Bedside evaluation of dysphagia (BED) screening

Swallowing function was examined using sub-items of the revised BED Screening (Hardy, 1995, 1999). The standardized BED estimates the potential risks of dysphagia and determines swallowing safety in adults. The screening sheet is scored by yes/no responses in identifying medical, behavioral, and oral-motor issues and observation of liquid/food swallows. When any “yes” response is detected, it indicates the potential presence of a swallowing problem. Clinicians then use the response results to determine whether more advanced assessment is recommended.

Using the selected items from the screening sheet, our study examined the situational condition with liquid/ food swallows. Three types of textures were evaluated by six condition items during the swallowing process, respectively. The six conditions were pocketing of material/residual in the oral cavity; multiple swallows per bolus; delay in triggering pharyngeal swallow; coughing or choking before, during, or after swallow; change in voice quality, and impaired laryngeal elevation. The numerical score points (0, 1) were denoted, and a total score was summed for each screening item. Specifically, while “yes” could be marked for any of the conditions, one point was given to indicate the swallowing problem existed; whereby a zero point was given for the “no” problem being observed. This screening section has the potential score range of 0 to 18 representing any objective dysfunction measured. Based on the rules of the BED Screening, “no ticks” are recommended for normal swallowing. Low scores suggest a better swallowing function in the study sample. By the BED Screening, it was not surprising that over 80% of the study sample were detected as suspected cases of geriatric dysphagia.