JCPSLP Vol 22 No 1 2020

Adams’ (2006) guidelines which outline a rigorous scientific approach to increase reliability and reduce author bias in narrative reviews. Search strategy A comprehensive search of the literature using a reproducible stepwise process sought to identify white and grey literature pertaining to SLP work in RACFs (see Figure 1). Population, Intervention, Outcome search terms were identified from the background literature and matched to database MeSH terms where available (see Table 1). Initially a systematic literature search was conducted across allied health (EBSCOHost, ProQuest), psychology and medicine (Web of Science, Cochrane Collaboration) databases. The initial database search results were extended with key author searches and completion of forward citation searches. In addition, searches of grey literature related to aged-care policy and professional guidelines for SLP in Australia, England and America were conducted to identify government and non-government organisational reports, professional magazine articles, and conference proceedings. Finally, direct contact was also made via email with SPA’s Senior Advisor Aged Care. All sources identified through this stepwise process were reviewed by the first author and inclusionary criteria applied. Inclusion criteria An alphanumeric system consistent with Green and colleagues (2006) critical appraisal tool, evaluated sources on quality parameters (authorship, publisher, currency, references, writing, reasoning; highest rating = 24) and topic relevance (highest rating = A) (see Table 2). To be eligible for inclusion in the review, an evaluation score above 20:B and publication date of between January 2010 and May 2019 was required. In addition, Australian sources must have mentioned the RACF context and discussed service level themes. Finally, international sources which contributed to broader issues or key concepts were also recorded. Results and analysis Figure 1 displays the results of the search strategy at each step of the review process. The initial search resulted in 860 sources. Duplicates were removed, and the remaining 655 were title reviewed for topic relevance. A shortlist of 57 papers underwent abstract review. From these, 42 were selected for full review. Sixteen papers were excluded from the final review because they did not relate specifically to service level factors for SLP practice in RACFs (e.g., may have discussed resident perspectives, dysphagia malpractice, cross-cultural communication, etc.). Of the final 26 papers, 15 could be considered SLP focused and 11 setting focused (see Table 2). Extracted articles were synthesised using qualitative thematic analysis consistent

vulnerable in our society (Walker & Paliadelis, 2016). RACF residents are typically admitted at 82–84.5years of age (Smith, 2019) with 51% having a diagnosis of dementia (Smith, 2019). Frailty, complex multi-morbidities, dysphagia, communication difficulties, depression and loneliness are also common concerns in RACFs in Australia and internationally (Bennett et al., 2015a; Casper, 2013; Jeng, 2015; Theurer et al., 2015; Walker & Paliadelis, 2016). SLP in RACFs Speech-language pathologists provide services to residents in RACFs who often experience a range of conditions impacting communication and swallowing (Bennett et al. 2015; Bennett et al., 2015a; Bennett et al., 2016). These include typical ageing, dementia, cerebrovascular and neurological disease (Burke & Shafto, 2008; Casper, 2013). Multi-morbidities are common, creating complex clinical presentations and functional impairments that impact upon quality of life (QOL) (Bennett et al., 2015a; Casper, 2013; Jeng, 2015; Walker & Paliadelis, 2016). SLP interventions in RACFs may include direct, environmental or palliative approaches (Bennett, Cartwright, & Young, 2019; Chahda et al., 2017). A speech-language pathologist’s scope of practice in RACFs includes: assessment and management of swallowing and mealtime difficulties; assessment and management of cognitive-communication and language difficulties; service management including education, multi or interdisciplinary teamwork, advocacy and quality improvement initiatives (Speech Pathology Australia [SPA], 2015). SPA’s rationale for these services is to provide holistic care to reduce disorder associated risks, improve QOL, maintain independence and support participation access (SPA, 2015). However, while resident needs in this population clearly correlate with the SLP scope of practice, literature indicates the skills and services of speech- language pathologists may be underutilised in RACFs (Bennett, Cartwright, & Young, 2019; Bennett et al. 2015; Bennett et al., 2015a; Bennett et al., 2016; Chahda, Mathisen, & Carey, 2017; Smith & Kenny, 2015). Several authors note the complexity of RACFs as service sites; however, they also describe gaps in key clinical supports which contributes to a disconnect between best and actual practice (Bennett, Young, & Cartwright, 2019; Chahda et al., 2017; Smith & Kenny, 2015). In other complex service settings (e.g., schools, mental health facilities, justice) clinical guidelines are instrumental in establishing best- practice. This narrative literature review aims to describe: 1. Current SLP practices in RACFs, and 2. The service delivery level factors influencing the provision of SLP services in RACFs. Method A rigorous and systematic narrative literature review was conducted consistent with the Green, Johnson, and

Table 1. Literature review search terms.

Population

(“Nursing.home”.OR.”Residential.aged.care”.OR.”aged care”.OR.”High. care”.OR.”Assisted.living.facility”.OR.”Convalescent. home”.OR.”Old people*.home”.OR “Old.person*.home”.OR.”Rest home*”.OR.”Retire*.home*”.OR.“long-term care” .OR.“long term care” .OR.“skilled nursing” .OR skilled service*”) (“Speech.patholog*”.OR.”Speech therap*”.OR.”Communicat*”.OR.”Communicat* group”.OR.”Conversat*”OR “Conversat*. group”.OR.”Express*”.OR. “dysphag*”.OR “swallow*”.OR.”Social*.support”) (“social.connect*”.OR.”Quality of life”.OR.”Standard*.of living”.OR.”Life.quality”.OR “Welfare”.OR.”Well.being”.OR.”Well-being”. OR.”Livab*”.OR.”living.condition”.OR “level.of.living”.OR.”scale.of.living”.OR.”Emotion*express*”.OR.“Psychosocial”)

Intervention

Outcome

54

JCPSLP Volume 22, Number 1 2020

Journal of Clinical Practice in Speech-Language Pathology