Dysphagia in older adults is a frequent and serious condition that is under recognised and under referred to Speech Pathology (SP) from Emergency Departments (ED). Dysphagia impairs swallowing efficiency and safety with increased risk of aspiration pneumonia, mortality, malnutrition, frequent hospital admissions with prolonged Length of Stay (LOS) and increased healthcare costs. Research demonstrates that up to 30% of adults admitted to hospital emergency Departments display signs of dysphagia.

At our acute metropolitan hospital in Brisbane, data suggested that dysphagia was not being identified early enough in patient admissions. For example, only 2 patients had been referred to SP through ED during a 3 month period. Chart audits of patients at risk of dysphagia admitted to medical wards revealed nurse-led dysphagia screening was either absent, inconsistent or inaccurate, resulting in few referrals to SP. There were over 30 clinical incidents relating to the lack of dysphagia screening and subsequent mismanagement of dysphagia reported over a 20 month period. Incidents related to: patients not receiving oral medication, prolonged periods of malnutrition and dehydration, aspiration pneumonia, lung abscess, respiratory failure, asphyxiation and death.

To respond to these issues, the Speech Pathology team implemented a 6 month trial in ED to screen for dysphagia using a validated tool. Results were consistent with the literature with just over 30% of patients identified as having dysphagia. The main populations at risk were those over 65 years of age who presented with: (1) fall; (2) respiratory infection/COPD; (3) delirium; (4) back pain and (5) dizziness/syncope. There were positive impacts on length of stay, and medical and nursing staff reported that this model of care improved risk assessment and discharge planning.

This project supported dysphagia screening in ED before patients who are at high risk of dysphagia are dispersed throughout the hospital.

1. Early identification and intervention for dysphagia improves patient and service outcomes
2. Speech Pathology has a valuable role to play in emergency and acute settings
3. Exploration of the most suitable models for dysphagia care (including screening/identification) is required. In settings such as Emergency, Speech Pathology led assessment may be needed over traditional models (e.g. nurse led screening)

In South Western Sydney Local Health district, 10% of adult acute inpatients received Videofluoroscopy Swallowing Studies (VFSS). Due to practice constraints of acute services, clinicians prioritise when allocating available VFSS appointments to optimise patient outcomes and clinician resource. Patient factors that influence change in outcomes following receipt of VFSS are not well understood. This study aimed to identify factors that influence change or no change in functional oral intake scale (FOIS) following VFSS.

A prospective file audit was conducted for 269 adult acute inpatients referred for VFSS, within six-months, across five metropolitan hospitals. Change was described as: numerically positive change towards unrestricted oral intake (FOIS 7); no change in FOIS; or numerically negative change towards nil by mouth (NBM) status (FOIS 1) pre and post VFSS. Data analysis was completed with descriptive statistics and nominal logistic regression.

The three main VFSS referral reasons were: identification of silent aspiration, unclear bedside assessment and guidance for diagnosis or prognosis. There was no change in FOIS following receipt of VFSS in 48% of patients, 7% showed negative change towards NBM status, and 45% showed positive change towards full oral intake. Compared with no change, the factors associated with a negative numerical change towards NBM were increased age, higher Penetration Aspiration Score and reason for referral (unclear bedside assessment). Compared with no change, the factors associated with a numerically positive change towards unrestricted oral intake were hospital site and reason for referral (dysphagia of unknown cause, guide diagnosis and prognosis and investigation of potential structural change).

Numerical change or no change may result in a positive outcome for the patient if the VFSS has assisted to prevent an aspiration pneumonia or guide intervention. Additional qualitative research is required to further understand service factors and clinician decision-making for referral to VFSS in the acute setting.

1. A small proportion of adult acute inpatients receive VFSS.
2. Reason for VFSS referral (dysphagia of unknown cause, guide diagnosis and prognosis and investigation of potential structural change) influence numerically positive change in functional oral intake status following receipt of VFSS
3. A higher Penetration - Aspiration score and unclear bedside assessment influence numerically negative change in functional oral intake status following receipt of VFSS.

Purpose: Drooling is a common symptom of Parkinson’s. However, limited research existed on the impact that drooling has on the lives of people with Parkinson’s. Previous research was mostly quantitative, so further qualitative research related to investigating the specific nature of the impact was warranted. This study aimed to explore the social, emotional and physical impacts that drooling has on people with Parkinson’s lives.

Method: Semi-structured interviews were conducted with 11 people with Parkinson’s. Ages ranged from 51 to 85 and their perceptual drooling severities were varied. A qualitative, reflexive thematic analysis of interview transcripts was undertaken.

Results: Three key themes and six subthemes emerged from the interviews. These main themes included factors that make drooling worse, the impact of drooling on different aspects of life, and drooling strategies and treatments. Drooling impacts related to activities and participation, emotions and relationships were established. A lack of suitable treatment options was apparent. Participants opted for use of management strategies, with several participants describing inconveniences related to these strategies. Most participants sought professional advice for their drooling.

Conclusion: These findings show the significant social and emotional impacts that the symptom of drooling has on the lives of people with Parkinson’s. The lack of suitable treatment options warrants the need for further research into more holistic and sustainable treatment options for drooling.

1. Drooling associated with Parkinson's impacts activities and participation, emotions and relationships
2. There is a lack of suitable treatment options available for drooling for people with Parkinson's
3. People with Parkinson's reported that there were inconveniences associated with the management strategies that they use.