Implementation of Instrumental Assessment to Assess Dysphagia in Older Adults Receiving Long-Term Care Services: A Scoping Review

Background/Objectives: Dysphagia, a prevalent condition among older adults, poses significant health risks if not accurately assessed and managed. Instrumental assessments (IAs) like videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) allow detailed examinations of swallowing physiology but are underutilized in long-term care settings due to logistical challenges. This study aims to explore the current practice patterns, stakeholder perspectives, and barriers to and facilitators of IA implementation in these settings. Methods: A scoping review was conducted following the PRISMA-ScR guidelines, analyzing the literature from databases including CINAHL Complete, EMBASE, MEDLINE, and SCOPUS. A total of 1339 articles were identified. After the removal of 332 duplications, 1007 articles were screened, with four meeting the inclusion criteria for describing IA implementation or stakeholder perspectives in community-based long-term care settings for older adults. Results: This review identified significant underutilization of IA in long-term care settings, primarily due to logistical barriers and transportation issues. Stakeholders, particularly speech-language pathologists (SLPs), acknowledged the benefits of IA in improving dysphagia management but encountered challenges in accessing these assessments. Mobile FEES (mFEES) emerged as a promising solution, offering on-site assessments that could enhance the accuracy and timeliness of dysphagia care. Conclusions: While IA is crucial for effective dysphagia management in older adults, its implementation in long-term care settings is hindered by various barriers. mFEES presents a viable solution to improve IA accessibility and representativeness. Further research is warranted to develop context-specific implementation strategies and to explore the perspectives of all stakeholders involved in dysphagia care.