19 research outputs found
Recommended from our members
Risk feeding: from protocol to model of care
Dharinee Hansjee explains how her risk-feeding protocol, established to guide decision-making regarding feeding options with the frail elderly population, has evolved into a model of care
Recommended from our members
A safer approach to risk feeding
As a first step in developing a safer approach to risk feeding, I conducted a review of seven patients on a ward for older people in an acute care hospital who were referred to speech and language therapy during March 2011. Not all had a confirmed history of dementia but all lacked capacity to make their own decisions on nutrition planning. A review of the medical case notes established the number of days from admission to when a nutrition plan was put in place. A crucial finding was that there was a delay in nutrition planning for five out of the seven patients. A more detailed analysis of the medical notes revealed that following a clinical swallowing evaluation by an SLT, the five patients were 'unsafe' on all consistencies trialed, were at risk of developing aspiration pneumonia and needed a multidisciplinary team decision on the way forward with nutrition. Another key finding related to the inconsistencies of the diet regime for these patients. Some were placed on a normal diet and fluids and referred to speech and language therapy when there was reduced oral intake; others were made nil by mouth with intravenous fluids, compromising their safety and comfort. My findings highlighted the need to introduce a process to better manage nutrition and hydration in this patient group and it seemed integral to develop a system to inform and hasten the decision-making process. This led to the development of a risk feeding protocol
Recommended from our members
Risk feeding: the story continues
With the rising incidence of dysphagia in older people in hospitals (Leder and Suiter, 2009), geriatricians are more frequently seeking advice from their multidisciplinary team colleagues on nutrition planning (Chaklader, 2012). The survey results reflect this, indicating older people’s teams are supportive of the pathway and find a protocol beneficial. Although the survey participants noted a reduction in wait times for a nutritional plan to be put in place, a number were in the early stages of the introduction of a protocol – therefore, formal audit results were unavailable. However, all participants using a protocol expressed positive, coordinated management of the patient with increased awareness from the multidisciplinary team of risk feeding and a pragmatic approach to management
Recommended from our members
Poster presentation: a safer approach to risk feeding, implementation
No Abstract available (copyright restriction placed by publisher)
Recommended from our members
The risk feeding model of care: impact on length of stay readmissions
No Abstract available (copyright restriction placed by publisher)
Recommended from our members
Risk assessment: a consultation on the term 'risk feeding'
The survey has highlighted both enablers and barriers to the use of the term ‘risk feeding’, as well as some solutions for consideration. Consensus on terminology will need to be collaborative, requiring systems-wide involvement from the respective disciplines. Our duty of care is to objectively guide individuals and families, with an emphasis on the value of the discussion and the interdisciplinary model of care underpinning these decisions. Locally agreed terminology should be the way forward until a national consensus is agreed
Recommended from our members
Frailty, swallowing and dysphagia
Purpose of Review:
This paper is a brief overview of the relationship between frailty, swallowing and dysphagia. Its goal is to explore the interplay between age and sarcopenia in the development of dysphagia, which is known to be linked to aspiration pneumonia. It is postulated that there is growing justification for routine screening for dysphagia in older frail people, to enable rehabilitation of swallowing through exercise and nutritional intervention, after a hospital stay.
Recent Findings:
The global population is ageing, with a particular increase in the very old and frail. Frail people have a limited functional and physiological reserve and often have sarcopenia. Any subsequent insult (trauma, illness, medication change) frequently results in decompensation and the need for a hospital stay. Often, in these patients, there are changes in the biomechanics of swallowing that can cause impairment and dysphagia. But, many patients adapt the way they eat with subtle compensatory techniques, to bypass this difficulty. It is possible that many more people, than is currently evident, have undiagnosed dysphagia. Pneumonia and respiratory disease are common reasons for hospital admission in the frail elderly population. Dysphagia with aspiration is an important aetiological factor in pneumonia, which is a serious health concern with increasing age. Dysphagia may simply be a consequence of physiological decompensation, related to age, frailty and sarcopenia. Dysphagia is not systematically screened for and may not be identified in many older frail people who have adapted their swallowing, to accommodate their dysphagia. This may be a significant factor in pneumonia-related hospital admissions. Swallow rehabilitation, after such admission to hospital, is also rarely offered in the acute medical setting. This needs to change to reduce recurrent admission, morbidity and mortality.
Summary:
The population is ageing. Sarcopenia, frailty and dysphagia are common with increasing age. Pneumonia is a common admission to hospital and often, aspiration secondary to dysphagia is a common cause. Proactive identification and intervention has the potential to reduce morbidity, hospital admission, length of hospital stay and mortality
Recommended from our members
Decisions with eating and drinking in older adults admitted with pneumonia and referred for swallowing difficulties
Purpose
Older patients with pneumonia are commonly restricted from oral intake due to concerns towards aspiration. Eating and drinking with acknowledged risks (EDAR) is a shared decision-making process emphasising patient comfort. As part of our project to find the barriers and facilitators of EDAR, we aimed for this initial study to see how frequently EDAR was selected in practice.
Methods
We performed a retrospective cohort study at an acute hospital where EDAR was initially developed, of patients aged ≥ 75 years-old admitted with pneumonia and referred to speech and language therapy.
Results
Out of 216 patients, EDAR decisions were made in 14.4%. The EDAR group had a higher 1-year mortality than the modified/normal diet groups (p < 0.001). Pneumonia recurrence rate did not differ significantly between the groups (p = 0.070).
Conclusion
EDAR decisions were comparatively less common and most were associated with end-of-life care. Underlying reasons for the low EDAR application rate must be investigated to maximise patient autonomy and comfort as intended by EDAR while minimising staff burden
A new simple screening tool—4QT: can it identify those with swallowing problems? A pilot study
As people and the population age, the prevalence of swallowing problems (dysphagia) increases. The screening for dysphagia is considered good practice in stroke care, yet is not routinely undertaken in the management of frail older adults. A short swallow screen, the 4QT, was developed following a review of the literature. The screen has four questions relating to swallowing that can be asked by a member of the health care team. A convenience sample of 48 older frail patients on an acute frailty ward was recruited into a Quality Improvement project. Their swallow was screened using the EAT-10 and 4QT. A speech and language therapist assessed for the presence of dysphagia using a standardised assessment for dysphagia. The 4QT was as effective as the EAT-10 in identifying older frail adults with potential swallowing problems (Κ = 0.73). The 4QT has 100% sensitivity, 80.4% specificity and positive predictive value (PPV) 50%, negative predictive value (NPV) 100%. The 4QT is a highly sensitive but not specific swallow screen, only 50% of people reporting swallowing problems were confirmed to have a degree of dysphagia by the SLT. The 4QT is a simple screening tool that could be used by all staff, but requires further research/evaluation before it is widely accepted into clinical practice
Recommended from our members
Decoloniality and healthcare higher education: critical conversations
Background
We explore the theoretical and methodological aspects of decolonising speech and language therapy (SLT) higher education in the United Kingdom. We begin by providing the background of the Rhodes Must Fall decolonisation movement and the engagement of South African SLTs in the decoloniality agenda. We then discuss the evolution of decoloniality in SLT, highlighting its focus on reimagining the relationships between participants, students, patients and the broader world.
Objective
The primary objective of this discussion is to fill a gap in professional literature regarding decoloniality in SLT education. While there is limited research in professional journals, social media platforms have witnessed discussions on decolonisation in SLT. This discussion aims to critically examine issues such as institutional racism, lack of belonging, inequitable services and limited diversity that currently affect the SLT profession, not just in the United Kingdom but globally.
Methods
The methods employed in this research involve the engagement of SLT academics in Critical conversations on decolonisation. These conversations draw on reflexivity and reflexive interpretation, allowing for a deeper understanding of the relationship between truth, reality, and the participants in SLT practice and education. The nature of these critical conversations is characterised by their chaotic, unscripted and fluid nature, which encourages the open discussion of sensitive topics related to race, gender, class and sexuality.
Discussion points
We present our reflections as academics who participated in the critical conversations. We explore the discomfort experienced by an academic when engaging with decolonisation, acknowledging white privilege, and the need to address fear and an imposter syndrome. The second reflection focuses on the experiences of white academics in grappling with their complicity in a system that perpetuates racism and inequality. It highlights the need for self-reflection, acknowledging white privilege and working collaboratively with colleagues and students toward constructing a decolonised curriculum. Finally, we emphasise that while action is crucial, this should not undermine the potential of dialogue to change attitudes and pave the way for practical implementation. The paper concludes by emphasising the importance of combining dialogue with action and the need for a nuanced understanding of the complexities involved in decolonising SLT education.
Conclusion
Overall, this paper provides a comprehensive overview of the background, objectives, methods and key reflections related to the decolonisation of SLT higher education in the United Kingdom. It highlights the challenges, discomfort and responsibilities faced by academics in addressing decoloniality and emphasizes the importance of ongoing critical conversations and collective action in effecting meaningful change