Practice Patterns of Speech-Language Pathologists Managing Dysphagia in Dementia: A Cross-Sectional Survey in the United States

Abstract

Purpose The purpose of this study was to describe the practice patterns of speech-language pathologists (SLPs) managing dysphagia in persons with dementia (PWD) in the United States. We wanted to investigate if clinicians are (a) adequately prepared to manage dysphagia in PWD, (b) confident in their ability to manage dysphagia in PWD, (c) performing comprehensive dysphagia assessments in PWD, and (d) using evidence-based techniques to manage dysphagia in PWD. Method A web-based survey comprising 32 questions was developed, field-tested, and distributed to members of the American Speech-Language-Hearing Association's Special Interest Groups 13 and 15, as well as members of online SLP forums. Two hundred fifty-one responses were obtained and analyzed using descriptive methods. Results Respondents were experienced SLPs working primarily in acute care and skilled nursing facility settings. Their confidence in assessment and treatment was found to significantly increase with years of experience ( p < .001). The majority indicated more continuing education opportunities need to be offered related to managing dysphagia in PWD. Most reported using assessments that have not been validated for PWD. Clinical swallow examinations were utilized more frequently than instrumental exams to inform treatment planning. There was variability in the treatment techniques used to manage dysphagia in PWD, with a focus on use of compensatory strategies and providing caregiver training. Respondents listed several barriers to managing dysphagia in PWD and stated influences on their clinical decision making. Conclusions While some trends emerged regarding dysphagia practice patterns among SLPs managing PWD in the United States, a lack of consensus regarding best practices was apparent. The establishment of formal diagnostic standards, the elucidation of the underlying mechanisms of different types of dementia, and the development of evidence-based treatments for managing dysphagia in PWD could help improve SLP management of dysphagia in dementia and reduce the significant burden of this disease.