The risk of dysphagia increases with age and the prevalence of dysphagia in aged care facilities is 41–52%. Dysphagia increases the risk of aspiration, asphyxiation, malnutrition, pneumonia and ultimately death. Modifying food and fluids, by providing mashed or pureed foods and thickened liquids, or offering tube feeding can reduce these risks. Yet eating and drinking is also an immensely pleasurable activity and many people opt not to take these recommendations. This study aims to explore the perceptions of the multidisciplinary team around eating and drinking at risk and the knowledge, skills and resources they needed to support this. Six focus groups comprising 32 participants from speech and language therapy, medical, nursing, occupational therapy and non-clinical backgrounds participated in the study. Thematic analysis identified four main themes: a) dynamic shared decision-making; b) communicating effectively to support and inform eating and drinking at risk decision-making; c) enabling eating and drinking at risk in practice; and d) risks and implications for clinicians and staff. The findings demonstrate how complex it can be to support people with dysphagia in aged care settings to eat and drink at risk. Decision-making around the issue was felt to be a dynamic process influenced by many factors including patient fluctuations, organisational guidelines and staff resources and support. Given the clinical, ethical and moral considerations staff from all disciplines require appropriate support and guidance at organisational level. Supporting people to eating and drink at risk is an important component of genuine person-centred care, and requires appropriate resources and training.
Swallowing the risk: managing dysphagia in aged care
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