Background
Methods/design
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improve language skills in older individuals;
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be positively accepted by older individuals within LTC facilities; and
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improve the social participation of older individuals, with respect to
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everyday communication,
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swallowing- and eating-related everyday activities, and
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the preservation of cognitive abilities.
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Characterization of LTC facilities as clusters and participants
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aged 65 years or older and residing in an LTC facility;
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no mild or moderate frailty (i.e., Clinical Frailty Scale: level < 5), according to Rockwood [14] (as assessed by caring professionals);
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able to give informed consent (as assessed by caregivers and, if applicable, legal guardians); and
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sufficiently able to hear (i.e., 80% speech comprehension at an everyday speech volume).
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a current diagnosis of a swallowing, speech, and/or language disorder and an associated prescription for speech, swallowing, or language therapy;
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suspected aspiration (i.e., EAT-10 score > 2);
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moderate or severe dementia (i.e., DemTect ≤ 8); and
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estimated life expectancy of < 6 months, based on the “Double Surprise Question” (as assessed by caring professionals) [15].
Ethics
Data collection
Sample size calculation
The OrkA intervention
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orofacial perception (i.e., experiencing the oral cavity and oral stereognosis exercises);
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tonus and coordination training of oral cavity muscles;
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isotonic and isometric exercises of facial, lip, and tongue muscles;
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alternating movements;
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exercises for pharyngeal and veloparyngeal activation (including airflow control exercises, negative pressure exercises, and laryngeal elevation); and
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compensatory aspects, including upright posture, bolus preparation, and postural changes in swallowing techniques.
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semantic feature analysis (e.g., categorization, sorting tasks, and identification of commonalities);
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lexical retrieval (e.g., analysis and synthesis tasks concerning word forms);
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part-whole relations, involving sequences of daily activities; and
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hyperonyms and hyponyms.
Evaluation
time point | study period | ||||||
---|---|---|---|---|---|---|---|
enrollment | allocation | post-allocation | close-out | ||||
inclusion of LTC-facilities | statification randomization | pre-inter-vention (t0) | intervention | post-inter-vention (t1) | 6-month follow up (t2) | intervention waiting group | |
Enrollment | |||||||
review of inclusion criteria of the LTC-facilities | X | ||||||
allocation of the LTC-facilities | X | ||||||
informed consent of the LTC-residents | X | ||||||
Assessment | |||||||
demografic and clinical data of the LTC-residents | X | ||||||
inclusion criteria of the LTC-residents: Clinical Frailty Scale | X | ||||||
inclusion criteria of the LTC-residents: speech audiometry | X | ||||||
clinical assessments | |||||||
cognitive ability: Dementia-Detection-Test (DemTect) | X | X | X | ||||
language ability: Regensburg Word Fluency Test (RWT), semantic and phonological verbal fluency | X | X | X | ||||
swallowing ability: Timed Test of Swallowing Capacity (TTSC) | X | X | X | ||||
Questionnaire about every day Communication Practice– Communicative Activity Log (CAL) | X | X | X | ||||
quality of everyday swallowing: Eating Assessment Tool (EAT-10) | X | X | X | X | X | ||
process evaluation | |||||||
notes and protocols of the intervention process diary of the Residents | X | ||||||
evaluation of the intervention: feedback questionnaire for residents | X | ||||||
intervention group | X | ||||||
control-waiting group | X |
Description of the study process
Data processing and statistics
Discussion
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investigating the feasibility and effects of a preventive training program on swallowing and communicative capabilities;
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preserving social participation in the daily lives of older LTC facility residents;
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maintaining meals as a social and interactive event for as long as possible;
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activating sensitive and motor skills in the orofaciopharyngeal area to counter age-related swallowing disorders; and
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stimulating communicative abilities, with a focus on semantic-lexical activation to maintain linguistic abilities.