Dysphagia Flashcards
What is dysphagia?
Essentially it is difficulty chewing or swallowing
How common is dysphagia (in which particular populations)? What are risk factors?
About one third of residents in long term care facilities have difficulty in swelling solid oral dosage forms (SODF)
Dysphagia is remarkably common in the general population
GERD is a risk factor for dysphagia as well as odynophagia
Intermitten dysphagia was associated with anxiety, while progressive dysphagia was associated with depression
How is dysphagia diagnosed?
Dysphagia needs to be evaluated by a speech language pathologist (SLP)
Official diagnosis by a physician is based on evaluation by a SLP
In the community, not many individuals have dysphagia as an active diagnosis
In very brief terms, what does a speech language pathologist do with regards to dysphagia?
They will evaluate the swallow and determine the diagnosis
What does an occupation therapist do with regards to dysphagia?
Adapts mealtime environments; including visual presentation of the meal to encourage eating, and creation of a setting that encourages attention to the meal
Enhances feeding skills; including strategies to create feeding independence and provision of appropriate adapted utensils
Positions the body to facilitate optimal digestion and arm use for independent and safe eating
What does a registered dietician do with regards to dysphagia?
Consulted for unexplained weight loss, poor appetite, inadequate oral intake, difficulty chewing, mealtime management concerns, constipation, and urinary tract infections related to reduced fluid intakes
Routine screening for dysphagia during meal observation and nutritional assessments
Manages all aspects of achieving and maintaining optimal hydration and nutritional status through oral, enteral and parenteral routes of administration
What do pharmacists do with regards to dysphagia?
Evaluate drug-related causes of dysphagia
Suggest treatments for xerostomia (dry mouth)
Modify time of administration and dosage form and make medication recommendations to minimize, eliminate or adapt to dysphagia where appropriate
Communicate with the dysphagia team regarding drug causes of dysphagia and treatments for same
What are the three phases of swallowing?
Oral phase
Pharyngeal phase
Esophageal phase
Describe the oral phase of swallowing
Food is chewed and mixed with saliva to form a bolus
Voluntary swallowing is initiated and the tongue pushes the bolus posterior towards the pharynx, stimulating several receptors to start the swallowing response
Describe the pharyngeal phase of swallowing
The swallowing response stops the breathing and raises the larynx for the bolus to pass
The bolus is transported by peristalsis across the closed vocal folds and epiglottis into the esophagus through the cricopharyngeal sphincter
Describe the esophageal phase of swallowing
Peristalsis drives the bolus through the lower esophageal sphincter into the stomach
What are the causes of dysphagia?
Patients may have one or a combination of conditions that may predispose them to feeding and/or swallowing impairments
There are three main sources that may place a person at risk for dysphagia:
-neurological
-physical/structural disease or injury
-psychogenic conditions
What are acquired neurological causes?
Defined as coming from or relating to a disease, condition or characteristic that develops after birth such as:
- CVA (stroke)
- Head trauma
- Polio
What are congenital neurological causes?
Defined as existing at or after birth, as a defect or medical condition, such as:
- cerebral palsy
- ringed esophagus
- musculoskeletal abnormalities at birth
- metabolic disturbances at birth
- internal organ deformities at birth
- genetic disorders
What are degenerative neurological causes?
Defined as a progressive decline in the condition of one’s organs, cells or overall health from cause such as:
- ALS
- Parkinson’s disease
- Huntington’s disease
- Multiple sclerosis
- Dementias
