Understanding Dysphagia Care in the Community Setting

Abstract

Factors including health policy reform and the aging population are increasing demand for quality healthcare in the community. People with dysphagia are supported by speech-language pathologists (SLPs) in hospital and community settings; however, little is known about the nature of dysphagia services offered by SLPs in the community. The aim of this study was to investigate SLP services and practices provided to community-based adults with dysphagia. A national cohort (n = 144) of SLPs working with community-based clients with dysphagia completed an online survey. Results revealed that clients with neurological conditions comprised the largest proportion of the caseload. Primary referral sources were family doctors (42.4%) or other health professionals (37.5%), with low rates of self-referral. Services were primarily delivered via individual sessions (84.1%), usually within the client’s home (80% saw clients at home). While many clinicians were using both clinical and instrumental assessments, half had to refer clients to the other services to access instrumental assessment. Most provided assessment and rehabilitation services, though a few (28.5%) reported using formal outcome or quality-of-life measures. Only 43.8% referred or encouraged clients or caregivers to access support or social groups and a few SLPs incorporated social participation or client well-being aspects in treatment. Speech-language pathology (SLP) practices in the community appear similar to what occurs in the acute setting, which are inherently biomedical. This may not be optimal care for clients with dysphagia who live at home and their caregivers. Further exploration about what clients and caregivers want from community-based SLP services is warranted.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Leff B. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005;143:798.

    Article  PubMed  Google Scholar 

  2. 2.

    Bliss J, While AE. Meeting the needs of vulnerable patients: the need for team working across general practice and community nursing services. Lond J Prim Care. 2014;6:149–53.

    Article  Google Scholar 

  3. 3.

    Department of Health. Help to stay at home. https://agedcare.health.gov.au/older-people-their-families-and-carers/staying-at-home/help-to-stay-at-home (2015). Accessed 31 Jan 2018.

  4. 4.

    United Nations Department of Economic and Social Affairs Population Division. World population ageing. Report no.: ST/ESA/SERA/390. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf (2015). Accessed 31 Jan 2018.

  5. 5.

    Lines LM, Lepore M, Wiener JM. Patient-centered, person-centered, and person-directed care: they are not the same. Med Care. 2015;53:561–3.

    Article  PubMed  Google Scholar 

  6. 6.

    Means R, Richards S, Smith R. Community care: policy and practice. 4th ed. Hampshire: Palgrave Macmillan; 2008.

    Google Scholar 

  7. 7.

    Australian Government. National Disability Insurance Scheme Act 2013. http://www.legislation.gov.au/Details/C2016C00894/Html/Text. Accessed 1 Aug 2018.

  8. 8.

    Eckert JK, Morgan LA, Swamy N. Preferences for receipt of care among community-dwelling adults. J Aging Soc Policy. 2004;16:49–65.

    Article  PubMed  Google Scholar 

  9. 9.

    Department of Health. Better outcomes for people with chronic and complex health conditions. https://www.health.gov.au/internet/main/publishing.nsf/Content/76B2BDC12AE54540CA257F72001102B9/$File/Primary-Health-Care-Advisory-Group_Final-Report.pdf (2015). Accessed 31 Jan 2018.

  10. 10.

    Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;24:476–80.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Kawashima K, Motohashi Y, Fujishima I. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Dysphagia. 2004;19:266–71.

    Article  PubMed  Google Scholar 

  12. 12.

    Lindgren S, Janzon L. Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women in an urban population. Dysphagia. 1991;6:187–92.

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol. 2007;116:858–65.

    Article  PubMed  Google Scholar 

  14. 14.

    Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151:765–9.

    Article  PubMed  Google Scholar 

  15. 15.

    Bloem BR, Lagaay AM, van Beek W, Haan J, Roos RA, Wintzen AR. Prevalence of subjective dysphagia in community residents aged over 87. BMJ. 1990;300:721–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Brown K, Worrall L, Davidson B, Howe T. Exploring speech-language pathologists’ perspectives about living successfully with aphasia. Int J Lang Commun Disord. 2011;46:300–11.

    PubMed  Google Scholar 

  17. 17.

    Page C, Howell D. Current clinical practice of speech-language pathologists who treat individuals with aphasia: a grounded theory study. J Interact Res Commun Disord. 2014;6:1–23.

    Article  Google Scholar 

  18. 18.

    Rose M, Ferguson A, Power E, Togher L, Worrall L. Aphasia rehabilitation in Australia: current practices, challenges and future directions. Int J Speech Lang Pathol. 2014;16:169–80.

    Article  PubMed  Google Scholar 

  19. 19.

    Verna A, Davidson B, Rose T. Speech-language pathology services for people with aphasia: a survey of current practice in Australia. Int J Speech Lang Pathol. 2009;11:191–205.

    Article  Google Scholar 

  20. 20.

    Mathers-Schmidt BA, Kurlinski M. Dysphagia evaluation practices: inconsistencies in clinical assessment and instrumental examination decision-making. Dysphagia. 2003;18:114–25.

    Article  PubMed  Google Scholar 

  21. 21.

    Pettigrew CM, O’Toole C. Dysphagia evaluation practices of speech and language therapists in Ireland: clinical assessment and instrumental examination decision-making. Dysphagia. 2007;22:235–44.

    Article  PubMed  Google Scholar 

  22. 22.

    Rumbach A, Coombes C, Doeltgen S. A survey of Australian dysphagia practice patterns. Dysphagia. 2018;33:216–26.

    Article  PubMed  Google Scholar 

  23. 23.

    Steele CM, Allen C, Barker J, Buen P, French R, Fedorak A, et al. Dysphagia service delivery by speech-language pathologists in Canada: results of a national survey. Can J Speech Lang Pathol Audiol. 2007;31:12.

    Google Scholar 

  24. 24.

    Loeb MB, Becker M, Eady A, Walker-Dilks C. Interventions to prevent aspiration pneumonia in older adults: a systematic review. J Am Geriatr Soc. 2003;51:1018–22.

    Article  PubMed  Google Scholar 

  25. 25.

    Serra-Prat M, Palomera M, Gomez C, Sar-Shalom D, Saiz A, Montoya JG, et al. Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age Ageing. 2012;41:376–81.

    Article  PubMed  Google Scholar 

  26. 26.

    Martino R, Beaton D, Diamant NE. Perceptions of psychological issues related to dysphagia differ in acute and chronic patients. Dysphagia. 2010;25:26–34.

    Article  PubMed  Google Scholar 

  27. 27.

    Couper MP. Designing effective web surveys. Cambridge: Cambridge University Press; 2008.

    Google Scholar 

  28. 28.

    Fowler F, Cosenza C. Writing effective questions. In: de Leeuw ED, Hox J, Dillman D, editors. International handbook of survey methodology. New York: Routledge; 2008. p. 136–60.

    Google Scholar 

  29. 29.

    Rickards G, Magee C, Artino AR. You can’t fix by analysis what you’ve spoiled by design: developing survey instruments and collecting validity evidence. J Grad Med Educ. 2012;4:407–10.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Perry A, Skeat J. AusTOMS for speech pathology. Melbourne: La Trobe University; 2004.

    Google Scholar 

  31. 31.

    McHorney CA, Bricker DE, Kramer AE, Rosenbek JC, Robbins J, Chignell KA, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia. 2000;15:115–21.

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Law M, Baptiste S, Carswell A, McColl M, Polatajko H, Pollock N. Canadian occupational performance measure. 4th ed. Ottawa: Canadian Association of Occupational Therapy Publications ACE; 2005.

    Google Scholar 

  33. 33.

    Kiresuk TJ, Smith A, Cardillo JE, Library E. Goal attainment scaling: applications, theory, and measurement. New York: Psychology Press; 2014.

    Google Scholar 

  34. 34.

    Breadner BW, Warr-Leeper GA, Husband SJ. A study of public awareness of speech-language pathology: then and now. Hum Commun Can. 1987;18:10–3.

    Google Scholar 

  35. 35.

    Byrne N. Why do students from related professions choose not to enter speech-language pathology? Int J Speech Lang Pathol. 2010;12:344–51.

    Article  PubMed  Google Scholar 

  36. 36.

    Greenwood N, Wright JA, Bithell C. Perceptions of speech and language therapy amongst UK school and college students: implications for recruitment. Int J Lang Commun Disord. 2006;41:83–94.

    Article  PubMed  Google Scholar 

  37. 37.

    Danila O, Hirdes JP, Maxwell CJ, Marrie RA, Patten S, Pringsheim T, et al. Prevalence of neurological conditions across the continuum of care based on interRAI assessments. BMC Health Serv Res. 2014;14:1–14.

    Article  Google Scholar 

  38. 38.

    Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30:744–8.

    Article  CAS  PubMed  Google Scholar 

  39. 39.

    Kalf JG, de Swart BJM, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord. 2012;18:311–5.

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Miller N, Noble E, Jones D, Burn D. Hard to swallow: dysphagia in Parkinson’s disease. Age Ageing. 2006;35:614–8.

    Article  PubMed  Google Scholar 

  41. 41.

    Walker RW, Dunn JR, Gray WK. Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson’s disease. Dysphagia. 2011;26:92–6.

    Article  PubMed  Google Scholar 

  42. 42.

    Alagiakrishnan K, Bhanji RA, Kurian M. Evaluation and management of oropharyngeal dysphagia in different types of dementia: a systematic review. Arch Gerontol Geriatr. 2013;56:1–9.

    Article  PubMed  Google Scholar 

  43. 43.

    Langmore SE, Olney RK, Lomen-Hoerth C, Miller BL. Dysphagia in patients with frontotemporal lobar dementia. Arch Neurol. 2007;64:58.

    Article  PubMed  Google Scholar 

  44. 44.

    Geeganage C, Beavan J, Ellender S, Bath PMW. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst Rev. 2012;10:CD000323.

    PubMed  Google Scholar 

  45. 45.

    Kertscher B, Speyer R, Palmieri M, Plant C. Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders: an updated systematic review. Dysphagia. 2014;29:204–12.

    Article  PubMed  Google Scholar 

  46. 46.

    Nund RL, Ward EC, Scarinci NA, Cartmill B, Kuipers P, Porceddu SV. Survivors’ experiences of dysphagia-related services following head and neck cancer: implications for clinical practice: experiences of dysphagia-related services in HNC. Int J Lang Commun Disord. 2014;49:354–63.

    Article  Google Scholar 

  47. 47.

    Speech Pathology Australia. Position paper: fibreoptic endoscopic evaluation of swallowing (FEES). Melbourne: Speech Pathology Australia; 2007.

    Google Scholar 

  48. 48.

    Schindler A, Vincon E, Grosso E, Miletto AM, Rosa RD, Schindler O. Rehabilitative management of oropharyngeal dysphagia in acute care settings: data from a large Italian teaching hospital. Dysphagia. 2008;23:230–6.

    Article  PubMed  Google Scholar 

  49. 49.

    American Speech-Language-Hearing Association. Adult dysphagia: overview. https://www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/ (n.d.). Accessed 31 Jan 2018.

  50. 50.

    Speech Pathology Australia. Clinical guideline: dysphagia. Melbourne: Speech Pathology Australia; 2012.

    Google Scholar 

  51. 51.

    Nund RL, Ward EC, Scarinci NA, Cartmill B, Kuipers P, Porceddu SV. The lived experience of dysphagia following non-surgical treatment for head and neck cancer. Int J Speech Lang Pathol. 2014;16:282–9.

    Article  PubMed  Google Scholar 

  52. 52.

    Rosenbek J, Donovan N. Oropharyngeal dysphagia outcome measurement. In: Cichero JA, Murdoch B, editors. Dysphagia found theory practice. Chichester: Wiley; 2006. p. 543–66.

    Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge the speech-language pathologists who participated in this study for sharing their practices and experiences, including those who took the time to pilot the survey and provide invaluable feedback. Thanks also go to research assistant, Georgina Klokman, who assisted with data analysis.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Simone R. Howells.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 37 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Howells, S.R., Cornwell, P.L., Ward, E.C. et al. Understanding Dysphagia Care in the Community Setting. Dysphagia 34, 681–691 (2019). https://doi.org/10.1007/s00455-018-09971-8

Download citation

Keywords

  • Dysphagia
  • Clinician practices
  • Community
  • Deglutition
  • Deglutition disorders