Dysphagia

Dysphagia (swallowing difficulty) is a common condition among residents in aged care facilities. It may be due to physiological changes associated with ageing or the side effect of medication. Any changes to the normal function of the mouth, pharynx, larynx and oesophagus can produce signs and symptoms of dysphagia. [1]

Most commonly it is associated with neurological diseases particularly dementia, Parkinson’s disease (PD), motor neurone disease (MND) and stroke.

Dysphagia carries increased risk of:

  • poor nutrition
  • dehydration
  • aspiration, and
  • pneumonia.

People with dysphagia may also experience difficulty with:

  • speech
  • facial droop, and
  • difficulty controlling head or neck movements.

Recognising dysphagia

Resident (or caregiver) may be asked if they experience (observe) the following:

  • choking when eating or drinking or a feeling of food sticking in the throat
  • drooling of saliva or food escaping from the mouth, or
  • coughing during or after eating or drinking.

Other indications of dysphagia include:

  • weight loss
  • very slow eating and drinking times
  • refusing food and fluids, and
  • retaining food and fluids in the mouth. [2]

Management

Where possible an assessment by a speech pathologist should inform care planning. In rural and remote areas speech pathologists may not be available. Registered Nurses may be required to assess residents for dysphagia and should have appropriate training. [3]

  • Useful Tip

Near the end-of-life burdensome assessments may not be consistent with goals of care.

  • A multi-disciplinary approach to manage treatable causes of dysphagia such as dry mouth, dental problems and medications affecting swallowing ensures best practice
  • All staff providing meal time assistance should have education in assisting residents with swallowing problems and managing choking episodes
  • Staff should be aware of the specific care needs of the residents they attend
  • Processes should be in place to ensure that food and fluids of the correct consistency are available.

Dementia

Swallowing difficulties are common in people living with dementia. They are further compounded by the motor and cognitive impairments associated with this disease.
People with dementia may:

  • not recognise food
  • have reduced appetite
  • be unable to feed themselves due to weakness
  • have an inability to coordinate movements to transfer food from plate to mouth.

Parkinson’s disease

Residents who experience “on off” periods will eat and drink more safely during the “on” phase of their medications.

Motor neurone disease

Swallowing difficulties may be an early symptom of MND. They can cause weight loss and malnutrition significantly reducing quality of life. People living with MND may have feeding tubes inserted to ensure adequate nutrition.
Excess production of saliva (sialorrhoea) is a common symptom with MND. When combined with swallowing problems, this may result in drooling. This can be difficult to manage discretely and also reduces quality of life.

Stroke

Dysphagia is very common in the acute phase of a stroke. While symptoms often resolve within the first month after a stroke many people experience permanent difficulty. Pneumonia is also common following a stroke, and may account for 35% of post stroke deaths. It is thought that dysphagia and subsequent aspiration is the major cause of post stroke pneumonia. [1]

 

Related Evidence

RAC PubMed Dysphagia Search

  1. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7(1):287-98. Epub 2012 Jul 30.
  2. Kayser-Jones J, Pengilly K. Dysphagia among nursing home residents. Geriatr Nurs. 1999 Mar-Apr;20(2):77-82; quiz 84.
  3. Cichero JA, Heaton S, Bassett L. Triaging dysphagia: nurse screening for dysphagia in an acute hospital. J Clin Nurs. 2009 Jun;18(11):1649-59.

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Last updated 30 January 2017