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Management of swallowing problems in community settings

02 July 2019
Care of the Older Person
02 July 2019
Volume 24 · Issue 7

Abstract

There is an increase in the demand for community services to provide care closer to home, and care teams are placing a growing emphasis on admission avoidance and early discharge. Community and district nurses are key professionals in this care delivery and are required to be alert to the risk factors for clinical deterioration, such as dysphagia (swallowing problems). Especially in older adults and those with frailty, dysphagia can cause a wide range of problems, from dehydration and malnutrition to respiratory tract infections that warrant antibiotic use and even hospitalisation. This article describes how dysphagia can be identified and managed in the community setting and explains the benefits and impact of speech and language therapy and wider multidisciplinary team intervention.

Advances in medical care combined with an ageing population have led to an increase in the number of individuals living for longer and with multiple health conditions (NHS England, 2014; 2019). A focus on delivering care closer to home driven by the 5 year forward view (NHS England, 2014) and more recently the NHS Long term plan (NHS England, 2019) has placed a growing emphasis on admission avoidance and supporting early discharges. A consequence of this is a growing number of people requiring health and social care provision in their own homes, on an increasingly frequent basis and for more complex health needs. Such care often involves multiple disciplines providing input to the same individual. Some teams host several disciplines, such as the integrated care teams, and thus are able to provide fully integrated care to an individual. Conversely, in other services, different disciplines may be based in places that are geographically disparate and hosted by multiple organisations. Such disciplines have to integrate ‘virtually’ into the care that is delivered around the patient (King's Fund, 2018).

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Dysphagia
Community nurses
Frailty
Long-term conditions
Multidisciplinary team