Assisted Living, News, Skilled Nursing Facility

Individualized strategies for managing dysphagia

Editor’s note: This post is an excerpt taken from the full article published in the August issue of PPS Alert for Long-Term Care. Not a subscriber? Sign up today!

The act of swallowing, for those who do not have difficulty with it, can feel like second nature. But when this ability starts to diminish—a common symptom of aging—affected individuals are forced into a world where things that are necessary to survive, such as food and water, pose potentially life-threatening challenges. Studies show that approximately 53%–74% of long-term care facility residents have dysphagia.

Medicare defines dysphagia as a disorder that:

can cause food to enter the airway, resulting in coughing, choking, pulmonary problems, aspiration or inadequate nutrition and hydration with resultant weight loss, failure to thrive, pneumonia and death. It is most often due to complex neurological and/or structural impairments including head and neck trauma, cerebrovascular accident, neuromuscular degenerative diseases, head and neck cancer, dementias, and encephalopathies. For these reasons, it is important that only qualified professionals with specific training and experience in this disorder provide evaluation and treatment. (Medicare Benefit Policy Manual, Chapter 15)

“Dysphagia in the geriatric population deserves more focus in all avenues,” says Renee Kinder, MS, CCC-SLP, RAC-CT, director of education for Encore Rehabilitation Services in Louisville, Kentucky. “These avenues include prevention, risk factors, early identification, treatment options, options for individual choice, and diet options for individuals who present with dysphagia.”

Karl Steinberg, MD, CMD, a longtime nursing home medical director who chairs the Public Policy Committee for The Society for Post-Acute and Long-Term Care Medicine (AMDA), believes identification and treatment of dysphagia will become increasingly important for multiple reasons. “We will continue to care for more residents with dementia-related dysphagia, and this population can be a challenge. Educating both health care providers and residents’ families to improve their quality of life and create realistic expectations is critical,” he says. An additional reason for excellent diagnosis and care for residents with dysphagia relates to liability, says Steinberg. “We are seeing more nursing home negligence lawsuits involving allegations of aspiration pneumonia related to inappropriate feeding. Helping people understand that modified diets and feeding tubes do not prevent aspiration can be a great risk management tool.”  Providers can help residents by recognizing the many signs and symptoms of dysphagia. These include:

  • Difficulty controlling liquids and secretions in the mouth, drooling, or food falling out of the mouth
  • A wet or gurgly-sounding voice
  • A weak voice in combination with other signs or symptoms
  • Taking a long time to begin a swallow
  • Swallowing several times for a single bite of food
  • Food leaking from the mouth or nose
  • Frequent throat clearing
  • Lack of a gag reflex
  • Weak cough before, during, or after a swallow
  • Coughing or choking on food, fluids, or saliva
  • Pocketing food
  • A feeling of fullness, tightness, or pain in the throat or chest when swallowing
  • A sensation of food or saliva sticking in the esophagus or sternal area
  • Feeling as if a foreign body or “lump” is sticking in the throat
  • Drooping appearance of the lower face in combination with other signs or symptoms
  • Asymmetrical appearance of the face in combination with other signs or symptoms
  • Spitting food out or refusing to eat
  • Recurrent upper respiratory infections or persistent low-grade fever
  • Unintentional weight loss
  • Signs and symptoms of abnormal or inadequate nutrition or malnutrition