Dysphagia screening in residential care settings: A scoping review

Abstract

Background: Older adults with dysphagia are at a higher risk of experiencing serious complications where dysphagia is not identified and adequately managed. Nursing personnel are critical for timely identification and management of dysphagia and prevention of these subsequent serious complications in residential care settings.

Objectives: To identify dysphagia screening tools used in residential care and to establish whether validated and used as per guidelines, their diagnostic accuracy and reliability and to identify the prevalence rate of dysphagia in this setting.

Design: A scoping review based on Arksey & O'Malley (2005) methodological framework.

Data sources: An electronic search of databases CINAHL, Pubmed and Scopus was conducted. Reference lists were checked in all identified articles for additional studies. Peer-reviewed publications describing the process of identifying dysphagia and using a screening protocol in residential care settings were considered for inclusion.

Review methods: All identified studies were screened by reading of titles, keywords and abstracts. Those articles that were deemed eligible for inclusion were read in full.

Results: Nineteen quantitative studies and one mixed-methods study out of 1,674 articles were included in the review. Thirteen different instruments for dysphagia screening were identified, with the Modified Water Swallow Test being the most commonly used. Other diagnostic procedures, such as fiberoptic endoscopic evaluation of swallowing, pulse oximetry or cervical auscultation, were implemented along with the administration of a dysphagia screening tool in six studies. The 3-Ounce Water Swallow Test, the Yale Swallow Protocol and the Gugging Swallowing Screen were identified as the instruments with the best clinical accuracy values. The reported prevalence of dysphagia in this setting ranged from 15% to 70%.

Conclusions: Formal dysphagia screening in residential care settings is not common practice. The dysphagia screening tools identified in this review are not validated for use in this setting. The implementation of dysphagia screening protocols specific to this population may facilitate identification of dysphagia and avoid complications.

Keywords: Deglutition disorders; Diagnosis; Dysphagia; Nursing home personnel; Nursing homes; Residential care; Scoping review; Screening.