Evaluation of the Prevalence of Screening for Dysphagia among Older People Admitted to Medical Services – An International Survey

Abstract

Background : With the increasing age of the world population, the number of old and frail people is increasing. Respiratory disease is a common reason for hospital admission for older people. Aspiration of saliva, which is probably infected, is the likely etiological agent. The incidence of an abnormal swallow is high in frail older people. Despite the high incidence of swallow problems among older people, many hospital services do not routinely screen older people for dysphagia. Methods : A survey, using Research Electronic Database Capture (REDCap), was carried out via email for a convenience sample of contacts working in hospitals worldwide. They were asked; 1) type of medical services, 2) does your service screen older (>80 years) people for swallowing problems, 3) have nursing staff and medical staff trained to administer a swallow screen, 4) is a swallowing rehabilitation program offered to older people, and 5) which elements of a rehabilitation program are offered and used. Results : One hundred and fifty people with consent from 29 countries responded to the survey. Of them, 75% work in an acute hospital, 15% in rehab, and 10% in community. In total, 62% responded that they do not or only occasionally screen older people for swallowing difficulties; 50% of the medical staff and 27% of the nursing staff were not trained to administer a swallowing screen. A rehabilitation swallowing program was offered in 63% cases, with chin tuck against resistance (83%), tongue strengthening (87%), and shaker maneuver (79%) being more common than electric stimulation (21%). Conclusions : The results of this study suggest that most health facilities do not routinely screen older people for swallowing problems, and the majority of them do not train their staff. The majority of facilities were offering a rehabilitation program. In addition, it is likely that many people are not receiving the appropriate proactive intervention because swallowing problems are not being proactively sought.