Troubles de la déglutition des résidentes et résidents en EHPAD : connaissances et pratiques des professionnels. Des représentations à la recherche de consentement.

Abstract

Context: Many residents of French nursing homes have swallowing disorders. These disorders are expressed through various and numerous symptoms, specific and non-specific. The consequences of swallowing disorders are multiple and can be fatal. However obstructive aspiration is not the only consequence to consider. The residents’ quality of life must remain the most important factor in institutionalized elderly people. Medical and paramedical professionals are all concerned by swallowing disorders and their management. Texture-modified meals are often suggested as an adaptation regarding swallowing disorders, although some inconveniences may occur. Current scientific data indicate that professionals in nursing homes have incomplete knowledge of swallowing disorders. Moreover, obtaining informed consent before implementing an adaptation does not seem systematic. Ethical principles do not allow a systematic response to the moral dilemmas encountered when residents refuse modified textures. In addition, the legal implications and professional liability regarding obstructive aspirations are unclear. Objectives: The aim of our study was to analyze professional practices in French nursing homes regarding informed consent, and to identify a possible correlation between consent collecting and training level. The data collected with our study could then be used to create relevant training for nursing home professionals. Method: To test our hypotheses, we produced a survey for professionals working in nursing homes in France. Results: This questionnaire revealed incomplete knowledge among professionals in nursing homes about swallowing disorders as well as a major feeling of anxiety about these troubles. In addition, consent was not systematically sought before the introduction of texture-modified meals.  Conclusions: This study demonstrates a desire for training among nursing home professionals. It also legitimizes the latter and highlights several themes to broach. New training courses based on these results could allow an improvement in the quality of life of residents in nursing homes, with better consideration of the fundamental rights of the elderly.