Minimizing risks, maximizing quality of life for residents
By Bushra Hashmi, RD
Canada’s aging population is expected to contribute to a continued rise in cases of dysphagia, according to a paper published in the Canadian Journal of Dietetic Practice and Research. If not treated and diagnosed in a timely manner, dysphagia can lead to aspiration, malnutrition, dehydration, and reduced quality of life.
Dysphagia is characterized by difficulty swallowing solids, liquids, or both, and is classified as either oropharyngeal or esophageal. Oropharyngeal dysphagia involves difficulty starting a swallow when the brain cannot properly coordinate with the tongue, which may cause a person to hold food in the mouth or forget to chew. Esophageal dysphagia involves difficulty moving food into the esophagus and may feel like food is stuck at the base of the throat.
According to the Canadian Institute for Health Information, 69 per cent of residents in Canadian long-term care homes have dementia, and 87 per cent experience some degree of cognitive impairment. As dementia advances, it can contribute to dysphagia and raise the risk of choking, pneumonia, and malnutrition.
In fact, oropharyngeal dysphagia affects an estimated 84 per cent to 93 per cent of people with moderate to severe dementia.
In long-term care facilities, the entire health-care team should be aware of any difficulties a resident has with eating, drinking, or taking medications. This team includes nurses, dietitians, physicians, speech-language pathologists, occupational therapists, care aides, and food service staff.
Causes and symptoms
Dysphagia is caused by neurological disorders, stroke, Parkinson’s disease, structural issues (tumors, strictures), aging-related changes and cognitive disorders.
Signs and symptoms to monitor for dysphagia are coughing, drooling, difficulty chewing, sensation of food “stuck” in throat, wet or gurgly voice, and choking while eating. Aspiration can cause pneumonia, fever, shortness of breath, and in rare cases death.
Beyond the physical difficulties, some of the symptoms such as choking can cause emotional distress on both the resident and care provider.
Managing dysphagia
In long-term care facilities the goals of dysphagia care vary based on each resident’s preferences and involve balancing potential interventions with their likely benefits.
Management strategies may include diet modifications, postural adjustments, oral care, and feeding techniques to help residents eat and drink safely.
Regardless of what strategy is undertaken, it is important to note that the primary aim of any dysphagia management protocol is to maximize quality of life while minimizing risk and discomfort. Goals of care should be discussed with the resident, family, and interdisciplinary team, and reviewed regularly as the disease progresses.
Fraser Health provides a decision support tool to guide dysphagia assessment, along with forms for managing swallowing difficulties in long-term care facilities.
A major challenge in dysphagia care is the limited availability of trained personnel to assess and manage swallowing disorders. More resources and professional training are needed to support effective dysphagia assessment and care.
Qualified dysphagia professionals, including speech-language pathologists, occupational therapists, and registered dietitians, can provide expert assessment and management of swallowing disorders.
Safe swallowing in older adults living in long-term care depends on timely dysphagia diagnosis and the appropriate use of texture-modified diets and fluid consistencies.
In long-term care homes, registered dietitians assess each resident and recommend modified diets and fluids based on individual needs to help prevent dysphagia-related complications. These interventions support hydration and nutrition while lowering the risk of choking and aspiration.
Bushra Hashmi has been a registered dietitian for over 19 years and holds a Master of Science in Food and Nutrition. She is the CEO of Nutrasmart Clinical Services, where she provides clinical services in long-term-care facilities across British Columbia. She has participated in various research studies, including work on the role of protein in muscle strengthening among the geriatric population, and the effects of vitamin D supplementation in seniors affected by COVID-19. More recently, her work has focused on the management of dysphagia in seniors living in long-term care, using evidence-based approaches to texture-modified diets and fluids. Her primary goal is to maximize quality of life while minimizing risks and discomfort for residents.