Validation of the Choking Risk Assessment and Pneumonia Risk Assessment for adults with Intellectual and Developmental Disability (IDD).
Two five-minute checklists validly spot adults with IDD who need swallow or pneumonia precautions.
01Research in Context
What this study did
Sheppard et al. (2017) tested two five-minute checklists. One flags adults with IDD who might choke while eating. The other flags adults who might get pneumonia.
They gave the checklists to adults with intellectual or developmental disabilities. Staff answered yes-or-no questions about chewing, coughing, medicine, and posture.
What they found
The CRA and PRA reliably sorted people into high- or low-risk groups. High specificity means few false alarms. Moderate sensitivity means most true risks are caught.
You can trust a low score. A high score tells you to act.
How this fits with other research
Plant et al. (2007) built the RADD, a 25-minute cognitive screen for the same population. Their work showed a short, low-floor test can still be valid. Joan’s team copied that logic for medical risk.
Perez et al. (2015) later showed the RADD also spots dementia in adults with Down syndrome. Both tools give you a quick go/no-go signal for a serious health issue.
Humphries et al. (2009) reviewed nutrition screens for adults with IDD and found no standard set. The new CRA and PRA fill a similar gap for breathing and swallowing risks.
Why it matters
You can finish both checklists before lunch. A low score lets you skip thickened diets or chest x-rays. A high score gives you data to justify a swallow study or pneumonia vaccine. Use them at intake, annual reviews, or after any choking incident.
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02At a glance
03Original abstract
BACKGROUND: Risk assessments are needed to identify adults with intellectual and developmental disability (IDD) at high risk of choking and pneumonia. AIM: To describe the development and validation of the Choking Risk Assessment (CRA) and the Pneumonia Risk Assessment (PRA) for adults with IDD. METHODS: Test items were identified through literature review and focus groups. Five-year retrospective chart reviews identified a positive choking group (PCG), a negative choking group (NCG), a positive pneumonia group (PPG), and a negative pneumonia group (NPG). Participants were tested with the CRA and PRA by clinicians blind to these testing conditions. RESULTS: The CRA and PRA differentiated the PCG (n=93) from the NCG (n=526) and the PPG (n=63) from the NPG (n=209) with high specificity (0.91 and 0.92 respectively) and moderate to average sensitivity (0.53 and 0.62 respectively). Further analyses revealed associations between clinical diagnoses of dysphagia and choking (p=0.043), and pneumonia (p<0.001). CONCLUSIONS: The CRA and PRA are reliable, valid risk indicators for choking and pneumonia in adults with IDD. Precautions for mitigating choking and pneumonia risks can be applied selectively thus avoiding undue impacts on quality of life and unnecessary interventions for low risk individuals.
Research in developmental disabilities, 2017 · doi:10.1016/j.ridd.2017.07.016