出版社：Utrecht University, Maastricht University, Groningen University
摘要：Aim : Eating involves a range of functions including motor, sensory, and cognitive skills. Feeding, eating, drinkning (FEDS) and swallowing disorders can occur with the breakdown of any of the aforementioned functions. Difficulty swallowing, or dysphagia, can result in both physical and nutritional issues that can put a person at risk of aspiration, choking, malnutrition and death. While there are no figures on the prevalence of dysphagia in an older intellectual disability residential population, studies have shown that 28.6 – 68% of people with dementia have a FEDS disorder. Other studies have shown that 36% people with an intellectual disability in a hospital based setting can have a FEDS disorder. It is also acknowledged that the FEDS disorders within this population can largely go unrecognised. Malnutrition in a residential setting in Ireland has been identified as 25% - 32% of residents in a care home. Method : 5 key areas were audited staff practices versus therapist guidelines as follows: 1) food and fluid consistencies; 2) supervision and support; 3) environment 4) Documentation of FEDS and 5) nutritional guidelines. A training programme was developed to address deficits in these areas, rolled out to all staff involved in providing care and support to resident at mealtime. Staff were also surveyed in relation to their training needs pertaining to providing support at mealtime. Each service user was risk assessed using the INDI/IASLT guidelines on management of FEDs difficulties in the residential care setting. Each service user was proved with a mealtime placemat, colour coded to indicate their level of risk in relation to FEDs at mealtimes and with all their FEDS guidelines. The practices on the unit were re-audited 3 months and 1 year post intervention Results : The results show an improvement in the implementation of FEDs guidelines, in particular the improvement of implementation of nutrition guidelines, which improved from 31% to 87.5% 3 months post implementation of the communication tool. A year post implementation show the change was sustained. There was also a significant improvement in the implementation of consistency recommendations from 80% to 97.5%. This change was also sustained 1 year post intervention. In addition to the improvement of FEDS guidelines with the placemat communication tool, the nutritional status of residents at risk of malnutrition also improved. The average weight gain in residents (n=7) at risk of malnutirion was 3.4kg over the period of a year. Conclusion : Effective communication tools in the form of a placemat to carers can help improve communication of FEDS guidelines and improve nutritional status of people at risk of malnutrition.
关键词：nutrition ; intellectual disabilities ; communication ; feds ; mealtimes
