Swallowing difficulties: a prognostic signpost (original) (raw)
Related papers
Dysphagia is a Complex Problem
Dysphagia is a term that describes difficulty swallowing. Patients with dysphagia, in addition to the risk of pneumonia due to food and drink entering the lungs and infection, also have an increased risk of severe malnutrition and dehydration due to reduced food and fluid intake. Malnutrition itself additionally affects the deterioration of the loss of muscle function, the rehabilitation of the act of swallowing and increases the risk of infection.
Dysphagia, 2016
The oropharyngeal swallow involves a rapid, highly coordinated set of neuromuscular actions beginning with lip closure and terminating with opening of the upper esophageal sphincter. The central coordination of this complex sensorimotor task uses a widespread network of cortical, subcortical, and brainstem structures. Many diseases and disorders affecting the central swallowing network or downstream peripheral nerves, muscles, and structures may result in an impaired oropharyngeal swallow. In addition, aging is also associated with multifactorial changes of swallowing physiology for which the term presbyphagia has been coined. Oropharyngeal dysphagia broadly affects respiratory safety due to the increased risk of aspiration, and swallowing efficacy leading to the impeding danger of insufficient nutrition and hydration.
Disorders of Swallowing: Palliative Care
Otolaryngologic Clinics of North America, 2009
Dysphagia, or difficulty swallowing, occurs commonly, especially in elderly and debilitated patients. The exact prevalence of dysphagia is unknown, but some reports suggest that the prevalence could be as high as 22% in persons aged more than 50 years. 1 Approximately 10 million people are evaluated annually in the United States for swallowing difficulties. 2 Several studies conclude that between 300,000 and 600,000 individuals in the United States are affected by neurogenic causes of dysphagia each year. 3 Within the hospital setting, many persons experience dysphagia due to general weakness, debilitation, severe pulmonary disease, intubation, or a reduced level of alertness. These numbers clearly indicate a significant burden for treatment teams and patients alike.
Dysphagia. Part 1: General issues
Anaesthesiology Intensive Therapy, 2020
Swallowing disorders-such as aphagia, odynophagia and dysphagia are increasingly observed among patients in intensive care units (ICU). Aphagia means inability to swallow, and odynophagia means painful swallowing. Their most common causes are inflammatory or neoplastic lesions in the oropharynx, or the consequences of oncological treatment, e.g. radiotherapy [1-3]. Dysphagia is an abnormality in the swallowing process, i.e. ingestion of food, grinding it, and transporting it from the oral cavity through the oesophagus to the stomach. The severity of the pathology may vary depending on the aetiology. It can be caused by structural anomalies in the upper gastrointestinal (GI) tract or functional disturbances of the nervous and/or muscular systems [3]. Both the diagnosis and treatment of dysphagia require the cooperation of specialists in many fields of medicine. It seems that anaesthesiologists should be included in this group [3]. Dysphagia significantly worsens the patients' quality of life. It results in increased morbidity and mortality, mainly due to a higher risk of aspiration and subsequent aspiration pneumonia, as well as to difficulties in the intake of food and/or fluids by mouth, which leads to malnutrition [1]. Diagnosis and determination of the cause of dysphagia is crucial, and in many cases it offers the opportunity to treat and/or compensate for swallowing problems and thus reduce the risk of complications. The final effect of the therapy, however, is
Frailty, Swallowing and Dysphagia
Current Physical Medicine and Rehabilitation Reports
Purpose of Review This paper is a brief overview of the relationship between frailty, swallowing and dysphagia. Its goal is to explore the interplay between age and sarcopenia in the development of dysphagia, which is known to be linked to aspiration pneumonia. It is postulated that there is growing justification for routine screening for dysphagia in older frail people, to enable rehabilitation of swallowing through exercise and nutritional intervention, after a hospital stay. Recent Findings The global population is ageing, with a particular increase in the very old and frail. Frail people have a limited functional and physiological reserve and often have sarcopenia. Any subsequent insult (trauma, illness, medication change) frequently results in decompensation and the need for a hospital stay. Often, in these patients, there are changes in the biomechanics of swallowing that can cause impairment and dysphagia. But, many patients adapt the way they eat with subtle compensatory techniques, to bypass this difficulty. It is possible that many more people, than is currently evident, have undiagnosed dysphagia. Pneumonia and respiratory disease are common reasons for hospital admission in the frail elderly population. Dysphagia with aspiration is an important aetiological factor in pneumonia, which is a serious health concern with increasing age. Dysphagia may simply be a consequence of physiological decompensation, related to age, frailty and sarcopenia. Dysphagia is not systematically screened for and may not be identified in many older frail people who have adapted their swallowing, to accommodate their dysphagia. This may be a significant factor in pneumonia-related hospital admissions. Swallow rehabilitation, after such admission to hospital, is also rarely offered in the acute medical setting. This needs to change to reduce recurrent admission, morbidity and mortality. Summary The population is ageing. Sarcopenia, frailty and dysphagia are common with increasing age. Pneumonia is a common admission to hospital and often, aspiration secondary to dysphagia is a common cause. Proactive identification and intervention has the potential to reduce morbidity, hospital admission, length of hospital stay and mortality.
Balneo Research Journal, 2014
Swallowing is a complex process consisting in transporting food from mouth to the stomach; it involves voluntary and reflex activity of more than 30 nerves and muscles, requiring complex neuromuscular coordination and brainstem and cortical centers for controle. Dysphagia is defined as a alteration in the swallowing process, which cause difficulty in transporting saliva and aliments from the mouth trough the pharynx and esophagus into the stomach. It is a frequent symptom, affecting especially old people, people with neurological diseases, cancers of head and neck or severe reflux. Dysphagia can result from a wide variety of functional or structural deficits of the oral cavity, pharynx, larynx or esophagus, which could e caused by neurological conditions. Dysphagia carries serious health risks: malnutrition, dehydration, increase risk of infections. Effective dysphagia management requires an interdisciplinary approach; the goal of rehabilitation is to identify and treat abnormalities of swallowing while maintaining safe and efficient nutrition.
Understanding Dysphagia in Dementia: The Present and the Future
Current Physical Medicine and Rehabilitation Reports, 2015
Dysphagia is common in patients with dementia of varying types and often results in serious health consequences, including malnutrition, dehydration, aspiration pneumonia, and even death. Due to progressive cognitive and functional decline, patients with dementia experience difficulties throughout the eating process which encompasses all aspects of self-feeding and swallowing function. Variations in underlying neuropathology and disease severity may influence specific swallow disorders observed. New functional neuroimaging modalities offer exciting possibilities to increase understanding of neural control of swallowing that will lead to design of novel treatments. Current treatment approaches include a combination of compensatory strategies for swallowing, cueing from caregivers, and modifications to the dining experience that maximize independence during mealtime. A new focus on development of treatment regimens, possibly involving taste and smell receptor stimulation and rehabilitative exercise that may be implemented during the prodromal stages of dementia, is necessary to prevent or delay further swallowing decline.
Journal of the American Medical Directors Association, 2015
To evaluate influences of disease severity and food texture on prevalence and type of dysphagia in hospitalized geriatric patients. We screened for dysphagia in 161 geriatric inpatients with different forms of dementia and 30 control patients. Signs of aspiration were registered with 3 different food consistencies (water, apple puree, and slice of an apple) and the latency until the first swallow was documented. Geriatric department of an academic teaching hospital in Hamburg, Germany. Compared with the controls, patients with dementia more often showed signs of aspiration. In the patients with dementia, signs of aspiration occurred more frequently with water (35.6%) than with a slice of an apple (15.1%) or apple puree (6.3%). We observed an inverse relationship between Mini-Mental State Examination score level and the suspected rate of aspiration, as well as with the length of latency until the first swallow of puree. The prevalence of dysphagia is high in patients with dementia, e...