Caregiver Checklist for Dysphagia Risk (CCDR) development and preliminary evaluation: a pilot study

Abstract

Background: The potential risk for dysphagia may be a concern in the elderly population and can often lead to aspiration pneumonia. Due to a shortage of speech therapists in South Africa, nurses and caregivers within care facilities are typically the individuals who are responsible for monitoring eating and drinking of the residents at the care facilities. This makes them ideal for early identification of individuals at risk of dysphagia. Method: The aim of this study was twofold 1) to document current tools used to identify dysphagia in the elderly in care facilities by way of a scoping review and 2) to establish the preliminary diagnostic accuracy, validity, and reliability of a researcher-developed tool, the Caregiver Checklist for Dysphagia Risk (CCDR) as informed by the scoping review. The study used the scoping review methodological framework and quantitative cross-sectional correlational design for its respective parts. The caregivers and residents from a care facility were recruited using convenient and purposive sampling, respectively. The CCDR was, completed by caregivers, thereafter the Eating Assessment Tool (EAT-10) was administered by the researcher to residents with and without suspected risk of dysphagia for a total sample of 32 residents (n=32). Data Analysis: Data was analysed using thematic analysis for the scoping review and, descriptive and inferential statistics for data pertaining to the CCDR. Content validity was established using a scoping review that assisted with the content of the CCDR. The reliability was measured using Cronbach’s Alpha to determine internal consistency. Concurrent validity of the CCDR was established by correlating the results against the results of the EAT-10. Diagnostic accuracy in the form of sensitivity and specificity were assessed. Results: The scoping review identified tools currently being used to identify dysphagia with the elderly and confirmed that no tool exists for this population in the South African residential care context. A lack of one appropriate tool led to the development of the CCDR. Preliminary results of the CCDR indicated a strong internal consistency (Cronbach’s Alpha = 0,815), moderate positive correlation (Pearson’s r(30) = 0.499, p < 0,001; Spearman’s Rank Order r(30) = 0.454, p < 0,001), a high sensitivity (0,90) and specificity (0,82) indicating promise in its use. Implications: Clinical implications reveal that the CCDR can identify dysphagia risk in elderly residents in care facilities. Theoretically, this tool adds to existing dysphagia resources in the scientific world by providing a tool, to identify dysphagia risk. Further research may include multiple research sites as well as explore caregiver feedback and investigate feasibility of the use of the CCDR with community-dwelling elderly.