Clare Stevenson, Dysphagia Support Team Co-ordinator, Speech and Language Therapist, South Eastern Health & Social Care Trust, addresses dysphagia among the elderly population – and points out the proactive interventions which can help, such as devising a swallowing care plan.

On Christmas day your patient is with their family; surrounded by paper hats; corny jokes are shared and groaned at; and a feast is before them – succulent turkey, juicy ham, crispy roasties. Their mouth is watering, but they have dysphagia! Suddenly this is a bit more challenging, a little less accessible, maybe less enjoyable, and can provoke some anxiety.

Dysphagia is defined as an eating, drinking, or swallowing difficulty, estimated to affect nearly one-in-nine elderly people living independently in the community (1), and 50-to-75 per cent of nursing home residents. (2)      

People with a range of conditions experience dysphagia; if they have head and neck cancer, COPD, stroke, Parkinson’s, or dementia, among others, they are vulnerable to difficulties. So, dysphagia is all around us, though most of us take swallowing for granted.

Swallowing is controlled by cortical and brain stem areas, cranial nerves, and multiple muscles are needed to complete a swallow, not to mention sight, smell and taste, all crucial to our experience of eating and drinking. Things can go wrong at any stage, having a varied impact on swallowing.

Does Dysphagia Matter?

Dysphagia affects safety and wellbeing for some, leading to chest infections, pneumonia, choking and discomfort. It can also have a negative impact on a person’s quality of life and their family’s lives. Imagine Christmas dinner again and we can see easily how people with dysphagia can be affected socially, impacting connectedness to those around them and participation in situations that include eating and drinking with or around others.

As well as the safety issues, people with dysphagia may require additional support with nutrition and hydration.

What Can you do?

Dysphagia affects people all day, every day. As a healthcare professional you can play your part in helping someone to live well with dysphagia:

You can identify when there is a problem, signposting people for help from their local speech and language therapist (SLT)

You can reassure people about their swallowing care plan and help them understand their needs

You can support nutrition and hydration; this need not be complex, as a simple ‘Fancy a glass of milk or a snack?’ can be helpful, and following the swallow care plan if there is one

Checking on whether someone has eaten that day and if they have had enough to drink can support their wellbeing

You can also facilitate psychological wellbeing and inclusion in eating and drinking situations by building these actions into your relationship and interactions or creating these opportunities with others if you can

Other things that we take for granted can also be difficult for a person with dysphagia. Activities such as oral hygiene, which is important to reduce respiratory consequences of dysphagia, can be prompted and assisted if needed. Brushing teeth, tongue, inner cheeks, roof of mouth and gums are all important, even if the person has dentures

Dysphagia really is everybody’s business and you can make a difference!

How Can I Identify Dysphagia?

Ask yourself if you are observing or hearing about the following from the person you suspect may have dysphagia:

Coughing or choking when eating / drinking

Regular or recurring chest problems i.e. infections or changes in breathing when eating and drinking

Changes in voice when eating and drinking e.g. a ‘gurgly’ or wet voice when speaking

Swallowing appears to need a lot of effort

Needing lots of swallows for each mouthful

Food particles are inside the mouth after eating

High-risk behaviours when eating and drinking, such as cramming food in, not chewing, holding food in the mouth, eating or drinking very quickly

If you note any of these and are concerned, you may be seeing signs of dysphagia.

What Should I do if I am Concerned?

Seek advice from your SLT colleagues, usually based in health and care centres or in local hospitals, or speak to the GP. SLT assessment may be required to diagnose dysphagia and devise a swallowing care plan for the person with dysphagia.

What Might a Swallowing Care Plan Include?

The SLT will devise a plan with the person that may include recommendations for positioning, modified textures for food or fluids, supervision requirements, any rehabilitation or therapy aimed at improving swallowing, and use of any specialist equipment that increases swallowing safety. An important part of the plan is consideration of what matters most to the person with dysphagia.

What’s Exciting in Dysphagia Right Now?

In Northern Ireland the Public Health Agency is undertaking a regional programme taking forward several dysphagia priorities to develop systems, processes, and services for people living with dysphagia. This work has, and continues to, involve a wide range of health professionals working together with people who have dysphagia to achieve the project aims.

      More information about the project can be found on the Public Health Agency website by visiting www.pha.site/dysphagia.

      If you would like to understand more about dysphagia in general, you can find more information on the Royal College of Speech and Language Therapy website at

www.rcslt.org/speech-and-language-therapy/clinical-information/dysphagia.

References

1. Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M and Hamdy S Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus 2011, 24(7):476-80

2. O’Loughlin G, Shanley C. Swallowing problems in the nursing home: a novel training response. Dysphagia 1998; 13, 172-183