Audiology and Speech Pathology - Theses
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ItemAn Australian Model of Mobile Flexible Endoscopic Evaluation of Swallowing (mFEES) for Adults in Residential Aged Care Homes( 2022)Many older adults living in residential aged care homes (RACHs) experience swallowing difficulties (oropharyngeal dysphagia – OD) due to age related changes and medical comorbidities. Sequelae of OD may be serious, including choking (the second leading cause of preventable deaths in RACHs), pneumonia, dehydration, malnutrition, and reduced quality-of-life. Timely instrumental swallowing assessment (ISA), including Flexible Endoscopic Evaluation of Swallowing (FEES), can play a pivotal role in differential OD diagnosis and tailored dysphagia care, reducing the risk of avoidable OD complications. In Australia, ISA services are not available onsite in RACHs, meaning that vulnerable, older adults must travel off-site for assessment, and may experience mobility, cognitive, and fiscal barriers to assessing timely ISA. Models of mobile ISA offered onsite RACHs, may help to address these access barriers by eliminating the need for residents to travel for assessment, facilitating more timely and personalised OD care. However, literature dedicated to exploring ISA in RACHs is limited, and there are no published models of mobile ISA in RACHs in Australia. Consequently, there is a need to systematically explore issues in offering ISA in a RACH setting and the value of a mobile service model in supporting person-centred, timely swallowing care. In this research program, mixed methods and principles of triangulation (grounded in the pragmatic paradigm) helped to examine evidence on ISA in RACHs from different sources, including published and grey literature, RACH clinical records, the opinions of speech-language-pathologists, residents, their nursing staff, and legally appointed medical decision makers. Through four, sequential studies we systematically explored the following: the role of ISA in RACHs; barriers and facilitators to ISA; Australian practice patterns in the use of ISA in RACHs; and the feasibility of an Australian mFEES service model. We found that ISA may play a valuable role in OD diagnosis, prognostication, and care in adults in RACHs. Despite agreement between sources that there is a clinical need for ISA in RACHs, there was no evidence of ISA being used in Australian RACHs. These data informed the development of an Australian mFEES service model, designed to eliminate travel-related ISA access barriers. Data from our feasibility study, conducted in RACHs in metropolitan and regional Victoria, suggested that mFEES is a safe, well-tolerated, and practical service model with potential to minimise OD sequelae by facilitating timely, person-centred, and collaborative swallowing care. The mFEES service model aligned with recent findings of the Australian Royal Health Commission into Aged Care Quality and Safety, emphasising the importance of person-centred healthcare, delivered with collaboration and innovation. Results of this thesis contribute to emerging literature on the use of ISA in RACHs by providing data to support judicious use of ISA in this setting and an Australian mFEES service model to address existing barriers associated with off-site assessment. Our findings can be used as a platform for future research with larger participant numbers to explore the impact of the mFEES service model on clinical risk, healthcare, and fiscal outcomes at a resident, community, and healthcare-service level. More broadly, it can assist in advocacy initiatives to improve the safety and quality of swallowing care for older adults living in RACHs in Australia.