Managing an unwell loved one’s swallowing difficulties can be unpleasant and frightening for everyone involved. While caring for someone we care about how they are cared and nourished, when the capacity of enjoying food is removed, caregivers may experience feelings of failure and powerlessness.
Of course, this is hard; when our best efforts result in coughing or gagging, it’s challenging to feel good about our care. However, we must know that this is not our fault. Numerous disorders can impair one’s ability to swallow. As caretakers, all we can do is educate ourselves about our loved ones’ diseases and cope in the most effective manner possible.
Hospice staff frequently interacts with patients who have dysphagia. For example, Melodia Care nurses and health coaches offer caregivers tips on recognizing dysphagia signs and assisting a senior in eating securely.
What Is Dysphagia?
Dysphagia is a medical term that relates to difficulties in swallowing. It can be transient or permanent and depending on the etiology it may or may not degenerate with time.
Dysphagia can manifest itself in a variety of ways.
- Certain foods/liquids were reported to be challenging to swallow.
- When eating or drinking, coughing or choking may occur.
- After eating and drinking, the voice becomes wet.
- Saliva drooling is persistent.
- Chest infections that recur/aspiration pneumonia (just over half of patients with dysphagia suffer from aspiration).
Dysphagia can be caused by neurological illnesses such as stroke, progressive diseases (such as Parkinson’s disease and dementia), obstructive diseases (such as esophageal stricture) or muscle causes (such as achalasia and sarcopenia).
It is critical to obtain a complete clinical history to determine the etiology of dysphagia. If a mechanical obstruction is detected, investigation and treatment to ease the block may be indicated unless the patient is near death.
As a degenerative neurological disease proceeds, a significant population of patients develop oropharyngeal dysphagia. Additionally, half of nursing home residents experience some kind of difficulty swallowing. Dysphagia and the associated risk of aspiration are markers of a poor prognosis and should prompt discussion of therapeutic goals in this setting. Dysphagia manifests itself in the following ways:
- Consumption of additional time and effort during meals
- At any time, food, liquid or saliva may leak from the mouth.
- Foods are “cheeked” rather than swallowed
- During and after meals, gurgling sounds or voice
- Coughing, gagging or frequently choking when eating
- Loss of weight
- Congestion of the chest
- Pneumonia caused by aspiration
Hospice care is designed to maximize patients’ comfort and quality of life by managing the pain and discomfort associated with a terminal illness. Hospice does not attempt to shorten or lengthen a patient’s life; instead, it focuses on their medical, emotional and spiritual needs.
Among the numerous misunderstandings regarding hospice care is that it prevents patients from receiving food and water, which is untrue.
Palliative care for swallowing difficulties is defined in this article as a treatment for severe and persistent dysphagia or intractable aspiration when normal swallowing cannot be restored and previous attempts to restore normal swallowing have been ineffective. Palliative care for dysphagia is not reserved for the terminally ill, as patients who have trouble swallowing might live a long time. Instead, palliative care for dysphagia focuses on optimizing swallowing function, preserving lung health and promoting nutritious eating despite decreased swallowing capacity when a patient becomes utterly incapable of swallowing despite all attempts at intervention; the emphasis of therapy shifts to determining ways to supply appropriate nutrition for the patient.
Normal Swallowing Mechanism
The oral, pharyngeal and esophageal phases of swallowing can be distinguished. The initial oral phase is largely voluntary and involves placing food or drink in the mouth, preparing it and finally conveying it to the throat. The oral phase’s efficiency is influenced by motor skills, meal consistency, taste, hunger and motivation.
In the pharyngeal phase, food is transported from the oropharynx to the oesophagus via coordinated mechanisms. This phase may occur unintentionally but may also be consciously modulated by cortical and subcortical input. The esophageal step is entirely involuntary and partially controlled by the autonomic nervous system. This article will discuss only oral and pharyngeal dysphagia or oropharyngeal dysphagia.
Diagnosis & Treatment Of Dysphagia
Before discussing palliative care for dysphagia, it is necessary to explore the usual strategy in assisting all patients who have difficulties swallowing. In most cases with oropharyngeal dysphagia, an underlying medical or functional cause must be established before appropriate treatment may be undertaken.
A chronic type of dysphagia may be present if the underlying medical problem is permanent or progressing. While surgery and medication may help alleviate the swallowing problem, behavioral and nutritional interventions are frequently the most successful. Specialists in speech-language pathology are educated to evaluate and treat dysphagia using behavioral approaches.
A multidisciplinary approach is advantageous when implementing a holistic management strategy for dysphagia. This may include speech and language therapists, nutritionists, occupational therapists, physiotherapists, caregivers, nurses, physicians and the individuals themselves along with their family. The multidisciplinary team should collaborate to optimize the mealtime experience and improve the overall quality of life while considering the individual’s preferences whenever possible.
Management strategies may include the following:
- Changing the consistency of liquids to make them safer to swallow, for example, by thickening drinks.
- Diets with altered texture
- Positions, techniques and specialized equipment that facilitate self-feeding. Feeding dependence on others is a significant risk factor for developing aspiration pneumonia.
- Swallow muscle strengthening strategies and exercises.
- Oral dietary supplements.
- Nutrition and hydration with the assistance of a clinician.
Individual needs and desires should always be considered. Oral consumption provides pleasure and serves a social, emotional and cultural function in addition to sustenance. Individuals can benefit from mealtimes because they offer a social routine and an opportunity to engage with others, increasing their quality of life. It is critical to be aware of another person’s preferences/dislikes maximizing satisfaction. Meal timings should also be evaluated, particularly in connection to fatigue levels.
Wherever possible, persons should consider future planning to communicate their eating decisions should their swallow function decrease.
Patients at the hospice are nearing the end of a disease process. Doctors estimate that the disease has progressed to the point that a patient’s life expectancy is now six months or fewer. They recognize that the digestive system is the first organ to fail which permits you to plan on eating less in the future. When transitioning, one of the early signs you may experience is eating less and sleeping more.
One hospice myth is that hospice treatment dehydrates or starves patients, which is not valid. The patient will gradually consume less and eventually quit eating. Nurses and staff are trained to recognize their patients’ natural hunger cues and deliver food or drink as needed. During hospice care, hospice agencies do not prevent patients from eating or drinking. Rather than that, they are just proactive in ensuring that patients do not overeat or overdrink, resulting in further anguish throughout the dying process.
You can reach Melodia Care at any time of day or night by contacting us through our 24/7 online customer support chat or by calling 1-888 635-6347 (MELODI-7).