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.
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.