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