Dysphagia and Dementia in UK Nursing Homes: Stop the Carousel.
Maureen McCartney BSc (Hons) MSc RCSLT
Division of Psychology and Language Sciences, University College London
m.mccartney@ucl.ac.uk.
AIM OF POSTER:
• Outline assessments of dysphagia (swallowing difficulties) and malnutrition in dementia in UK
nursing homes.
• Explore factors that influence successful intervention, targeting dysphagia and malnutrition in
dementia
BACKGROUND:
•75% of residents in long term care have dementia1
•Of these, 93% of institutionalised elderly patients with dementia have dysphagia and feeding difficulty2
•Increasing feeding dependency is a prominent feature and a major cause of malnutrition in individuals with dementia3
•Assisting individuals with dementia and feeding difficulty to eat is an area of nursing care which is inadequate and potentially life threatening4
•Malnutrition costs (arising from treating the malnourished patient in acute and long term care facilities) costs the UK more than £7.3bn a year – more than double the cost for obesity5
•Dementia care is characterised by a significant lack of evidence on person centred outcomes and lack of evaluation of the current state of service delivery6
ASSESSING DYSYPHAGIA AND MALNUTRITION IN RESIDENTS
WITH DEMENTIA
There are two main screening tools for identifying dysphagia and malnutrition:
•Malnutrition
Malnutrition Universal Screening Tool (MUST)
MUST provides guidance on the most appropriate nutrition intervention for malnutrition.
•Dysphagia
Dysphagia assessment: performed by a Speech and Language Therapist
Therapist
Designed to identify problems with swallowing and make recommendations to improve oral
intake, whilst reducing risk associated with dysphagia.
Several assessment tools exist, yet there is limited research into improving the oral intake of
individuals with dementia and dysphagia.
FACTORS IMPACTING SUCCESSFUL EATING AND DRINKING IN DEMENTIA
Decreased cognitive and functional status of residents with
dementia
Profile of health care workers in the UK
Feeding difficulties:
•Reduced food recognition, altered taste and chewing
difficulties.
•Inability to access food, fluids or feed independently.
Swallowing disorders:
Organisational factors
Knowledge:
Resources:
•No training in dementia care for health care workers 7
•Mealtimes in residential settings are task centred (focus on
getting job done) causing stress for residents and staff ,
resulting in inadequate resident care.
•Untrained carers may exacerbate existing difficulties with
eating and drinking8
•Non traditional learners and lower levels of literacy mean that
standard training methods are ineffective 9
•Delayed or absent swallow, resulting in increased risk of
choking2
MY RESEARCH:
RESEARCH
Shall investigate the impact of training and follow up support forums on:
knowledge, skills, competencies and attitudes of health care workers
the dining room experience of nursing home residents with dementia
the health status of residents with dementia.
Plus the impact of:
Healthcare worker led versus health professional led support forums.
•Barriers to effective care provision include; poor pay,
minimal long term career benefits and negative attitudes
towards residents and work8
REFERENCES:
REFERENCES
1. ROYAL COLLEGE OF PHYSICIANS (1998) Enhancing the health of older people in long term care: clinical guidelines. London.
2. FEINBERG, M. J., EKBERG, O., SEGALL, L. & TULLY, J. (1992) Deglution in elderly patients with dementia: findings of
videofluoroscopy evaluation and impact on staging and management. . Radiology, 183, 811- 814.
3. RIVIERE, S., GUYONNET., S., ANDRIEW, S., NOURHASHEMI, F., LAUQUE, S., CANTET, C., SALVA, A., FRISONI, G., &
VELLAS, B. (2002) Cognitive function and caregiver burden: predictive factors for eating behaviour disorders in Alzheimer's
disease. International Journal of Geriatric Psychiatry, 17, 950-955
4. MCGILLIVRAY, T. M., G. (1999) Assisting demented patients with feeding: problems in a ward environment. A review of the
literature. Journal of Advanced Nursing, 29, 608 - 614.
5. BAPEN (2003) Health Economic Report – The cost of disease-related malnutrition in the UK & economic considerations for the
use of oral nutritional supplements (ONS) in adults. London.
6. KNAPP, M. P., M. (2007) Dementia UK. The full report. Alzheimer’s Society. (Ed. London, King's College London and the London
School of Economics
7. ROPER, J. M., SHAPIRA, J. & BECK, A. (2001) Nurse caregiver feelings about agitation in Alzheimer's disease. Journal of
Gerontological Nursing, 27, 32-39.
8. WATSON, R., & DEARY, I (1996) Is there a relationship between feeding difficulty and nursing intervention in elderly people with
dementia? . Dementia, 1, 44-54.
9. BECK, C. (2001) Identification and assessment of effective services and interventions: the nursing home perspective. . Ageing and
Mental Health, 5 S99 -S111. .
10. KEENEY, S., HASSON, F., & MCKENNA, H. (2005) Healthcare assistants' experiences of perceptions of participating in a training
course. Learning in Health and Social Care, 4, 78 – 88