hard facts to swallow
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Hard Facts to Swallow
Findings of the Cavan/ Monaghan Dysphagia Working Group
Pauline AckermannSenior Speech and Language Therapist
Gwen RiceDietitian MINDI
What is Dysphagia?
The process of swallowing is highly complex: preparatory stage, oral stage, pharyngeal stage, oesophageal stage
Thomas (2001) states that dysphagia is a common consequence of many different types of illness or injury resulting in mechanical or neurological impairment of the swallowing process.
Healthy Ageing- What’s the outcome for this lady if she has Dysphagia?
Cavan/ Monaghan - North Eastern Area
Profile of Counties Cavan and Monaghan
Total of 6,498 sq. kilometres. Total population:
2002 344,926 1996 306,155.
+ 38,771 (+12.7%).
Profile of Counties Cavan and Monaghan
2002 Census:
36,471 people aged 65+, which is a 5% increase on 1996 Census
3,525 people aged 85+ living in this Board, representing a 31% increase since 1996.
Incidence of Dysphagia
Local Data from Cavan/ MonaghanAcute Hospitals:
12 month period 167 patients admitted with CVA
It is estimated that 45% of thesepatients will have dysphagia
Incidence of Dysphagia
Over 5 years it is estimated that thisaccounts 375 patients who will have dysphagia as a result of a CVA alone; excluding other conditions such as Parkinson’s Disease, Motor Neuron Disease etc.
Incidence among older people
Estimates of dysphagia among individuals older that 50 years range from 16 to 22%.
12 to 13% of patients in short-term care hospitals and up to 60% of nursing home occupants have feeding difficulties
Up to 95% of patients with Parkinson’s disease have video fluoroscopic disturbance of deglutition (cited by Thomas, 2001)
Consequences of no Dysphagia service
Aspiration
Malnutrition
Dehydration
Increased length of hospital stay
Mortality
Vulnerable Patient
Ambition to Promote Health
Qualified Professional
Diagnosisand
treatment
ADysphagia
Service
BetterPatient
Outcomes
Patient Empowerment
Health Promotion
Solution
Dublin Based
Services
ServiceDelivery
InappropriateReferrals
Separate Professionals
NoDysphagia
Service
Formation of the Dysphagia Working Group
Dysphagia Working Group SurveyCurrent Situation
We Know:
Dysphagia is prevalent in patients with CVA
There is no assessment and treatment services for patients with dysphagia in the Cavan/Monaghan region
Dysphagia Working Group SurveyCurrent Situation
o Lack of knowledge about nature of dysphagia
Lack of awareness of the impact of dysphagia on patient QOL
Lack of knowledge of the requirements of a dysphagia service
Dysphagia Questionnaire
Profile of respondent Knowledge of Dysphagia Management of Dysphagia at present:
practice, problems, supports Views, comments, suggestions Separate Questionnaire for Care
Attendants
Two-sided A4 sheet with 13 questions; combination of ticks and comments
Analysis of Questionnaire
126 completed questionnaires werereturned out of 574
Response rate: 22%.
Some findings…
Groups represented by respondents
Nursing (Acute)
17%
Medical21%
Nursing (Residential)
21%
Physiotherapy14%
Occupational Therapy
7%
Care attendants
20%
Problems encountered by medical staff
2
2
1
1
1
5
1
2
3
2
9
1
6
1
1
1
1
3
3
0 1 2 3 4 5 6 7 8 9 10
Feeding diff iculties
Aspiration
Aspiration pneumonia
Choking
Low intake of food
Poor nutrition
? Esophageal w eb
Problem sw allow ing scope
Weight loss
Dehydration
No SLT
Diagnosis by Dr
Inadequate service
Communication problems
Anxiety of patient
Frustration of patient
Lack of follow -up services
No problems
No response
Current supports for medical staff
8
3
1
1
1
1
1
1
1
1
1
1
2
6
7
0 1 2 3 4 5 6 7 8 9
Dietitian
Medical Assessment
Physiotherapist
Occupational therapist
GPs
Gastroscopes
OPD appts
Referral to CRC
Surgical
NPO
Liquidised food
Radiology
Endoscopy
No supports
No response
Care attendants
Q3: Do you have any training to help you work with patients with swallowing difficulties?
Yes15%
No85%
Care attendants
109
32
1
0
2
4
6
8
10
Daily Weekly Monthly Never Varies
Q4b: How often do you come across patients with swallowing difficulties?
Comments/Suggestions of Dysphagia Service
1
1
1
1
2
2
2
3
3
4
4
4
4
10
10
23
46
Well Wishes!
Reduce the placement of PEG/NG
Funding
High Risk for Patients and Staff
Support Group
"Forgotten Issue" and Poor Service
Inappropriate referral
Under impression that there w as a service
Service Inequality
Videoflouroscopy
Requirement for Community/follow up care
Quality of Life for Patient
Quality of Care to Patient
Protocols/Assessment tools
Multidisciplinary Approach is required
Training and Education
Urgent/Essential Service
Conclusion
Solution
Separate Professionals
Patient
Bibliography
Thomas, Briony (2001). Manual of Dietetic Practice – 3rd edition. Blackwell Science Limited.
Cavan/Monaghan Student Induction Pack (2005)
Cavan/ Monaghan Dysphagia Working Group Position Document (unpublished)
North Eastern Health Board (NEHB) High Level Operational Plan 2004
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