Doctor's Review: Medicine on the Move

December 15, 2017
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Hard to swallow

Swallowing disorders affect all ages. Children with developmental disorders, cerebral palsy, cleft lip and palate, and various neurological disorders can suffer with dysphasia. In adults, up to 73 percent of stroke patients can have dysphasia.(1) Older individuals are also at risk of having difficulty chewing and swallowing their food.

Dysphasia can impact a person’s nutritional status and long-term health and recovery. One study actually suggests that the malnutrition caused by the difficulty in chewing and swallowing food can worsen a condition.(2)

Dysphasia is a risk factor for the development of malnutrition.(3) Studies suggest that 35 percent of Canadians over the age of 65 have vitamin and mineral deficiencies while up to 65 percent of hospitalized elderly are malnourished.(4)

The team that assesses and makes recommendations for a patient with swallowing disorders can include a primary-care physician, a speech-language pathologist, an occupational therapist and a dietitian.(5)

An integral part of the physical exam is to observe the patient swallowing. Have the patient drink some water and observe them for over a minute to see if they cough. This simple test could screen for people who have dysphasia while they wait for accurate imaging tests. Once the assessment is complete, the appropriate dietary modification can take place.

The texture of both solid and liquid foods needs to be addressed. It can be difficult to swallow liquids and dehydration can become a problem. Adding a commercial thickener to liquids can help. When introducing thickeners to the diet, add them slowly and keep adjusting to reach the correct consistency. If a patient is hesitant to continue using the thickener, suggest another brand. A study of 43 patient using thickeners showed that all the participants found at least one type of thickened beverage as having an acceptable taste.(6)

Typically, the texture of the food also has to be modified. The diet can progress to various stages ranging from soft to puréed foods.(7) While consistency is important, it’s also essential that the food tastes and looks good.(8) One can buy puréed food that’s shaped to look like “regular” food. Obviously, some patients may eventually need enteral feedings if they are unable to swallow.

Setting the stage for mealtimes is also important. Some clients find it easier to swallow when they’re sitting at an angle or with their head tilted. It’s also important to allow adequate time to eat slowly at each meal.(9) Another small change that can have an impact is how the meal is served. Ultimately, many small changes will go a long way to encouraging a patient to eat more and maintain their nutrition status and quality of life.

This article was accurate when it was published. Please confirm rates and details directly with the companies in question.

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