Posted on Friday, 24th April, 2020
Dysphagia continues to be a topic of great importance in Aged Care. We spoke to speech pathologists, Bernadette Dutton and Sophie Crouch, from Loqui in Queensland, who shared their insights and the latest findings on dysphagia.
There are three different types of dysphagia, which range from temporary to acute to chronic depending on the cause:
1. Temporary dysphagia
This is caused by things such as poor oral health and other medical reasons which, once healed, will improve or cure the swallowing issues.
2. Acute dysphagia
This is usually caused by poor health, such as a cold or flu, that impacts the body’s reflexes. It can be positively affected by improved nutrition and specific exercises. It is however common in those with dementia, which often means nutrition and exercises are a challenge.
3. Chronic dysphagia
This is usually the result of nerve impairment, such as a brain injury or stroke, and is usually a permanent condition requiring constant management.
Bernadette’s article How to Manage Dysphagia refers to the findings of numerous scientific studies including:
- Those with dementia will likely also suffer from dysphagia as dementia progresses.
- Nearly all those in advanced stages of dementia will also suffer from dysphagia.
- A large percentage of people with dementia are at a significantly higher risk of pneumonia, including aspiration pneumonia.
- Increased dependence on being fed by others (as dementia progresses) increases the risk of dysphagia and other problems.
- Early detection of dysphagia can reduce risks of malnutrition, dehydration, chest infections, aspiration pneumonia and choking.
- Failure to detect dysphagia has significant medical, emotional and social consequences.
Dysphagia as a result of dementia is more than just normal ageing-related bodily changes—it is complicated by the brain damage seen in dementia. It requires close monitoring for any improvement or decline so any necessary texture modifications can be made.
Dementia sufferers are least able to self-treat as they have trouble remembering instructions, and often have reduced awareness of food and drink in their mouth. Therefore, continuous education and training of Aged Care carers, including chefs, is essential.
Bernadette suggests the following key pieces of advice for Aged Care Chefs and carers:
- If fatigue is an issue, offer small amounts of food more frequently, eg. six smaller/mini-meals a day.
- Encourage snacking throughout the day (finger food).
- If drinking foods is easier than eating foods, offer more energy drinks or liquid food.
- Serve moulded or shaped minced and pureed meals to improve interest and recognition of the food being presented.
- Contrast colours to distinguish between food on the plate.
- Know each person’s mealtime requirements/preferences, and offer foods they enjoy at the right texture modification.
- Include residents in the meal planning and preparation, if possible.
Ensuring optimal nutritional intake and a safe and pleasurable mealtime experience for everyone with dysphagia is definitely a team effort requiring the skills of speech pathologists, chefs, food service staff and carers. Regular communication with and training for all care and kitchen staff is essential for staying up to date with information relating to dysphagia.