E14 Not All Aspiration is Equal: The Evidence Behind The BOLUS Framework with Melissa Kane
Dysphagia Research BitesShow Notes
Aspiration and aspiration pneumonia are not the same thing. We know this theoretically. In this episode of Dysphagia Research Bites, Chantelle sits down with Melissa Kane to unpack a 2022 tutorial paper that illustrates the case for looking beyond aspiration itself and toward the individual: their host defences, their medical complexity, their oral health, their lifestyle, when determining the real risk of an adverse event.
This episode covers: Why the presence of aspiration does not have a linear relationship with adverse outcomes The BOLUS Framework: a clinical tool that consolidates existing evidence into a practical set of risk-assessment questions spanning Bolus variables, Oral care, Lifestyle and ADLs, Unintended (Iatrogenic) risks, and System Health How oral health, feeding dependence, mobility, tube presence, and medical co-morbidities each factor into aspiration risk The importance of person-centred language when discussing risk with clients and families How using this framework in a real-world case enabled a client who was nil by mouth to significantly increase their oral intake and improve quality of life
The publication this episode is based on:
Palmer, P. M., & Padilla, A. H. (2022). Risk of an adverse event in individuals who aspirate: A review of current literature on host defenses and individual differences. American Journal of Speech-Language Pathology, 31(1), 148–162. https://doi.org/10.1044/2021_AJSLP-20-00375
Some of the tools & articles mentioned in this episode: EAT-10 (Eating Assessment Tool-10):https://www.nhsexpertcorner.com/sites/default/files/2021-04/eat10toolenglish_form.pdf Drooling Frequency and Severity Scale (DFSS): https://www.movementdisorders.org/MDS-Files1/PDFs/Task-Force-Papers/sm004.doc Functional Oral Intake Scale (FOIS): https://www.archives-pmr.org/article/S0003-9993(05)00196-6/abstract Oral Health Assessment Tool (OHAT):https://www.dental.sa.gov.au/assets/downloads/Care-for-older-people-toolkit/Residential-care/3.-Oral_Health_Assessment_Tool-OHAT.PDF Langmore, S. E., Terpenning, M. S., Schork, A., Chen, Y., Murray, J. T., Lopatin, D., & Loesche, W. J. (1998). Predictors of aspiration pneumonia: How important is dysphagia? Dysphagia, 13(2), 69–81. https://doi.org/10.1007/PL00009559 — available via: https://pubmed.ncbi.nlm.nih.gov/9513300/ Ashford, J. R. (2005). Pneumonia: Factors beyond aspiration. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 14(1), 10–16. https://doi.org/10.1044/sasd14.1.10 — the Three Pillars framework is also summarised at: https://www.sasspllc.com/three-pillars-of-pneumonia O'Keeffe, S., Murray, A., Leslie, P., Collins, L., Lazenby-Paterson, T., McCurtin, A., Mulkerrin, S., & Smith, A. (2021). Aspiration, risk and risk feeding: A critique of the Royal College of Physicians guidance on care of people with eating and drinking difficulties. Advances in Communication and Swallowing, 24(1), 1–10. https://doi.org/10.3233/ACS-210031
For comprehensive evidence-based dysphagia education beyond the podcast, head to: https://www.dysphagiabites.com/clinical-swallow-evaluation-course
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