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Recognising the signs of swallowing issues in older adults

Posted by ProPortion Foods Blog on Oct 9, 2019 in Dysphagia

Any failure in the act of swallowing is known as dysphagia.

 

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.

 

Signs to look for

 

signs to look for include coughing before swallowing, during or after eating, heartburn or reflux, drooling, frequent chest infections, storing food in the cheeks, taking a long time to eat, or reluctance to eat or swallow anything.

 

Changes in facial features, speech or voice, like slurring or gurgling, could indicate silent aspiration.

 

People who have experienced stroke are at high risk and should be immediately screened for swallowing problems before ingesting anything.

 

People with other high-risk medical conditions as outlined above should be asked if they have experienced any issues with swallowing.

 

 

What’s next?

 

It is very important to identify swallowing problems and their cause as early as possible.

 

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.

 

 

 

Want to know more about dysphagia?

 

Managing dysphagia – food and non-food approaches

Posted by ProPortion Foods Blog on Sep 11, 2019 in Dysphagia

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.

 

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.

 

 

Nutritional considerations

 

Dysphagia needs to be carefully managed in any patient, but older populations are of particular concern. Nutrition management is more important than ever to ensure the well-being of older adults, who are at increased risk of malnutrition. This can result from insufficient calories and macronutrients such as protein or micronutrients – vitamins and minerals.

 

To avoid malnutrition, food and liquid consumption needs to be optimised according to the patient’s needs. This may include adding nutritional supplements and providing fortified or nutrient-dense options – like adding milk powder or butter to food – while ensuring foods and liquids are at the correct level of texture-modification for the individual. By using one or more of these options, the risk of malnutrition can be significantly lowered and improve quality of life.

 

Because thin fluids are avoided for fear of choking, it is important to maintain good hydration, and watch out for signs of dehydration including dark-coloured urine, skin turgor and dry membranes.

 

 

Non-food approaches to treatment

 

Several strategies can help patients swallow, including postural adjustments, swallow manoeuvres, trained feeding assistance, adaptive feeding equipment like special cups, dishes and utensils, and a distraction-free environment.

 

Treatment for dysphagia includes medical, surgical and behavioural options. Interventions to rehabilitate the swallow function include sensory stimulation, biofeedback, electrical nerve stimulation and a range of different strengthening exercises.

 

Exercises are designed to target specific muscles involved in swallowing. These oral-motor treatments range from passive to more active. Examples include sliding up a pitch scale and holding a high note to elevate the larynx or holding the tongue forward between the teeth while swallowing (with no food or liquid in the mouth). There are other variations on targeting muscles while swallowing, like the “effortful swallow”, “supraglottic swallow” and “super supraglottic swallow manoeuvre”.

 

More physically, the “shaker exercise” involves lying down, raising the head slightly off the ground and looking at the toes for a few seconds, before putting the head back down. This is repeated few times, and the whole sequence three to six times a day. In the “hyoid lift manoeuvre”, the patient sucks up and moves up to 10 pieces of paper with a straw into a cup. These and other exercises are provided as part of an individual treatment plan.

 

 

 

In this report The Future of Dysphagia we outline the problem, evolving solutions and technological advancements in the area.

Telehealth for Managing & Monitoring Dysphagia

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.

 

 

Telehealth

 

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.

 

 

Testing the technology

 

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.
 

International dysphagia diet guidelines are here

Posted by ProPortion Foods Blog on May 1, 2019 in Dysphagia

Global guidelines to standardise dysphagia diets have finally reached Australia. The IDDSI framework, while not mandatory, came into effect 1 May, 2019.

 

Here’s a brief recap followed by insights into what to expect.

 

 

Why IDDSI?

 

Older adults are at high risk for swallowing difficulties, otherwise known as dysphagia. Estimates suggest dysphagia affects up to one in five older people living in the community and around half of those in assisted living facilities.

 

It’s a serious concern that can result in choking or suffocation if food or drinks go down the wrong way. Managing the condition, while some swallowing ability is still present, involves the use of texture-modified foods and thickened liquids.

 

The International Dysphagia Diet Standardisation Initiative (IDDSI) lays down food guidelines to ensure that people with dysphagia can eat safely.

 

Viscosity is tailored according to dysphagia severity, ranked from soft and bite-sized to pureed food, and thin to extremely thick drinks. Proportion Foods’ SmartserveTM passed the test last year when it was classified as Level 4 Puree.

 

Australia has used its own dysphagia diet guidelines since 2007, but research has grown since then.

 

IDDSI aims to standardise the terminology and testing of these rankings around the world, for people of all ages in all care facilities. Australia is joining more than 20 other countries including New Zealand, the US, Canada, and several European nations in implementing it.

 

 

Making the transition

 

It will take time and organisation for health care providers and institutions to complete the transition – in the meantime both old and new frameworks will both be used so it’s important to be familiar with each of them.

 

The Australian Standards for Texture Modified Foods and Fluids – to be phased out – classifies fluids as mildly, moderately and extremely thick and food as soft, minced and moist, and smooth pureed.

 

IDDSI categorises foods as regular, soft and bite-sized, minced and moist, pureed and liquidised. Drinks go from thin to slightly, mildly, moderately and extremely thick. Pureed and liquidised food overlap with extremely thick and moderately thick fluid, respectively.

 

It’s apparent when comparing these standards that there is some overlap between them. But it is important to note differences. For instance, Level 6 of the IDDSI, which aligns with Texture A – Soft Diet, specifies that foods must be in ‘bite-sized’ pieces.

 

To adopt the new guidelines, organisations will need to review and overhaul policy and documentation, educate staff (IDDSI workshops will support this), and review menu items.

 

All relevant team members – including speech pathologists and dietitians – and external stakeholders – GPs, local hospitals – will also need to be informed and involved in the process.

 

Speech Pathology Australia, the primary body for speech pathologists, has made a statement in support of the new guidelines that can be accessed on their website below.

 

The site also provides supporting material including information on old and new standards and educational posters.

 

References

 

https://www.leadingnutrition.com.au/getting-iddsi-ready-what-do-we-need-to-do/

https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Modified_Foods_and_Fluids_Terminology/SPAweb/Resources_for_Speech_Pathologists/Professional_Resources/Modified_Foods_and_Fluids_Terminology.aspx?hkey=822fd30c-b7d4-45c3-9071-a20a7b38bb52

https://iddsi.org/around-the-world/ 

The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/

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