and aspects of patient care: health factors, individual patient factors, and contextual factors. A second model consisting of modifiable risk factors included access, treatment type, patient perceptions, self-efficacy, health literacy, support factors, and provider bias. Conclusions This conceptual model allows clinicians and researchers to identify and explore the mechanisms driving adherence. Continual refinements of this model should be made as future studies uncover how the interconnectedness of factors affects adherence in dysphagia management. The models we have presented here are ready for clinical application and should also serve researchers as they generate hypotheses and design targeted research questions.
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Affiliation(s)
- Brittany N. Krekeler
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Otolaryngology–Head & Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Kailey Vitale
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
| | - Joanne Yee
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
| | - Ryan Powell
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
| | - Nicole Rogus-Pulia
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Otolaryngology–Head & Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
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Espinosa-Val MC, Martín-Martínez A, Graupera M, Arias O, Elvira A, Cabré M, Palomera E, Bolívar-Prados M, Clavé P, Ortega O. Prevalence, Risk Factors, and Complications of Oropharyngeal Dysphagia in Older Patients with Dementia. Nutrients 2020; 12:nu12030863. [PMID: 32213845 PMCID: PMC7146553 DOI: 10.3390/nu12030863] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 11/21/2022] Open
Abstract
The prevalence of older patients with dementia and oropharyngeal dysphagia (OD) is rising and management is poor. Our aim was to assess the prevalence, risk factors, and long-term nutritional and respiratory complications during follow-up of OD in older demented patients. We designed a prospective longitudinal quasi-experimental study with 255 patients with dementia. OD was assessed with the Volume-Viscosity Swallowing Test and a geriatric evaluation was performed. OD patients received compensatory treatments based on fluid viscosity and texture modified foods and oral hygiene, and were followed up for 18 months after discharge. Mean age was 83.5 ± 8.0 years and Alzheimer’s disease was the main cause of dementia (52.9%). The prevalence of OD was 85.9%. Up to 82.7% patients with OD required fluid thickening and 93.6% texture modification, with poor compliance. OD patients were older (p < 0.007), had worse functionality (p < 0.0001), poorer nutritional status (p = 0.014), and higher severity of dementia (p < 0.001) than those without OD and showed higher rates of respiratory infections (p = 0.011) and mortality (p = 0.0002) after 18 months follow-up. These results show that OD is very prevalent among patients with dementia and is associated with impaired functionality, malnutrition, respiratory infections, and increased mortality. New nutritional strategies should be developed to increase the compliance and therapeutic effects for this growing population of dysphagic patients.
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Affiliation(s)
- Mᵃ Carmen Espinosa-Val
- Geriatric department, Hospital de Sant Jaume i Santa Magdalena, Consorci Sanitari del Maresme, 08304 Mataro, Spain; (M.C.E.-V.); (M.G.); (O.A.); (A.E.)
| | - Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory. CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataro, Spain; (A.M.-M.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mercè Graupera
- Geriatric department, Hospital de Sant Jaume i Santa Magdalena, Consorci Sanitari del Maresme, 08304 Mataro, Spain; (M.C.E.-V.); (M.G.); (O.A.); (A.E.)
| | - Olivia Arias
- Geriatric department, Hospital de Sant Jaume i Santa Magdalena, Consorci Sanitari del Maresme, 08304 Mataro, Spain; (M.C.E.-V.); (M.G.); (O.A.); (A.E.)
| | - Amparo Elvira
- Geriatric department, Hospital de Sant Jaume i Santa Magdalena, Consorci Sanitari del Maresme, 08304 Mataro, Spain; (M.C.E.-V.); (M.G.); (O.A.); (A.E.)
| | - Mateu Cabré
- Internal Medicine, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataro, Spain;
| | - Elisabet Palomera
- ResearchUnit, Fundació Salut del Consorci Sanitari del Maresme, Hospital de Mataró, 08304 Mataro, Spain;
| | - Mireia Bolívar-Prados
- Gastrointestinal Physiology Laboratory. CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataro, Spain; (A.M.-M.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory. CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataro, Spain; (A.M.-M.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-937-417-700
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory. CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataro, Spain; (A.M.-M.); (M.B.-P.); (O.O.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
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Ruiz Brunner MDLM, Cieri ME, Rodríguez Marco MP, Cuestas E. The photographic atlas of Spanish food consistency: a new tool for the treatment of dysphagia. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:858-861. [PMID: 31595755 DOI: 10.17235/reed.2019.6305/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION dysphagia requires texture-modified foods and thickened liquids, which is difficult to explain to patients and caregivers. METHODS an atlas has been developed and validated to explain the consistencies using the Likert scale questionnaire and the Delphi survey. The agreement and reliability of the tool were evaluated, with a minimum of 80%. The atlas was developed in Spanish. RESULTS an agreement of 93.3% (95% CI: 63.7-100%) was obtained during the evaluation and a value of 97.5% and a Kappa index of 0.96 (95% CI: 0.93-0.99; p = 0.016] were obtained during the validation processes. CONCLUSION the atlas is a new valid tool that can be used by health professionals.
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Affiliation(s)
| | - María Elisabeth Cieri
- Instituto de investigaciones en Ciencias de la Sal, Universidad Nacional de Córdoba, Argentinien
| | | | - Eduardo Cuestas
- Instituto de investigaciones en Ciencias de la Sal, Universidad Nacional de Córdoba, Argentinien
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Chadwick DD. Dysphagia Management for People With Intellectual Disabilities: Practitioner Identified Processes, Barriers, and Solutions. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2017. [DOI: 10.1111/jppi.12216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Darren D. Chadwick
- The University of Wolverhampton; Wolverhampton West Midlands United Kingdom
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Perez CM, Wagner AP, Ball SL, White SR, Clare ICH, Holland AJ, Redley M. Prognostic models for identifying adults with intellectual disabilities and mealtime support needs who are at greatest risk of respiratory infection and emergency hospitalisation. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:737-754. [PMID: 28497469 PMCID: PMC5518212 DOI: 10.1111/jir.12376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 11/15/2016] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Among adults with intellectual disabilities (ID), problems with eating, drinking and swallowing (EDS), and an associated need for mealtime support, are common, with an estimated 15% of adults known to specialist ID services requiring mealtime support. We set out to identify which adults with ID who receive mealtime support are at an increased risk of respiratory infections and emergency hospitalisation related to EDS problems. METHOD An exploratory, prospective cohort study was undertaken in the East of England. At baseline, structured interviews with the caregivers of 142 adults with ID and any type of mealtime support needs were used to gather information on health and support needs over the previous 12 months. These interviews were repeated at follow-up, 12 months later. The resulting dataset, covering a 24-month period, was analysed with logistic regression, using model averaging to perform sensitivity analysis, and backwards step-wise variable selection to identify the most important predictors. RESULTS Individuals with a history of respiratory infections (in the first year of study), those who had epilepsy and those with caregiver-reported difficulty swallowing were most likely to have respiratory infections in the second year. Adults with increasing mealtime support needs, epilepsy and/or full mealtime support needs (fed mainly or entirely by a caregiver or enterally) were at increased risk of emergency hospitalisation for EDS-related problems. CONCLUSIONS Our findings highlight the importance of carefully monitoring health issues experienced by adults with ID and EDS problems, as well as their eating, drinking and swallowing skills. However, the models developed in this exploratory research require validation through future studies addressing the EDS problems commonly experienced by adults with ID and their implications for health outcomes and quality of life. Further research into the relationship between epilepsy and EDS problems would provide much-needed insight into the complex relationship between the two areas.
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Affiliation(s)
- C. M. Perez
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - A. P. Wagner
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- Health Economics Group, Norwich Medical SchoolUniversity of East AngliaNorwichUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - S. L. Ball
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - S. R. White
- MRC Biostatistics UnitUniversity of CambridgeCambridgeUK
| | - I. C. H. Clare
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - A. J. Holland
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - M. Redley
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
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Robertson J, Chadwick D, Baines S, Emerson E, Hatton C. People with intellectual disabilities and dysphagia. Disabil Rehabil 2017; 40:1345-1360. [DOI: 10.1080/09638288.2017.1297497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Darren Chadwick
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Susannah Baines
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Eric Emerson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
- Centre for Disability Research and Policy, University of Sydney, Sydney, Australia
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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Guthrie S, Stansfield J. Teatime Threats. Choking Incidents at the Evening Meal. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 30:47-60. [DOI: 10.1111/jar.12218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Susan Guthrie
- Speech and Language Therapy; Lancashire Care Foundation Trust Whalley; UK
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Perez CM, Ball SL, Wagner AP, Clare ICH, Holland AJ, Redley M. The incidence of healthcare use, ill health and mortality in adults with intellectual disabilities and mealtime support needs. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:638-652. [PMID: 25363017 DOI: 10.1111/jir.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) experience a wide range of eating, drinking and/or swallowing (EDS) problems, for which they receive diverse mealtime support interventions. Previous research has estimated that dysphagia (difficulty swallowing) affects 8% of all adults with ID and that 15% require some form of mealtime support. People with ID (whether they require mealtime support or not) also experience a greater burden of ill health and die younger than their peers in the general population with no ID. METHODS Using an exploratory, population-based cohort study design, we set out to examine health-related outcomes in adults with ID who receive mealtime support for any eating, drinking or swallowing problem, by establishing the annual incidence of healthcare use, EDS-related ill health, and all-cause mortality. This study was conducted in two counties in the East of England. RESULTS In 2009, 142 adults with mild to profound ID and a need for any type of mealtime support were recruited for a baseline survey. At follow-up 1 year later, 127 individuals were alive, eight had died and seven could not be contacted. Almost all participants had one or more consultations with a general practitioner (GP) each year (85-95%) and, in the first year, 20% reportedly had one or more emergency hospitalizations. Although their annual number of GP visits was broadly comparable with that of the general population, one-fifth of this population's primary healthcare use was directly attributable to EDS-related ill health. Respiratory infections were the most common cause of morbidity, and the immediate cause of all eight deaths, while concerns about nutrition and dehydration were surprisingly minor. Our participants had a high annual incidence of death (5%) and, with a standardized mortality ratio of 267, their observed mortality was more than twice that expected in the general population of adults with ID (not selected because of mealtime support for EDS problems). CONCLUSIONS All Annual Health Checks now offered to adults with ID should include questions about respiratory infections and EDS functioning, in order to focus attention on EDS problems in this population. This has the potential to reduce life-threatening illness.
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Affiliation(s)
- C M Perez
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S L Ball
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A P Wagner
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
| | - I C H Clare
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - A J Holland
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - M Redley
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
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12
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Chadwick DD, Stubbs J, Fovargue S, Anderson D, Stacey G, Tye S. Training support staff to modify fluids to appropriate safe consistencies for adults with intellectual disabilities and dysphagia: an efficacy study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:84-98. [PMID: 23336612 DOI: 10.1111/jir.12013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Modifying the consistency of food and drink is a strategy commonly used in the management of dysphagia for people with intellectual disabilities (ID). People with ID often depend on others for the preparation of food and drink and therefore depend on those caregivers achieving the correct consistency to keep them safe and avoid discomfort during mealtimes. Clinical experience and prior research have demonstrated that although training can improve modification, carers often find modification difficult and potentially stressful and recommend additional support for carers. Fluid consistency is often modified through the addition of powdered thickener. This study investigates the efficacy of typical training and use of consistency guides, the Thickness Indicator Model (TIM) tubes, in helping carers to modify fluids accurately. METHOD A 3 × 3 pre-post experimental design with a control group was employed to compare the observed accuracy of modification across three groups and at three time points (pre-intervention baseline, immediately post-training intervention and 3-10 months post-training). Sixty-two paid carers who supported people with ID were recruited to participate in the study and each was randomly allocated to one of the three groups: a control group given written guidance only, a group who received typical training and written guidance and a group who received training, written guidance and the TIM tubes. RESULTS & CONCLUSIONS Typical training resulted in significantly greater carer accuracy in modifying fluid consistencies when compared with written guidance alone. Use of the TIM tubes also significantly improved accuracy in the modification of drinks compared with the group who modified with the aid of written guidance alone. At 3-10-month follow-up only the group who received typical training alongside the TIM tubes were significantly more accurate than the Written Guidance group. Further research is warranted to ascertain the effectiveness of the training and the utility of the TIM tubes in improving accuracy over a longer time scale and in individuals' usual living environments.
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Affiliation(s)
- D D Chadwick
- School of Applied Sciences, The University of Wolverhampton, Wolverhampton, UK
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Kwon CH, Kim YH, Park JH, Oh BM, Han TR. Validity and reliability of the korean version of the MD anderson Dysphagia inventory for head and neck cancer patients. Ann Rehabil Med 2013; 37:479-87. [PMID: 24020028 PMCID: PMC3764342 DOI: 10.5535/arm.2013.37.4.479] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/19/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To translate the MD Anderson Dysphagia Inventory (MDADI) which is a self-administered questionnaire that assesses effect of dysphagia on the quality of life for patients with head and neck cancer, into Korean and to verify the validity and reliability of the Korean version of MDADI. METHODS We performed 6 steps for the cross-cultural adaptation which consisted of translation, synthesis, back translation, review by an expert committee, cognitive debriefing, and final proof reading. A total of 34 dysphagia patients with head and neck cancers from Seoul National University Hospital answered the translated version of the questionnaire for the pre-testing. The patients answered the same questionnaire 2 weeks later to verify the test-retest reliability. RESULTS One patient was excluded at second survey because he changed his feeding strategy. Overall, 33 patients completed the study. Linguistic validations were achieved by each step of cross-cultural adaptation. We gathered statistically strong construct validity (Spearman rho for subdomain scores to total score correlation range from 0.852 to 0.927), internal consistency for subdomains (Cronbach's alpha coefficients range from 0.785 to 0.889) and test-retest reliability (intra-class correlation coefficient range from 0.820 to 0.955). CONCLUSION The Korean version of the MDADI achieved linguistic validations and demonstrated good construct validity and reliability. It can be a useful tool for screening and treatment planning for the dysphagia of patients with head and neck cancers.
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Affiliation(s)
- Chan-Hyuk Kwon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abstract
OBJETIVOS: verificar a presença e evolução da queixa de deglutição em pacientes afásicos pós- AVE e, a partir do relato dos familiares em relação à melhora das manifestações, analisar se a ocorrência da afasia interferiu no prognóstico da disfagia. MÉTODO: 30 pacientes afásicos pós-AVE na fase crônica foram entrevistados e, juntamente com seus familiares, responderam a um questionário sobre a presença e a permanência de queixas de deglutição pós-AVE e aspectos relacionados, bem como melhoras ocorridas em relação aos quadros de disfagia e afasia. Para verificar se a disfagia parece ter interferido no prognóstico da afasia, comparou-se as curvas de Kaplan-Meier dos pacientes que referiram queixas de disfagia com os que não referiram. RESULTADOS: 48% dos pacientes tiveram queixas de dificuldades de deglutição pós-AVE. Destes, 93% apresentaram mudanças positivas (melhora parcial ou total do quadro). O tempo médio para que o paciente apresentasse qualquer tipo de mudança (espontânea ou não) foi de 76 dias. 60% referiu melhora total da disfagia, sendo que 47% foram submetidos à terapia fonoaudiológica. Em relação à afasia, 87% dos pacientes referiram melhora, apesar de nenhum paciente ter referido melhora total. 57% haviam sido expostos à terapia fonoaudiológica para a afasia. O tempo médio referido para que o paciente apresentasse qualquer tipo de mudança positiva nas manifestações foi de 183 dias. Não houve diferença significante na melhora da afasia entre o grupo com e sem queixa de deglutição. CONCLUSÕES: dos pacientes afásicos avaliados neste estudo, 48% apresentou queixa de disfagia. Verificou-se, a partir do relato dos familiares, que a ocorrência da afasia parece não ter interferido no prognóstico da disfagia.
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Harding C, Halai V. Providing Dysphagia Training for Carers of Children Who have Profound and Multiple Learning Disabilities. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979509799103188] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ball SL, Panter SG, Redley M, Proctor CA, Byrne K, Clare ICH, Holland AJ. The extent and nature of need for mealtime support among adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:382-401. [PMID: 21988217 DOI: 10.1111/j.1365-2788.2011.01488.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND For many adults with an intellectual disability (ID), mealtimes carry significant health risks. While research and allied clinical guidance has focused mainly on dysphagia, adults with a range of physical and behavioural difficulties require mealtime support to ensure safety and adequate nutrition. The extent of need for and nature of such support within the wider ID population has yet to be reported. METHODS In this study, we have estimated the prevalence of need for mealtime support among people with ID in the UK, using a population of 2230 adults known to specialist ID services (in Cambridgeshire, UK, total population 586,900). In a sample (n = 69, aged 19 to 79 years, with mild to profound ID), we characterised the support provided, using a structured proforma to consult support workers and carers providing mealtime support, and health and social care records. RESULTS Mealtime support was found to be required by a significant minority of people with ID for complex and varied reasons. Prevalence of need for such support was estimated at 15% of adults known to specialist ID services or 56 per 100,000 total population. Within a sample, support required was found to vary widely in nature (from texture modification or environmental adaptation to enteral feeding) and in overall level (from minimal to full support, dependent on functional skills). Needs had increased over time in almost half (n = 34, 49.3%). Reasons for support included difficulties getting food into the body (n = 56, 82.2%), risky eating and drinking behaviours (n = 31, 44.9%) and slow eating or food refusal (n = 30, 43.5%). These proportions translate into crude estimates of the prevalence of these difficulties within the known ID population of 11.9%, 6.6% and 6.4% respectively. Within the sample of those requiring mealtime support, need for support was reported to be contributed to by the presence of additional disability or illness (e.g. visual impairment, poor dentition and dementia; n = 45, 65.2%) and by psychological or behavioural issues (e.g. challenging behaviour, emotional disturbance; n = 36, 52.2%). CONCLUSIONS These findings not only highlight the need for a multidisciplinary approach to mealtime interventions (paying particular attention to psychological and environmental as well as physical issues), but also signal the daily difficulties faced by carers and paid support workers providing such support and illustrate their potentially crucial role in managing the serious health risks associated with eating and drinking difficulties in this population.
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Affiliation(s)
- S L Ball
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK.
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Smith-Tamaray M, Wilson L, McAllister L. Factors affecting dysphagia management and compliance with recommendations in non-metropolitan healthcare settings. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 13:268-279. [PMID: 21563900 DOI: 10.3109/17549507.2011.573575] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
It is acknowledged that a team approach to management of stroke is essential to improving patient outcomes. For the speech-language pathologist (SLP), communication and swallowing are key concerns in stroke rehabilitation. However, little is known about how services are provided following stroke in non-metropolitan areas. This paper presents findings from a study investigating issues related to the provision of dysphagia services in non-metropolitan New South Wales (NSW) and Victoria. The theme 'You've got to have an impact' was one of the major themes identified from analysis of data gathered via semi-structured interviews with eight SLPs. Participants in this study highlighted compliance with recommendations as a point of breakdown in the care of the patient with dysphagia. Underlying compliance were issues related to team functioning that could hold the key to improving outcomes. These findings have implications for non-metropolitan SLPs' ability to participate within a stroke team, for the way care for patients with dysphagia is conceptualized, and for improvement of compliance with SLP recommendations.
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King JM, Ligman K. Patient Noncompliance With Swallowing Recommendations: Reports From Speech-Language Pathologists. ACTA ACUST UNITED AC 2011. [DOI: 10.1044/cicsd_38_s_53] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lemoncello R, Sohlberg MM, Fickas S, Albin R, Harn BE. Phase I evaluation of the television assisted prompting system to increase completion of home exercises among stroke survivors. Disabil Rehabil Assist Technol 2010; 6:440-52. [DOI: 10.3109/17483107.2010.542571] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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