Gettyimages 171591290.jpg Swallowing .jpg Resized

Eating is a basic function of life that is often an enjoyable experience most residents look forward to. Unfortunately, for many residents eating can pose challenges due to swallowing difficulties caused by dysphagia. Dysphagia is defined as difficulty or discomfort while swallowing. Early identification of residents at risk for or currently affected by dysphagia is crucial in the safety, well-being, and overall quality of life for long term care residents.

According to research, up to 68% of older adults in nursing homes are affected by dysphagia. Between 300,000-400,000 individuals in the U.S. are diagnosed with dysphagia each year. This is a wide-spread issue that long-term care workers need to be aware of and screen for early on to prevent further complications that may occur.

There are several factors that can contribute to increased risk for dysphagia. These include:

  1. Aging – there is direct correlation between increasing age and increased risk of dysphagia
  2. Low body weight & decreased muscle mass – inverse correlation with risk of dysphagia; lower body weight/decreased muscle mass, increased risk of dysphagia
  3. Cognitive impairment – Alzheimer’s disease, Parkinson’s disease, dementia
  4. Head and neck cancers, stroke, impaired esophageal physiology
  5. Malnutrition

Just as malnutrition screening is a vital tool in nutrition assessment, dysphagia screening is equally important. Screening for both malnutrition and dysphagia should be routinely performed in long-term care, in order to provide residents the best care for their individual needs. Those with dysphagia have a higher risk of nutritional deficits and/or are already malnourished, making it all the more important to identify those at risk or diagnosed with dysphagia.

Individuals at risk for or diagnosed with dysphagia are additionally at a higher risk of infection, malnutrition, respiratory/other complications, extended length of stay, increased costs & labor, and increased risk of mortality. All this to say, identifying those at risk for dysphagia early on will benefit both the resident, as well as the facility.

When new residents are admitted to the facility, it is important to immediately identify what diet order they were admitted with, if they have a diagnosis of dysphagia, if they have any other diagnoses that put them at higher risk for dysphagia (see list above), and if they have a prior history of chewing or swallowing difficulties. Upon admission, quickly and effectively communicating the resident’s diet order to the dietary staff is vital to ensure the proper diet is given. Additionally, consulting your facility’s speech therapist or registered dietitian for further evaluation can help prevent choking/aspiration incidents from occurring.

Continuous screening of residents throughout their time at the facility is equally important. Knowing what signs and symptoms to look for can help staff to identify someone who may be at risk or suffering from dysphagia. The signs and symptoms to look for include:

  1. Regurgitation
  2. Tracheobronchial aspiration
  3. Retrosternal pain
  4. Coughing
  5. Diminished lung sounds
  6. Gurgling while talking or breathing
  7. Pyrosis
  8. Hoarseness
  9. Choking
  10. Hiccups

If staff observe a resident displaying any of the above symptoms, immediately remove the food/fluid they are having difficulty with, document the incident, inform the appropriate management per your facility’s protocol (including the dietitian), and refer speech therapy for evaluation. Nursing staff have the ability to downgrade a resident’s diet as needed, when they are not tolerating their current diet.

All in all, dysphagia is a prevalent issue particularly in long-term care. It is something staff should be continually screening and monitoring for in order to reduce complications, costs, mortality, and improve overall quality of life for residents.

Resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995555/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426263/