Posted by ProPortion Foods Blog on Aug 28, 2019 in Dysphagia
Globally, for the first time, there are more people over 65 than under five years of age. Living longer can have several impacts on health and wellbeing, including dysphagia – which refers to any failure in the act of swallowing.
The condition can occur at any age but is most common with aging, affecting up to one in five community-dwelling older adults and around half of those living in aged care facilities.
A team of health professionals helps to manage dysphagia and navigate individuals through the act of safe swallowing and recovery, with speech pathologists at the helm and dietitians on board to carefully monitor a patient’s ability, progress and nutrition status.
In addition to innovations in feeding aids, other technological advancements promise to help with dysphagia treatment and management.
One targets remote treatment. The global demand for dysphagia services exceeds the number of available speech pathologists, and poses particular difficulties for people in rural areas. In line with rapid technological advancements, researchers have proposed that telerehabilitation could draw on progress in telehealth to help fill this gap.
First, more research needs to examine the feasibility and effectiveness of telerehabilitation for dysphagia diagnosis and treatment. Various practical, legal, policy and financial challenges also need to be overcome, an issue that American experts are addressing in the United States as the telehealth movement gains traction as a potentially viable option.
To test the feasibility of telerehabilitation in Australia, researchers from the University of Queensland piloted adapted remote clinical swallowing examinations to assess aspiration risk and clinical management of people with dysphagia via web conferencing. They found high levels of agreement with face-to-face examinations and identified technical, personal and training factors that will help facilitate this form of clinical management.
Overall, they concluded, “The current evidence provides a strong initial evidence base for supporting the use of telerehabilitation in the management of patients with dysphagia. This work will be integral in the process of establishing new models for dysphagia services, designed to enhance access to speech pathology services for more patients in the future.”
In this report The Future of Dysphagia we outline the problem, evolving solutions and technological advancements in the area.
Nearly one million Australians over 70 are taking five or more medicines every day, and this number is continuing to grow, researchers from the Universities of Western Australia and New South Wales have revealed in the Medical Journal of Australia.
Using multiple drugs together, especially five or more, can produce several adverse outcomes including side effects, dysphagia, nutritional deficiencies, impaired cognition, falls, hospital admissions and mortality.
In fact, the World Health Organisation has set a target to halve polypharmacy and other unsafe prescription practices as part of its third global patient safety challenge to reduce medication-related harm.
Older adults tend to have several chronic conditions and often take different drugs to reduce the symptoms and risk of complications. People with higher needs, hospital inpatients and aged care residents tend to take the most meds.
Drawing from a nationally representative sample of people eligible for PBS-listed drugs between 2006 and 2017, Dr Amy Page and co-authors found that the prevalence of polypharmacy grew by nine percent.
And because of population growth, there was a 52 percent increase in the number of people taking five or more medicines a day over that period. In community care, the number of older adults receiving medications has grown rapidly, doubling over the past 20 years.
The researchers say these estimates may be conservative, because they don’t factor in medicines and supplements obtained without a prescription.
Some medicines stopped being subsidised and would also have not been recorded; this may account for the fact that medication use started to decline again after 2016 – although it was close to one million in 2017.
It must also be noted that some drugs are being combined to reduce pill burden, and this should be factored into future investigations.
The researchers report that Australia’s polypharmacy rates are higher than the US or the UK and have been for some time.
While some medications may be necessary for older adults, there is widespread concern about inappropriate polypharmacy and its detrimental outcomes.
Professor Sarah Hilmer from the University of Sydney is one advocate for “deprescribing” unnecessary drugs – noting that some are used as preventative measures and are not even addressing an existing condition.
Sometimes people continue taking drugs into old age when they no longer need them. “Compounding this,” says Hilmer, “is the issue of the prescribing cascade – doctors prescribing a drug to treat the effects of another drug to treat the effects of another drug, without realising they are doing so.”
Her team is working on written resources for consumers as well as doctors.
Dr Page agrees, saying that strategies to improve people’s awareness about the potential risks in taking several medications should target both the public and health professionals.
Posted by ProPortion Foods Blog on Aug 14, 2019 in Uncategorised
The act of swallowing recruits more than thirty different nerves and muscles to move food and liquid down the correct channels from mouth to stomach.
Dysphagia refers to any failure in the act of swallowing. It can range from mild to severe, acute to chronic, and short- to long term, and result in unintentional weight loss, malnutrition and dehydration, social and psychological challenges, complications with other conditions, and, more seriously, life-threatening problems like choking, suffocation and lung infections or pneumonia.
Dysphagia can involve problems with any part of the process, including sucking, chewing, swallowing food, drinks, medication or saliva, and preventing substances from entering the airway and lungs.
It can also include difficulty keeping the lips closed to hold food, liquid or saliva inside the mouth. Further down, if oesophagus valves are weakened, food, drink and stomach acid can come back up.
The most common form is oropharyngeal dysphagia – difficulty with the reflexive act of swallowing itself which involves moving food or liquid from the mouth through the pharynx and into the oesophagus. The other main type is oesophageal dysphagia, which produces the feeling of food being stuck in the throat or chest and possibly chest pain.
The most frequent causes of dysphagia are neurological disorders including stroke, dementia and Parkinson’s disease. Other triggers include head injury, motor neuron disease, depression, chronic obstructive pulmonary disease, frailty, cancer and postoperative problems involving the head and neck.
Weakened muscles and sarcopenia can also impact swallowing. Pills themselves – which 40% of adults find hard to swallow – can cause dysphagia through medication side effects.
Posted by ProPortion Foods Blog on Aug 6, 2019 in Uncategorised
Imagine a cold, neon-lit food hall and the noise of chairs scraping loudly on the floor, the echo of clunky knives and forks and drab-looking slop served in plastic containers.
Contrast this with a warmly lit dining room with soft, melodic music in the background, the smell of cooking wafting from the kitchen, soft carpet underfoot and a colourful, tasty-looking smorgasbord of food options.
Engaging people’s five senses with pleasant stimuli can be very pleasurable and even therapeutic. It can also make a huge difference to the aged care dining experience.
Why is this important? First and foremost, because one in three older adults are silently suffering from malnutrition.
Improving the flavour – and nutrition content – of food served to older adults is an obvious imperative. Enhancing the sensory experience at mealtimes can further improve appetite and people’s desire to prolong the meal experience.
As celebrity chef Heston Blumenthal wrote, “We eat with our eyes, ears, nose, memory, imagination and our gut.”
Even when it comes to the food itself, aged care gets a very bad report card.
For instance, an analysis of unsolicited aged care correspondence just four years ago, after Maggie Beer launched her foundation to improve the situation, identified some unappetising themes around food provision.
The food itself was perceived as poor quality, and it caused distress and feelings of powerlessness for staff and families. Some constraints to serving better meals included restrictive food safety rules, inadequate budgets, poor employee attitudes and under-skilled kitchen staff.
An overwhelming need to address these problems and change food culture emerged.
A more recent Four Corners report exposed similar issues, including examples of poor quality food and people who couldn’t feed themselves being left hungry.
Australia’s interim report of the Royal Commission into Aged Care Quality and Safety is due by the end of October and the final report on 30 April 2020. But with so many problems to address, its terms of reference don’t even address mediocre food and dining.
This hasn’t stopped some organisations from forging ahead.
The Lantern Project, for instance, was “borne of the need to improve the quality of life of older adults through the joy of food”.
A national collaboration that hosts monthly meetings on the Gold Coast and webinars, it has 500 members from aged care across Australia.
Some of their initiatives include an app to capture stories that identify food service priorities, a video series, “Little Things”, to showcase innovations in food service and “The Lantern Approach”, a set of guidelines to improve aged care dining.
They have published 11 papers, and three working groups are exploring “dining experience”, “legal and quality food issues” and “food activities connecting generations”.
The Maggie Beer Foundation, of course, is another organisation working hard to make a difference, and improve the experience as well as the food.
Innovations don’t have to be as fancy as Michelin-starred chef Paco Roncero’s restaurant in Ibiza that projects emotive 360-degree images around the room and uses scent diffusers and a speaker system to supplement its elaborate 20-course meals.
However, some interesting research can offer insights into making small adjustments. For instance, food from a round plate tastes “sweeter” than from a pointy plate, which can make it taste more bitter.
Another study found that high-contrast blue plates and glasses increased food consumption by 25% and liquid intake by 84%. Red plates, on the other hand, are off-putting.
Ultimately, though, a warm, friendly environment with pleasant, familiar sights, smells and sounds served with tasty, nutritious food is enough to considerably improve people’s health and quality of life into old age.
Swallowing is a deceptively complex act that people do without thinking nearly a thousand times a day – not just when eating and drinking, but also during every waking minute. With ageing, many people develop varying degrees of difficulty swallowing. Not only does this interfere with enjoying foods and drinks, but it has a host of other ramifications for health and wellbeing.
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