The JBI Collaboration with Care Homesfor Older People

Andy LowndesPractice Development Fellow

Comparison of Barthel Index Scores Comparison of Barthel Index Scores for 24 admissions 1999, 2004, 2009for 24 admissions 1999, 2004, 2009

1999 2004 2009

5 Independent with a score below 5

2 Independent 1 Independent

2 highly dependent with score over 20

8 were highly dependent

15 were highly dependent

17 were dependent on staff for minimal

assistance

14 were dependent on staff for minimal

assistance

8 were dependent on staff for minimal

assistance

0 people were assessed as having swallowing

problems

6 people were assessed as having swallowing

problems

16 people were assessed as having swallowing problems

Dysphagia

• Difficulty swallowing

• Trouble swallowing liquids, foods, medication or saliva

• Adequate nutrition / hydration becomes a challenge

Conditions where we see Dysphagia

Dementia

Stroke

Neuromuscular disorders (e.g. Huntington’s chorea and Multiple Sclerosis)

Decreased salivary flow caused by Sjogren’s syndrome (.5M sufferers in UK)

Medications that have anticholinergic effects (e.g. antihistamines and antidepressants)

Parkinson’s

Poor dentition

Dysphagia in Care Homes for Older Dysphagia in Care Homes for Older PeoplePeople

• 40% to 60% of institutionalized elders have identifiable signs and symptoms of oropharyngeal dysphagia

• Here the difficulties in swallowing are due to problems with the mouth or throat often caused by underlying problems with the nerves and muscles that help control the swallowing process

Risks

• malnutrition and dehydration

• small particles of food can drop down into the lungs triggering a serious and possibly fatal lung infection (aspiration pneumonia)

The Netherton Court Dysphagia Project Team

• May Robertson – Home Manager

• Anne Murphy – Sister

• Lilly Paulose – Registered Nurse

• Moira Kerr – Senior Care Assistant

SIX

STEPS

Search Searching for the evidence

Appraise Level of Evidence

Summarise Training Needs Analysis

Training Package Built

Embed Policies (Management, Registered Nurse, Care Worker)

Manual Builder

Utilise Pre-Intervention Audit.

Implement Change

PACES + COOL

GRIP

Evaluate Post-Intervention Audit.

Kaizen

Disseminate

PACES + COOL

GRIP

SIX

STEPS

Search Searching for the evidence

Appraise Level of Evidence

Summarise Training Needs Analysis

Training Package Built

Embed Policies (Management, Registered Nurse, Care Worker)

Manual Builder

Utilise Pre-Intervention Audit.

Implement Change

PACES + COOL

GRIP

Evaluate Post-Intervention Audit.

Kaizen

Disseminate

PACES + COOL

GRIP