Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences
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COVID-19
Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences Raymond Fong 1,2
&
Kelvin C. F. Tsai 3 & Michael C. F. Tong 1,2 & Kathy Y. S. Lee 1,2
Accepted: 13 August 2020 # Springer Nature Switzerland AG 2020
Abstract The global 2019 novel coronavirus disease (COVID-19) pandemic has had devastating effects not only on healthcare systems worldwide but also on different aspects of the care provided to nursing home residents. Dysphagia management is a crucial component of the care provided to many nursing home residents. This article presents the dysphagia management strategies applied in Hong Kong during the COVID-19 pandemic and the related experiences. A two-tier protection system was implemented wherein residents were categorised according to their contact and hospitalisation histories. The provided swallowing management and personal protective equipment level differed between the two tiers. The article also discusses the referral and prioritisation of clinical services for residents requiring swallowing management, as well as the adaptations of swallowing assessment and management during the pandemic. The possible effects of COVID-19 on mealtime arrangements in nursing homes, the implications of the pandemic on the use of personal protective equipment and the use of telepractice in nursing homes were also discussed. This article has summarised the actions taken in this regard and may serve as a reference to clinicians who are responsible for swallowing assessments and dysphagia management in nursing homes. Keywords Dysphagia . COVID-19 . Nursing home
Introduction The World Health Organization (WHO) declared the 2019 novel coronavirus disease (COVID-19) to be a global pandemic in March 2020 [1]. COVID-19 has caused widespread devastation in communities worldwide, and even more significant increases in associated mortality in nursing homes relative to the surrounding communities [2]. Residents in nursing homes often have multiple health conditions and are therefore at a higher risk of mortality in a pandemic scenario. In the COVID-19 pandemic, this increased risk of mortality is not only due to the pandemic disease itself but also due to pre-
* Raymond Fong [email protected] 1
Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
2
Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
3
Speech Therapy Department, Methodist Centre, Hong Kong, China
existing medical conditions, regardless of the residents’ COVID-19 infection status. Dysphagia is a prevalent problem among nursing home residents. Previous studies have reported global prevalence rates ranging from 25 to 70% [3–5]. If neglected or mismanaged, dysphagia can lead to serious complications such as malnutrition, dehydration, aspiration pneumonia and death [6]. Dysphagia can be assessed using either noninstrumental or instrumental assessment methods. Clinicians rely large
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