People with intellectual disabilities and dysphagia

Abstract

Purpose. Dysphagia (difficulties in eating, drinking or swallowing) is associated with serious health complications and psychosocial sequelae. This review aims to summarise the state of the evidence regarding dysphagia in people with intellectual disabilities (excluding prevalence), identify gaps in the evidence base and highlight future research priorities. Method. Studies published from 1st January 1990 to 19 th July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests, and cross-citations. Studies were reviewed narratively in relation to identified themes. Results.A total of 35 studies were included in the review. Themes identified were: health conditions associated with dysphagia; mortality; health service use; practice and knowledge in supporting people with intellectual disabilities and dysphagia; intervention effectiveness;and quality of life. Dysphagia is associated with respiratory infections and choking, and may be under-recognised. Silent aspiration is common and may go unnoticed. Management practices exist but there are few intervention studies and no RCTs, hence the effectiveness of these is currently unclear.Conclusion. Dysphagia is a key concern in relation to people with intellectual disabilities.There is urgent need for research on the management of dysphagia in people with intellectual disabilities, including mealtime support offered, positioning, dietary modification and impact on wellbeing.

Adverse outcomes after major surgery in children with intellectual disability

“…To improve future care for such children, we suggest the following. 1Prolonged respiratory monitoring (such as continuous pulse oximetry monitoring, to ensure patent airway, adequate ventilation, and oxygenation), 41,42 prophylactic antiemetic therapy (preventing postoperative vomiting), 43,44 and an enhanced recovery after surgery approach could be applied to the perioperative period to make the major improvements in clinical outcomes and cost among children with intellectual disability. 45 (2) Psychiatrists and neurologists should routinely be included in the surgical healthcare teams to provide professional expertise on mental illness.…”

The convergent validity of a Dutch Screening tool for Dysphagia (Signaleringslijst Verslikken) for people with severe or profound intellectual and multiple disabilities

“…The DDS is not, however, the gold standard and therefore estimates of sensitivity, specificity, positive predictive value and negative predictive value could not be computed. Moreover, the DDS may be inadequate in the evaluation of pharyngeal aspects of dysphagia due to silent aspiration (Robertson et al, ). Using a stethoscope to evaluate cervical swallowing sounds intermittently during the meal would increase the sensitivity of assessment of the pharyngeal‐phase signs of dysphagia specified in the DDS (Calis et al, ).…”

“…Dysphagia in adults with intellectual disabilities (IDs) is potentially life‐threatening with negative health consequences including asphyxia, dehydration, poor nutritional status and choking. It can result in aspiration of food or liquids into the lungs resulting in respiratory tract infection (Robertson, Chadwick, Baines, Emerson, & Hatton, ). Indeed, it is reported that up to 40% of adults with intellectual disability and dysphagia will experience recurrent respiratory tract infections related to aspiration (Chadwick & Jolliffe, ).…”

“…Respiratory tract infection is one of the most common causes of death for people with intellectual disability and the principal cause of death in people with severe or profound intellectual and multiple disabilities (SPIMDs). Furthermore, such an outcome is potentially avoidable (Heslop et al, ; Hosking et al, ) and may be prevented through the enactment of dysphagia screening (Robertson et al, ).…”

“…In residential facilities, the assessment and management of dysphagia in people with SPIMD usually fall within the remit of speech and language therapists and undertaken using the Dysphagia Disorders Survey (DDS; Robertson et al, ). The DDS is a standardized, structured evaluation for the assessment of dysphagia in people with intellectual disability (Sheppard, ).…”