Dysphagia Management in Geriatric Medicine: Clinical Perspectives and Practice Patterns.

BACKGROUND

Swallowing care in older adults involves multiple providers, but how non-speech-language pathologist (SLP) providers approach dysphagia management is unclear. This study explored perspectives on dysphagia management among geriatrics-focused health care providers.

METHOD: A 21-item mixed-methods online survey study was disseminated to geriatrics-focused, licensed health care providers (excluding SLPs) using Qualtrics software (Qualtrics). The survey was opt-in, and all responses were collected anonymously. Health care providers were identified through various methods, including online forum postings, local and national presentations, and the snowball method. Data were analyzed descriptively, and free-text responses were examined using inductive thematic analysis with a jointly developed codebook. Two coders completed manual coding in Excel, and a third reviewer resolved discrepancies.

RESULTS

Eighty-two providers responded. Most felt confident (69.5%) and knowledgeable (81.7%) about dysphagia but wanted more training (74.4%), especially on interventions (75.6%). The primary screening barrier was poor integration into clinical workflows (52.4%), while perceived relevance to care (58.5%) was the primary screening facilitator. Though 92.7% of health care providers referred to SLPs when dysphagia was suspected, most did so for 1%-25% of patients (68.3%). Most respondents asked about swallowing in ≥ 50% of patients with dementia (69.6%). Thematic analysis revealed concerns that SLPs lack person-centered approaches, particularly regarding diet modifications. These concerns appeared related to other systems-level themes identified in the analysis, including limited interdisciplinary collaboration and constrained clinical resources.

CONCLUSIONS

Our study suggests a need for better collaboration among health care professionals to improve swallowing-related care for older adults. It is likely that structural changes within the broader education and workplace systems will be necessary to improve collaboration and optimize current approaches to swallowing care.