Dysphagia is a Difficult Diagnosis to Swallow

By Carla Bartlett, Director of Speech and Language Therapy (Social Care) at Cygnet Health Care and Dominique St Clair Miller Director of Speech and Language Therapy (Health Care) at Cygnet Health Care (www.cygnethealth.co.uk)

The majority of us enjoy snacks, meals and drinks without much thought or effort, for some people living with dysphagia this can be a difficult and frightening experience, with potentially significant consequences on health and quality of life.

Imagine that every time you are invited out for a meal, you have to think about whether you will be able to chew and safely swallow the food on the menu. Imagine that you are told it is not safe for you to eat your favourite food anymore as it is considered “high risk” for choking.

Imagine that every time you are faced with eating food, you feel tense and fearful – you are terrified you might choke. You barely have an appetite anymore and over time, you lose weight when you don’t mean to. Imagine that every time you take a drink, you cough and splutter so you avoid drinking to the extent that you become dehydrated and experience frequent urine infections. This can be the reality for people living with dysphagia. This is the reality for 560 million people worldwide. At Cygnet Health Care, Speech and Language Therapists (SLTs) assess, diagnose, and formulate management plans to support individuals with different aspects of eating, drinking, feeding and/or swallowing difficulties. The ultimate aim is to ensure safer swallowing whilst balancing quality of life with individuals preferences and beliefs. Our SLTs will seek support from other health care professionals where necessary. They will also make recommendations based upon the difficulties an individual is experiencing.

Sometimes this will include positioning advice, adaptive equipment, specific oral motor / sensory exercises or swallow techniques and food and fluid texture modification. However, for others, simply managing the speed at which they eat or prompting them to take smaller mouthfuls and chewing for longer can be enough.

There are also lots of things you can do to create an environment that is safer for eating and drinking. Simple strategies like sitting upright, creating a calm environment, switching off the radio or TV and limiting conversation can make the difference for many individuals who require support.

It is important that we raise awareness of this life-altering condition and are alert to its signs and symptoms to ensure those diagnosed with dysphagia are able to continue living a full and fulfilling life.

FIVE FACT BOXES

1. What is Dysphagia?
Dysphagia is the medical name for difficulties in swallowing. Dyshagia puts a person at risk negative health consequences such as, aspiration, asphyxiation and/or choking, malnutrition and dehydration, which can all be life threatening. If these risks are not managed appropriately people are at high risk of poor health, hospital admissions and reduced quality of life.

Dysphagia is secondary to a primary condition such as neurological disorders e.g. stroke, Parkinson’s Disease, Motor Neurone Disease, Wilson’s Disease, head injury; head and neck cancer e.g. laryngeal cancer; disorders associated with the elderly; disorders associated with trauma e.g. smoke inhalation; tracheostomy; ventilator dependent individuals; and learning disability to name a few. Dysphagia can also be drug-induced e.g. side effects of medication, and arise as a result from the treatment of diseases e.g. radiotherapy.

Swallowing may become difficult because the muscles and nerves used for chewing and swallowing become weak or uncoordinated. Food or drink can ‘go down the wrong way’ into the lungs instead of the stomach. This could lead to serious conditions such as recurrent chest infections and aspiration pneumonia.

2. Signs, Symptoms and Characteristics
Dysphagia is associated with an increased morbidity, increased mortality and a reduced quality of life. People may experience the following signs, symptoms and characteristics which carry serious consequences:

• Coughing, throat clearing and/or choking when eating or drinking
• Repeated chest infections or those that require multiple treatments to clear
• Difficulty managing specific foods, textures or drinks e.g. excessive chewing, spitting food out, losing food from the mouth, food and drink remaining in the mouth after attempted swallows
• Refusal of food and drink
• Anxiety around mealtimes, food, drink or when eating and drinking
• Malnutrition e.g. losing weight, weak skin, hair loss
• Dehydration E.g. Constipation, strong urine, UTI’s.
• Reporting difficulties with swallowing medication

3. Statistics
Dysphagia can occur in all age groups. Swallowing difficulties can occur as a result of a wide range of conditions.

However, in the adult population, dysphagia affects:
• 95% of people with Motor Neurone Disease
• 65% of people who have had a stroke
• 50% of people with Parkinson’s Disease
• 68% of people with dementia living in care homes
• 15% of people with a learning disability
• Up to 19% of people with mental health illness, where there is a link between dysphagia and side effects of medication.

4. Top 10 Safe Swallowing Tips:
1. Sit upright when eating and drinking
2. Reduce distractions whilst eating and drinking
3 Avoid talking with food in your mouth
4. Eat slowly
5. Take small mouthfuls of food and fluid
6. Pause between mouthfuls of food and fluid
7. Avoid high risk foods
8. Swallow twice on every mouthful
9. Have small, more regular meals
10. Stay upright for at least 30mins after eating and drinking

5. High Risk Foods to avoid:
There are certain food textures which can be harder to manage if you have dysphagia. As part of the assessment process, Speech and Language Therapists will provide specific guidance on how to make eating and drinking enjoyable but safe experiences.

They will advise of any foods that may carry greater risks, these may include:
• Crunchy Foods: Crunchy Toast, Flaky pastry, Dry biscuits, Crisps
• Crumbly Items: Bread crusts, Pie crusts, Crumble, Dry or flaky biscuits
• Hard Foods: Boiled or chewy sweets, toffees, nuts, seeds, large pieces of tough/chewy meat
• Husks and Bread: Sweetcorn, Bread crusts, Granary bread, Baguettes
• Stringy, Fibrous Texture: Raw vegetables and salad items, onions, raw hard fruit, melted cheese, Pickled vegetables, Bacon fat, sausages
• Vegetable and Fruit Skins: Orange segments, grapes, tomatoes, apple, peppers, potatoes, beans, potato skins
• Mixed Consistency Foods: Cereals that do not blend with milk, mince with thin gravy, soup with lumps, soaked bread