The COVID-19 pandemic has significantly impacted healthcare systems globally, particularly in nursing homes where residents are highly vulnerable. Dysphagia, or difficulty swallowing, is prevalent among nursing home residents, with global prevalence rates ranging from 25% to 70%. Effective management of dysphagia is crucial to prevent complications such as malnutrition, dehydration, aspiration pneumonia, and even death. This blog explores practical strategies and considerations for dysphagia management in nursing homes, as presented in the research article "Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences."
Two-Tier Protection System
During the peak of the pandemic, a two-tier protection system was implemented in nursing homes to categorize residents based on their contact and hospitalization histories. Residents were classified as either standard or at-risk. The at-risk group included those recently hospitalized or previously diagnosed with COVID-19. These residents underwent a 14-day quarantine before being downgraded to the standard level.
Referral and Prioritization
Referrals for dysphagia assessments were categorized as urgent or non-urgent. Standard-level residents received routine assessments, while only urgent cases among at-risk residents were prioritized. Tools like the Eating Assessment Tool 10 (EAT-10) and residents' medical histories were used to prioritize cases, ensuring a balance between risk and clinical outcomes.
Adaptation of Clinical Swallow Evaluation (CSE)
The CSE includes physical examinations and swallow trials. To minimize the risk of infection, non-aerosol generating procedures such as cognitive and dentition assessments were emphasized. Practices like volitional coughing and the use of certain swallowing maneuvers were avoided to reduce the risk of infection.
Adaptation in Dysphagia Management
Management strategies were adapted to minimize infection risks. For instance, sensory stimulation techniques that could trigger coughing were avoided. Expiratory muscle strength training (EMST) was limited to standard-level residents, and conservative management approaches like diet modification were employed for at-risk residents.
Effects on Mealtimes
Mealtime arrangements were altered to prevent infection spread. Residents either ate in their rooms or in small, segregated groups. These changes necessitated closer monitoring of residents' feeding behaviors and intake amounts to address any issues arising from sensory deprivation and social isolation.
Personal Protective Equipment (PPE)
PPE guidelines varied based on the residents' classification. For standard-level residents, face masks and gloves were the minimum requirement, while additional PPE like face shields and gowns were used for at-risk residents. Proper training in infection control was essential for all healthcare workers.
Use of Telepractice
Telepractice has been supported for dysphagia management, involving trained assistants at remote sites. However, its adoption in nursing homes was limited due to residents' cognitive limitations and the need for assistance with electronic devices. Telepractice remains a viable option for older adults living at home with caregiver support.
Conclusion
Dysphagia management in nursing homes during the COVID-19 pandemic required careful consideration to minimize infection risks while ensuring essential care. The strategies discussed in the research article provide valuable insights for clinicians. For more detailed information, please read the original research paper,
Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences.
