The prevalence of dysphagia in a long-term care facility

Butt Chedore, Kimberly A. L. (1997) The prevalence of dysphagia in a long-term care facility. Masters thesis, Memorial University of Newfoundland.

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Abstract

Dysphagia, or difficulty in swallowing, poses a major health threat if it is not promptly diagnosed and treated. Problems secondary to dysphagia may include malnutrition, aspiration pneumonia dehydration, psychosocial problems and increased health care costs secondary to professional time for feeding, treatment of medical complications, food wastage, and the length of time required to feed residents. The objectives of this research were to 1) determine the prevalence of dysphagia population in a long-term care institution in St. John's, Newfoundland. Other objectives were to determine the medical diagnoses and conditions associated with dysphagia, to assess the extent of complications secondary to dysphagia and to document management techniques currently being used. Information for this retrospective, descriptive study was obtained by medical record review and a questionnaire completed by nursing personnel. The study population consisted of 193 subjects (138 female/55 male) with a mean age of 75.6 years. Identification of dysphagia and the level of severity were based on the following: signs and symptoms of dysphagia, history of aspiration pneumonia, diagnosed neurological condition, documented reports of dysphagia, medical complications, and dietary modifications. The prevalence of dysphagia was 45.5%. Of the subjects with dysphagia, 56%, 39% and 6% were mildly, moderately and severely dysphagic, respectively. For only 22% of dysphagic subjects was dysphagia documented in the medical record. Nursing staff identified only 39% of subjects with dysphagia. They were able to identify all severely dysphagic subjects. Dysphagia was associated with fluid and texture modifications; poor hydration status; nursing reports of subjects being "not well nourished"; use of nutritional supplements, poor skin integrity; the need for crushed medications; impaired chewing ability; feeding dependency; and level of assistance required at meal time. Dysphagia was not associated with age; sex; inadequate nutritional intake; decubitus ulcers; length of time to be fed; weight status; use of antipsychotic or tricyclic antidepressant medications; difficulty swallowing medications; reports of "not being hungry"; and needing encouragement to eat. Due to small numbers it was possible to examine associations of dysphagia with medical conditions. Recommendations are provided for future management of dysphagic individuals in long-term care facilities.

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