Media

Ageing in place: Safe swallowing in the frail elderly living in the community

25 Aug 2015

 

The elderly often experience swallowing difficulties due to illness or frailty. These difficulties can negatively impact on nutrition, hydration, and quality of life of those affected. Most worryingly, swallowing difficulties can lead to fatalities due to inhalation of food and drink into the airway due to poor swallowing function. Hong Kong has an increasingly aging population, and the burden of care due to swallowing difficulties will rise with the increase in older adults. The Swallowing Research Laboratory of the Division of Speech and Hearing Sciences, Faculty of Education conducted a study funded by the Public Policy Research Funding Scheme to investigate 1) the prevalence and risk factors for swallowing problems in elderly people who are receiving subsidized community support services or living in subsidized nursing homes, and 2) the swallowing management knowledge and skills of the carers for elderly who have swallowing problems.

From 2013 to 2015, the research team conducted phone surveys with 34 elderly residential units and 21 elderly day care support units. It was found that 60% of those in residential homes and 40% of those receiving government subsidized elderly services experience varying degrees of swallowing difficulties. The team also visited 22 elderly residential units and 20 day care support units to conduct face-to-face assessment with 878 elderlies, with 43% of them having swallowing problems. Those who experienced swallowing problems reported lower quality of life compared to those who experienced none. Further investigation into the results of the study yielded a number of risk factors that place elderly people at higher risk for swallowing difficulties. Those who were male, needed to be fed, or had weak tongue muscles were two to three times more likely to have swallowing difficulties than other frail elderly. Other contributing risk factors included the need for high levels of care for activities of daily living; dementia; and co-occurrence of multiple diseases.

The project assessed 504 frontline staff from the nursing homes and 93 family members who were providing daily mealtime assistance for elderly with swallowing problems. The carers achieved around 60% accuracy in a swallowing safety and management knowledge questionnaire. The research team observed that 22% of the nursing home staff had to feed more than one elderly at the same time during mealtimes and most staff needed to improve their communication skills and attitudes during feeding.

Based on the results, it is estimated that around 45,800 elderly living in nursing homes have different degrees of swallowing problems. However, the nursing homes currently do not have enough funding to employ speech therapists to help these elderlies. It is recommended that the Government increase their funding to nursing homes to support the employment of in-house speech therapists. It is also recommended to review current training programs for nursing home frontline staff to ensure accurate and adequate training on swallowing safety and management is included, and to provide regular swallowing safety training for existing staff.

The Faculty of Education, The University of Hong Kong, and The Hong Kong Society for the Blind Residential Services will be signing a Memorandum of Understanding to establish a Partnership for Excellence in Communication & Swallowing Research on 25 August 2015. It covers the period from 2015 to 2020. The partnership aims to conduct research studies in advancing assessment and treatment for acquired communication and swallowing disorders in elderly with visual impairment; and to promote multidisciplinary evidence-based assessment and treatment protocols for acquired communication and swallowing disorders in elderly with visual impairment to local and regional settings. Pilot studies will first be carried out at the Kowloon Home for the Aged Blind.

For media enquiries, please contact Ms. Yuki Wong, Swallowing Research Laboratory, Division of Speech and Hearing Sciences, Faculty of Education, HKU (Tel: 3917 1568 / Fax: 2559 0060 / E-mail: yukiwyy@hku.hk). Please visit http://web.edu.hku.hk/media/20150825 to view the e-version of the press release, powerpoint and photos.