Â What is Dysphagia
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Dysphagia is a swallowing difficulty. Swallowing is a complex and rapid process involving voluntary and involuntary movements. There are 26 muscles and six cranial nerves involved. Impairments in any of these or their central control structures can lead to dysphagia. Swallowing difficulties are common in the elderly population as well as those with neurological disorders. Neurological disorders which can cause swallowing difficulties include Parkinsonâ€™s disease, Multiple Sclerosis, Huntingtonâ€™s disease, Motor Neuron Disease, Stroke and Dementia.
Adverse effects of dysphagia if left undiagnosed can result in dehydration, chest infections, weight loss, malnutrition and aspiration. Aspiration is the entry of food or fluid into the lungs and can result in pneumonia. â€œAspiration pneumonia is a major cause of morbidity and mortality among the elderly who are hospitalized or in nursing homesâ€ (Langmore et al, 1998). Prevention of aspiration pneumonia can reduce healthcare costs and improve health outcomes for patients (Langmore, 2002). â€œEarly diagnosis and effective management of dysphagia reduce the incidence of pneumonia and improve quality of care and outcomeâ€ (Rosenvinge and Ian, 2005).
HIQA (2009) standards and guidance on residential care for the older person recommends referrals to speech and language therapists on identification of signs of dysphagia for assessment and management. They also highlight the importance of staff training on safe feeding practices and education on identifying those at risk of nutritional and feeding problems.
Dysphagia often has a negative impact on the quality of life in the elderly community population (Chen et al, 2009). Therefore identification and management are of key importance.
Signs and symptoms of dysphagia include:
- Coughing when eating and/or drinking
- Recurrent chest infections
- Pocketing of food or fluids in cheeks
- Prolonged chewing of food
- Delay in swallow after placing food in mouth
- Reluctance to eat or drink.
There are four stages of swallowing: the oral prepatory stage, oral stage, pharyngeal stage and the oesphageal stage. The whole swallowing process, through all the phases, lasts eight to ten seconds.Dysphagia can occur at any of these stages. A speech and language therapist will perform a swallowing assessment to determine if the patient has dysphagia and at what stage of swallowing. Swallowing exercises, dietry modifications or postural manuvers or a combination of these will be made as appropriate.Â Severe dysphagia may render the patient unsafe for any oral diet and fluids and an alternative method of feeding must then be determined.
- Chen, P., Golub, J., S., Hapner, E., R. and Johns III, M., M. (2009) Prevalence of Perceived Dysphagia and Quality-of-Life Impairment in a Geriatric Population. Dysphagia. 24(1):1-6.
- HIQA (2009) http://www.google.ie/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CCgQFjAA&url=http%3A%2F%2Fwww.hiqa.ie%2Fsystem%2Ffiles%2FFood-Nutrition-Provider-Guidance.pdf&ei=JCQwU77WMsqS7QbHiIGYBg&usg=AFQjCNFvVht7PBtZNzbCVD5L8OwmHWKerw
- Langmore, S., E., Skarupski, K., A., Park, P., S, and Fries, B., E. (2002) Predictors of aspiration pneumonia in nursing home residents.17(4):298-307.
- Langmore, S., E., Terpenning, M., S., Â Schork, A., Â Chen, Y., Murray, J., T., Lopatin, D., Loesche, W., J. (1998) Predictors of Aspiration Pneumonia: How Important Is Dysphagia?Dysphagia. 13(2): 69-81.
- Perry, L. and Love, C., P. (2001) Screening for Dysphagia and Aspiration in Acute Stroke: A Systematic Review. Dysphagia. 16(1): 7-18.
- Rosenvinge, S., K. and Ian D. (2005) Starke Improving care for patients with dysphagia. Age Ageing. 34 (6):Â 587-593.
- Tai Ryoon Han, Nam-Jong Paik, Jin-Woo Park, Bum Sun Kwon (2008) The Prediction of Persistent Dysphagia Beyond Six Months After Stroke. Dysphagia. 23(1):59-64.
- Groher, M., E. and Crary, M., A. (2010) Dysphagia: Clinical Management in Adults and Children. Missouri: Mosby Elsevier.
- Marks, L. and Rainbow, D. (2001) Working with Dysphagia. Bicester: Speechmark.
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