Developing a Care Plan for Dysphagia Management

Dysphagia: Diagnosis Authentic Ryan Nugent-Hopkins Jersey , Treatment and Controversies Health Articles | March 31, 2016
Have you ever swallowed and had food "go down the wrong way"? For an estimated 15-40% of adults over the age of 60 this is a constant concern. Dysphagia is simply defined as any difficulty or inabilit...


Have you ever swallowed and had food "go down the wrong way"? For an estimated 15-40% of adults over the age of 60 this is a constant concern. Dysphagia is simply defined as any difficulty or inability to swallow. It is not a disease, but a disruption of a normal process. Problems at any point during the swallow can result in difficulty swallowing. A person with dysphagia may have a delayed, incomplete or absent swallowing response. Potential causes include obstruction, nerve and muscle problems and miscellaneous issues such as trauma Authentic Sam Gagner Jersey , medications, poor dentition and poor mouth care. Dysphagia can have a dramatic impact on an older person's nutritional status including development of malnutrition, unintended weight loss, dehydration, and other nutrition deficits.


Warning Signs of Dysphagia


Dysphagia sometimes goes undetected because the signs and symptoms may be confused with other problems or conditions. Warning signs include:


路 Coughing Authentic Oscar Klefbom Jersey , gagging, choking, weak cough, frequent throat clearing or hoarse voice


路 Poor control of head, mouth or tongue


路 Difficulty chewing Authentic Markus Granlund Jersey , moving food around or pocketing food in the mouth


路 Delayed or absent swallow reflex


路 Complaints of food sticking in the throat


If signs of swallowing problems are identified, referral should be made to the appropriate health care professional(s) to screen for dysphagia and assess for problems with dentition, pocketing of food in the mouth, pooling of liquids, suspected aspiration Authentic Kailer Yamamoto Jersey , risk of unintended weight loss and malnutrition. The EAT-10: A Swallowing Screening Tool may be used for screening, and a bedside swallow evaluation may be completed to determine need for further testing.


Diagnosis and Treatment


Tests may include a fiber-optic endoscopic evaluation procedure (FEES test) or video fluoroscopic swallowing study. Diagnosis of the type of dysphagia depends on the origin of the problem:


路 Oral Dysphagia: Difficulty initiating a swallow due to difficulty chewing, manipulating food in the mouth or propelling food to the back of the throat.


路 Pharyngeal Dysphagia: The food bolus penetrates the larynx due to a delayed swallow reflex, incomplete closure of the larynx or residues remaining in the pharynx after the swallow.


路 Esophageal Dysphagia: Food does not move easily through the esophagus due to esophageal dysmotility, structural blockage Authentic Mike Smith Jersey , stenosis or strictures due to gastro-esophageal reflux disease (GERD).


Once the type of dysphagia is diagnosed, treatment goals include: promoting a safe swallow to reduce risk of choking andor aspiration of food and fluid into the lungs; maintaining good nutritional status and adequate hydration; facilitating independent eating and swallowing; enhancing the enjoyment of eating and quality of life.


The interdisciplinary team and the patient work together to determine the most appropriate strategies for each individual. Traditional treatment strategies include: swallowing exercises and techniques to improve ability to gather food particles together, thermal stimulation, changes in foodfluid temperature, good oral care to reduce aspiration pneumonia Authentic Alex Chiasson Jersey , alterations in food texture andor fluid consistencies, alternating sips of liquid with food, proper positioning to ease swallowing, close monitoring and intervention during meals and snacks, andor adaptive equipment such as modified cups or straws.


Controversies in Dysphagia Management


Puree or mechanical soft food or thickened liquids are often recommended to treat dysphagia and prevent aspiration pneumonia. The thought is that cohesive foods tend to be easier to control in the mouth and easier to swallow Authentic Kyle Brodziak Jersey , and thickening liquids slows the time it takes for the fluid to move through the mouth and esophagus and allows better control of the swallow. However, many experts now believe that evidence does not support diet modification for reducing aspiration pneumonia. Several studies demonstrate that positioning andor modification of dietary consistency or texture does not reduce aspiration events in persons with dysphagia. As a result, the standard of care for dysphagia management may be changing, especially for management of older adults in skilled nursing facilities.


Swallowing abnormalities are common in older adults but do not necessarily require modified diet and fluid textures, especially if these restrictions adversely affect food and fluid intake. Some individuals with dysphagia may request regular food andor liquids because they don't like the diet that is ordered. In nursing homes Authentic Milan Lucic Jersey , all decisions on texture and consistency-modified diets should defer to the person (andor family) after medical advice on the risks and benefits have been provided. If the individual andor the family refuse recommended treatment, the facility should document that they have educated the individual andor family, and request an adjustment of the physician's orders and care plan to honor informed choice.


Developing a Care Plan for Dysphagia Management


Even though the standard of nutrition care for dysphagia is changing, and new recommendations may be released in the future as new evidence is made available, texture modifications Authentic Brandon Manning Jersey , fluid consistency alterations, and proper positioning continue to be the standard of care for dysphagia treatment in many healthcare settings.