This Policy defines the aspects of care to be followed when the service user has dysphagia in relation to eating and swallowing food and drink:
A: BACKGROUND INFORMATION:
1. Dysphagia refers to difficulties in swallowing, and if untreated in the service user can lead to malnutrition, dehydration, choking, and a general reduction in the quality of life. Some persons have difficulty in swallowing certain foods and liquids, while some cannot swallow at all.
2. Dysphagia can manifest itself through the following symptoms:
Swallowing difficulties (see 1. above)
Difficulty placing food in the mouth
Choking or coughing when eating or drinking
Bringing food back up, sometimes through the nose
A sensation that food is stuck in the throat or chest
Gradual and persistent, but unexplained, weight loss
Unexplained repeated chest infections
3. There are 2 types of dysphagia:
High dysphagia (oropharyngeal) - swallowing difficulties caused by problems with the mouth or throat.
Low dysphagia (oesophageal) - swallowing difficulties caused by problems with the oesophagus.
4. Dysphagia can occur as a result of the following conditions:
a single medical problem, such as a stroke
motor processing difficulties
oropharyngeal structural problems
central nervous system disorders
obstruction of the oesophagus through a growth, or narrowing of the oesophageal tube
poor oral health
mental health problems
side effects of medication
B: ASSESSMENT & TREATMENT:
1. The service user will be assessed by specialist therapists to determine the level of dysphagia being experienced. Assessments will focus upon the following and will form the basis of an appropriate Care Plan for treatment:
1.1 Nutrition and hydration, with particular emphasis on a healthy, balanced diet.
1.2 Historical problems with swallowing and / or choking, and whether the service user has a fear of choking. In particular, instances of regurgitation of swallowed food.
1.3 Food texture and preferred portion sizes; i.e. the need to cut food into manageable sized portions, or whether food needs to be pureed.
1.4 The rate at which the service user eats / consumes food. For example, eating too quickly (“bolting” the food) can cause swallowing difficulties.
1.5 The need for drinks or other liquids to aid the swallowing process; i.e. “washing down” the food.
1.5 Whether or not a level of assistance may be required to help the service user to eat. This will include identifying the need for specially adapted cutlery and utensils.
1.6 The service user’s medication regime, where possible side effects of some medicines may affect the ability to swallow.
1.7 Ergonomic considerations; i.e. where the service user takes his / her meals, and the postures adopted. For example, does the service user sit upright at a table, or are meals taken on a tray on his / her lap?
1.8 Ergonomic considerations, and levels of assistance that may be required for the physically disabled service user.
2. Treatment:
Treatment for dysphagia will depend upon whether the difficulty in swallowing occurs in the mouth or throat, or in the oesophagus. Treatment options include the following:
2.1 Swallowing Therapy, using the services of a speech and language therapist with specialist training in dysphagia, its causes and treatment options.
2.2 Dietary changes, using the services of a specialist dietitian who will be able to recommend changes in the service user’s diet, (for example, different food textures), and any assistance that may be needed with eating process.
2.3 Use of feeding tubes to by-pass the swallowing process. Feeding tubes are of 2 types; nasogastric tubes and PEG tubes:
2.3.1 Nasogastric tubes - for short-term use. The tube is passed through the nose and directly into the stomach.
2.3.1 PEG tubes - Percutaneous Endoscopic Gastrostomy. The tube is surgically implanted directly into the stomach, and is for longer-term use. See Policy No 3404.
2.4 Medication, used mainly for oesophageal dysphagia.
2.5 Specialised surgical techniques, e.g. endoscopic dilation, inserting a stent into the oesophagus, etc.
FORMS REFERENCES:
Form No: 3-400 Nutrition Risk Assessment
Form No: 3-402 Risk Assessment - Service User - Hydration
Form No: 3-412 Risk Assessment - Service User with Dysphagia
Form No: 3-413 Care Plan - Service User with Dysphagia