1. Hard Facts to Swallow Findings of the Cavan/ Monaghan Dysphagia Working Group Pauline Ackermann Senior Speech and Language Therapist Gwen Rice Dietitian MINDI

2. What is Dysphagia?  The process of swallowing is highly complex: preparatory stage, oral stage, pharyngeal stage, oesophageal stage  Thomas (2001) states that dysphagia is a common consequence of many different types of illness or injury resulting in mechanical or neurological impairment of the swallowing process.

3. Healthy Ageing- What’s the outcome for this lady if she has Dysphagia?

4. Cavan/ Monaghan - North Eastern Area

5. Profile of Counties Cavan and Monaghan  Total of 6,498 sq. kilometres.  Total population: 2002344,926 1996306,155. + 38,771 (+12.7%).

6. Profile of Counties Cavan and Monaghan 2002 Census: 36,471 people aged 65+, which is a 5% increase on 1996 Census 3,525 people aged 85+ living in this Board, representing a 31% increase since 1996.

7. Incidence of Dysphagia Local Data from Cavan/ Monaghan Acute Hospitals: 12 month period 167 patients admitted with CVA It is estimated that 45% of these patients will have dysphagia

8. Incidence of Dysphagia Over 5 years it is estimated that this accounts 375 patients who will have dysphagia as a result of a CVA alone; excluding other conditions such as Parkinson’s Disease, Motor Neuron Disease etc.

9. Incidence among older people  Estimates of dysphagia among individuals older that 50 years range from 16 to 22%.  12 to 13% of patients in short-term care hospitals and up to 60% of nursing home occupants have feeding difficulties  Up to 95% of patients with Parkinson’s disease have video fluoroscopic disturbance of deglutition (cited by Thomas, 2001)

10. Consequences of no Dysphagia service Aspiration Malnutrition Dehydration Increased length of hospital stay Mortality Vulnerable Patient

11. Ambition to Promote Health Qualified Professional Diagnosis and treatment Better Patient Outcomes Patient Empowerment A Dysphagia Service

12. Health Promotion

13. No Dysphagia Service Separate Professionals Inappropriate Referrals Service Delivery Dublin Based Services Solution Formation of the Dysphagia Working Group

14. Dysphagia Working Group Survey Current Situation We Know:  Dysphagia is prevalent in patients with CVA  There is no assessment and treatment services for patients with dysphagia in the Cavan/Monaghan region

15. Dysphagia Working Group Survey Current Situation o Lack of knowledge about nature of dysphagia  Lack of awareness of the impact of dysphagia on patient QOL  Lack of knowledge of the requirements of a dysphagia service

16. Dysphagia Questionnaire  Profile of respondent  Knowledge of Dysphagia  Management of Dysphagia at present: practice, problems, supports  Views, comments, suggestions  Separate Questionnaire for Care Attendants Two-sided A4 sheet with 13 questions; combination of ticks and comments

17. Analysis of Questionnaire 126 completed questionnaires were returned out of 574 Response rate: 22%.

18. Some findings…

21. Care attendants

24. Conclusion Patient Separate Professionals Solution

25. Bibliography  Thomas, Briony (2001). Manual of Dietetic Practice – 3 rd edition. Blackwell Science Limited.  Cavan/Monaghan Student Induction Pack (2005)  Cavan/ Monaghan Dysphagia Working Group Position Document (unpublished)  North Eastern Health Board (NEHB) High Level Operational Plan 2004