Dysphagia: A “Tough Pill to Swallow” for Caregivers and their Loved Ones

Presented by Novartis Nutrition

Swallowing is usually taken for granted. It is a reflex that is present before birth and stays with us throughout life. When swallowing becomes difficult or absent it is known as dysphagia, or more technically oral pharyngeal dysphagia.

Dysphagia affects up to 22% of people over 50 years old, and is usually a secondary problem or symptom of another disease or condition. It is found most often in people with neurological disorders such as stroke, Parkinson s disease, Alzheimer’s disease, ALS, brain injury, and even in those with head and neck cancer. The aging process itself produces a slower and less efficient swallow, and osteoarthritis of the spine and jaw along with the decreased muscle strength that occurs as part of aging can cause dysphagia, or make it worse.

The level of swallowing disability that occurs in dysphagia can range from minimal difficulty with certain foods and liquids to severe disability in swallowing anything without significant risk for choking. Poor oral intake leading to weight loss, malnutrition, and dehydration is common in people with undiagnosed or poorly managed dysphagia. Difficulty chewing and swallowing many foods and liquids that were previously enjoyed leads to reduced intake and can even result in the avoidance of certain foods and/or social situations where eating is the main focus. Choking is common and reduces the pleasure of eating with others.

Dysphagia is often undiagnosed until problems arise. In many cases, it is the patient or a family caregiver who first notices the problem. Common signs and symptoms of dysphagia may include any one or more of the following:

• Difficulty managing saliva
• Drooling of saliva or food
• Delay in swallowing while food or liquids are still in the mouth
• Coughing or choking before, during or after the swallow
• “Wet” gargly voice after the swallow
• Food coming out of the nose
• Complaints of multiple painful swallows
• Prolonged eating time/inability to finish a meal
• Food avoidance
• Weight loss
• Dehydration

Other “red flags” for dysphagia may include presence of:

• Mental confusion
• Garbled speech
• Acute or progressive neurological disease such as stroke
• Pneumonia, especially in the presence of a neurologic disease

Mealtime is a good time to observe these “red flags” and family caregivers play an important role in looking for them. Observation at other times of the day will also allow for picking up on potential swallowing problems with saliva. If symptoms are observed they should be discussed with the doctor as soon as possible. The doctor will then do a basic swallowing exam and most likely engage a therapist who specializes in dysphagia to diagnose and formulate an effective management plan.

Nutritional Management of Dysphagia

The good news is that dysphagia can be well managed with modifications to the texture and consistency of foods and liquids. Depending on the severity of the problem, many favorite  foods can be altered to provide textures that a person can chew and swallow more easily. Since thin liquids can be especially difficult for some people with dysphagia, instant thickeners and pre-thickened beverages are commercially available that can help you provide thicker-consistency liquids that are easier to swallow. In some cases, certain textures may need to be avoided entirely. The physician or swallowing therapist can direct you to a plan for using and purchasing these products. You can also contact a specialty medical food company for more information.

For more information, click on the links below:

www.DysphagiaOnline.com

www.novartisnutrition.com/us/articleDetail?id=3733

www.resource.walgreens.com