Centre for Neurosciences of Speech, The University of Melbourne, Melbourne, Australia.
Department of Audiology and Speech Pathology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
Dysphagia. 2022 Jun;37(3):510-522. doi: 10.1007/s00455-021-10296-2. Epub 2021 Apr 9.
Many adults in residential aged care homes (RACHs) live with oropharyngeal dysphagia (OD) and its physiological, psychosocial, and economic sequalae. Timely, evidence-based assessment of OD can help healthcare teams to create OD management plans that optimize consumer health and minimize healthcare costs. Instrumental swallowing assessment (ISA), specifically flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing studies (VFSS), is generally accepted to be an important component of dysphagia assessment and management in older adults. However, its role in RACHs has not been empirically examined. This study aimed to explore the role and use of ISA in adults in RACHs from the perspective of speech-language-pathologists (SLPs) experienced in a RACH setting and/or FEES and VFSS. A three-round electronic Delphi study was conducted to guide 58 SLPs in Australia towards consensus using a combination of multiple-choice questions, statements with five-point Likert scale agreement options, and open-ended questions. Participants' responses were analyzed using descriptive statistics and content analysis after each survey round. Feedback about group responses was provided before subsequent surveys. Consensus was defined as 70% or greater agreement. Participants reached consensus about obstacles and facilitators to the use of ISA in RACHs. Participants agreed that FEES was a valuable tool in RACHs and that a mobile service model may have advantages over standard off-site assessment. SLPs believed that appropriate governance processes, infrastructure and education were necessary to develop a safe, high-quality service. These views support equitable access to ISA across settings, aligning with person-centered care, re-ablement, and care-in-place.
许多居住在养老院的成年人患有口咽性吞咽困难（OD）及其生理、心理社会和经济后果。及时进行基于证据的 OD 评估有助于医疗团队制定 OD 管理计划，优化消费者健康，降低医疗成本。仪器吞咽评估（ISA），特别是灵活的内镜吞咽评估（FEES）和视频透视吞咽研究（VFSS），通常被认为是老年人吞咽评估和管理的重要组成部分。然而，它在养老院中的作用尚未经过实证检验。本研究旨在从在养老院环境中具有丰富经验的言语病理学家（SLP）的角度，探讨 ISA 在养老院成年人中的作用和用途，以及他们对 FEES 和 VFSS 的使用。本研究采用三轮电子 Delphi 研究，使用多项选择题、五分制同意选项陈述和开放式问题，指导 58 名澳大利亚 SLP 达成共识。在每次调查轮次后，使用描述性统计和内容分析对参与者的回答进行分析。在进行后续调查之前，提供有关小组答复的反馈。共识定义为 70%或更高的同意率。参与者就 ISA 在养老院中的使用障碍和促进因素达成了共识。参与者一致认为 FEES 在养老院中是一种有价值的工具，并且移动服务模式可能比标准的场外评估具有优势。SLP 认为，需要适当的治理流程、基础设施和教育来开发安全、高质量的服务。这些观点支持在各个环境中公平获得 ISA，与以人为本的护理、再赋能和就地护理相一致。
