About difficulties with eating and drinking
Swallowing difficulties can occur in the oral stage or the pharyngeal phase of swallowing.
The stages of swallowing
- Oral phase (difficulty chewing and controlling food in the mouth)
- Pharyngeal phase (difficulty triggering and safely completing the swallow)
Symptoms of swallowing difficulties include:
- A sticking sensation
- Fatiguing during meals/while eating
- Difficulty starting to swallow
- Difficulty chewing
About dysphagia management
Dysphagia may require ongoing management as the disease progresses. Assessing dysphagia usually consists of a Speech Pathologist taking a full medical history; discussing with family members or other staff members regarding current eating patterns or difficulties; assessing the nerves and muscles required for swallowing; observing the person eating and drinking a range of different textured food and fluids; and, where deemed necessary, referring the person for a scan of the swallow – known as a Modified Barium Swallow (1). Management should include education for the person with Dysphagia and their family and friends to ensure the whole team is equipped to support optimal management.
Dysphagia is significant for a number of reasons. Swallowing problems can lead to complications including:
- Poor nutrition
- Reduced enjoyment of meals (which is a major factor in social interactions and a means of pleasure for many individuals).
- Lung infections caused by swallowing “down the wrong pipe” into the lungs (aspiration pneumonia). (Note: Aspiration pneumonia is a potentially life-threatening lung infection caused by breathing in a foreign material like food, liquid, or bacteria-infused saliva that is pathogenic to the lungs and where the patient’s natural resistance to the material is compromised.
Langmore (2) suggests that the following factors should be considered in establishing the risk of aspiration pneumonia:
- Being fed by another person
- Having another person help with cleaning the mouth
- The number of decayed teeth, tube feeding
- Having more than one medical problem
- Taking multiple medicines
Treatment strategies are personalised to meet the needs of each individual (1). Treatment and management options may include:
- Modifying the thickness of drinks to increase control of fluids.
- Mincing or softening food textures.
- Reducing the size of mouthfuls taken at a time.
- Adjusting seating and utensils for eating (in conjunction with occupational therapy and physiotherapy recommendations).
- Allowing extra time for meals.
- Specific rehabilitation exercises for swallowing as specified by the treating Speech Pathologist
Clinicians working with patients with swallowing problems should carefully consider treatment options. It is important to use a holistic approach that ensures overall health, hydration, nutrition and that social factors are also considered.