Not All Aspiration is Equal: The Evidence Behind The BOLUS Framework with Melissa Kane

<p>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.</p><p><br /></p><p>This episode covers:</p><ul><li>Why the presence of aspiration does not have a linear relationship with adverse outcomes</li><li>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</li></ul><ul><li>How oral health, feeding dependence, mobility, tube presence, and medical co-morbidities each factor into aspiration risk</li></ul><ul><li>The importance of person-centred language when discussing risk with clients and families</li><li>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</li></ul><p><br /></p><p>The publication this episode is based on:</p><p><br /></p><p>Palmer, P. M., &amp; Padilla, A. H. (2022). Risk of an adverse event in individuals who aspirate: A review of current literature on host defenses and individual differences. <em>American Journal of Speech-Language Pathology, 31</em>(1), 148–162. <a href="https://doi.org/10.1044/2021_AJSLP-20-00375" rel="ugc noopener noreferrer" target="_blank">https://doi.org/10.1044/2021_AJSLP-20-00375</a></p><p><br /></p><p>Some of the tools &amp; articles mentioned in this episode:</p><ul><li><strong>EAT-10 (Eating Assessment Tool-10):https://www.nhsexpertcorner.com/sites/default/files/2021-04/eat10toolenglish_form.pdf</strong></li></ul><ul><li><strong>Drooling Frequency and Severity Scale (DFSS):</strong> <a href="https://www.movementdisorders.org/MDS-Files1/PDFs/Task-Force-Papers/sm004.doc" rel="ugc noopener noreferrer" target="_blank">https://www.movementdisorders.org/MDS-Files1/PDFs/Task-Force-Papers/sm004.doc</a></li><li><strong>Functional Oral Intake Scale (FOIS):</strong> <a href="https://www.archives-pmr.org/article/S0003-9993(05)00196-6/abstract" rel="ugc noopener noreferrer" target="_blank">https://www.archives-pmr.org/article/S0003-9993(05)00196-6/abstract</a></li><li><strong>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</strong></li></ul><ul><li>Langmore, S. E., Terpenning, M. S., Schork, A., Chen, Y., Murray, J. T., Lopatin, D., &amp; Loesche, W. J. (1998). Predictors of aspiration pneumonia: How important is dysphagia? <em>Dysphagia, 13</em>(2), 69–81. <a href="https://doi.org/10.1007/PL00009559" rel="ugc noopener noreferrer" target="_blank">https://doi.org/10.1007/PL00009559</a> — available via: <a href="https://pubmed.ncbi.nlm.nih.gov/9513300/" rel="ugc noopener noreferrer" target="_blank">https://pubmed.ncbi.nlm.nih.gov/9513300/</a></li><li>Ashford, J. R. (2005). Pneumonia: Factors beyond aspiration. <em>Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 14</em>(1), 10–16. <a href="https://doi.org/10.1044/sasd14.1.10" rel="ugc noopener noreferrer" target="_blank">https://doi.org/10.1044/sasd14.1.10</a> — the Three Pillars framework is also summarised at: <a href="https://www.sasspllc.com/three-pillars-of-pneumonia" rel="ugc noopener noreferrer" target="_blank">https://www.sasspllc.com/three-pillars-of-pneumonia</a></li><li>O'Keeffe, S., Murray, A., Leslie, P., Collins, L., Lazenby-Paterson, T., McCurtin, A., Mulkerrin, S., &amp; 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. <em>Advances in Commun