Dysphagia is a shockingly common issue. It frequently affects between 50 and 74 percent of care home residents; not to mention countless individuals suffering from a variety of neurological disorders, such as Parkinson’s disease, and even many young children.
Regardless of age or mental state, dysphagia is a frequent cause of preventable death due to an overall lack of understanding and capability of those within the healthcare, residential care and childcare sectors.
I have been working in this field of study for more than 30 years. As such, I have developed a passion for the importance of understanding dysphagia and have worked tirelessly to improve the quality of life of those living with the condition.
Below I have detailed exactly what dysphagia is and the ways in which it should be handled safely and sensitively.
What is Dysphagia?
To put it simply, dysphagia means difficulty swallowing. The condition has varying degrees of severity, from those with minor issues when it comes to eating and drinking, to those who are completely unable to swallow, or are unable to do so safely.
Problems with the structures or the neural control involved in any part of the swallowing process can result in dysphagia. A stroke, or separate disorder of the nervous system, can make it much more difficult for an individual to swallow safely.
If the tongue, cheek or throat muscles are weak, this can also result in difficulties chewing or moving the food, drink or saliva toward the stomach.
The leading issues associated with dysphagia, aside from the anxious or depressive state this potentially debilitating condition can lead to, are the physical problems.
Not only can it cause an inability to take in enough fluids and calories to effectively nourish the body; there are also the dangers of choking or aspiration at play.
Awareness and education
According to the National Patient Safety Agency ‘more than 60,000 people die annually from complications related to dysphagia’.
This makes it the sixth leading cause of death in the USA. Due to its frequency and potential severity, those working in the elderly care sector should be totally prepared to assist with anyone suffering from swallowing difficulties. Unfortunately, this isn’t currently the case for everyone.
To help healthcare workers gain a full understanding of the intricacies of the condition and prevent unnecessary deaths, education is key.
I have assisted in the creation of a comprehensive set of courses on dysphagia that has been researched and put together for health care workers and nurses.
These are due to be available from the learning management system myAko shortly, thoroughly detailing everything care staff must be aware of in order to effectively identify, support and care for individuals with swallowing difficulties.
There is currently a substantial waiting list of those seeking an appointment with a speech and language therapist, a list that has only increased since the outbreak of Covid-19.
Technology presents an opportunity for the NHS to reduce current waiting lists, as nurses and carers can complete the online training and support SLTs to undertake remote assessments, utilising technology like teleswallowing, ultimately improving early diagnosis and treatment.
The first stages of the education process for healthcare workers is understanding the five stages of the swallowing process and acknowledging how a single problem can lead to more serious complications. Recognising the severity of the issue can encourage people to start looking out for signs that people are suffering.
There are multiple, clear ways dysphagia can be identified in residents. Firstly, it may be reported by the individual themselves, or their families. Alternatively, you may notice a change in the individual’s behaviour around mealtimes.
This may display as food refusal, or noticeable difficulty when they attempt to chew or swallow their food or drink. Less obvious, but still notable, indications of dysphagia can include food and drink being left in the mouth after swallowing, or perhaps just a particularly long time between starting and finishing their meal.
If swallowing is an ongoing issue, the individual may even experience weight loss.
Equally, staff should also be mindful of aspiration. This symptom is far more obvious and can include constant coughing and throat clearing, sweating, eye watering and the individual’s face turning red.
Should aspiration continue over a prolonged period of time, individuals are likely to experience dehydration, weight loss, frequent chest infections, or even pneumonia.
It’s essential that care staff are able to screen for dysphagia as efficiently as possible, as any delay may have detrimental effects. In fact, delays in dysphagia screening have been associated with a one percent increase in stroke-associated pneumonia.
With all of the above in mind, it should be considered imperative for anyone in a position of care to have a comprehensive understanding of dysphagia and all that can be done to minimise the risks.
Aside from the possibility of death, swallowing difficulties can also have a huge impact on an individual’s emotional and psychological wellbeing, making it the duty of a care worker to do all they can to ease this struggle.
Dr. Elizabeth Boaden is a Fellow of the Royal College of Speech and Language Therapists.