Dysphagia Difficulty with Swallowing My mother has problems eating. She keeps the food inside her mouth and sometimes her saliva drools out... What is it, and what should we do? What is Dysphagia? Dysphagia is a medical term that means abnormal (‘Dys’) swallowing (‘phagia’). How does Dysphagia occur? The windpipe and the food pipe (oesophagus) share the same opening (mouth). During normal swallowing, the mouth, teeth and tongue breaks food into smaller pieces, mixes it with saliva, and pushes it into the food pipe.
The opening to the windpipe (epiglottis) will close automatically to prevent food from going into the windpipe (trachea) when the food is passing by. Any part of this that cannot be done well enough can cause Dysphagia. Who does it affect? Elderly persons, or those with an illness affecting the brain or nerve (e.g. stroke) or the structure of the mouth and throat.
Swallowing Disorder (Dysphagia) Fluid or food particles enter into the windpipe
What problems are caused by Dysphagia? In the mouth (oral phase) When a person has difficulty closing his lips completely, biting food into smaller pieces, mixing with saliva or pushing into the food pipe, this can cause: • Drooling • Choking • Leaving food in the mouth • Under-eating In the throat (pharyngeal phase) When the windpipe is unable to close automatically, some food particles enter into the windpipe. This can cause: • Choking • A wet gurgly voice • Frequent need to clear the throat • Feeling of food stuck in the throat • Under-nutrition
In the lungs When food particles travel into the lungs through the windpipe, this can cause: • Lung infection (pneumonia) as it carries bacteria • Breathlessness as it blocks air from entering the lungs What can be done for people with Dysphagia? Options for overcoming this condition depends on the disease causing it, the state of health and patient’s wishes or preferences. These include: 1. Full feeding by mouth (oral feeding) with a range of compensatory strategies as advised by a speech therapist. Compensatory strategies include: • Exercises to coordinate swallowing • Learning new swallowing techniques or eating positions to promote safe swallowing • Making dietary changes such as modifying the texture or consistency of food and water
2. A combination of oral and non-oral (artificial) feeding 3. Pleasure feeding using small amounts of food, mainly for enjoyment. Pleasure feeding is considered when nutritional and hydration needs are low, and overpromoting nutrition does not prolong life or is causing excessive distress 4. Full artificial nutrition using non-oral methods such as through a feeding tube
through the nose, mouth and throat, or through the abdominal wall over the stomach. While this ensures the delivery of nutrition into the stomach, food particles can still pass into the lungs when the stomach is full as the windpipe may not be closed securely. While all precautions are taken during the insertion, complications can also occur, especially if the patient is not able to cooperate or is very frail. What should we do? A patient-centred decision should be made with your loved one and your family, guided by your doctor and supported by your nurse, and other multidisciplinary team members such as your dietitian and speech therapist.
Tube feeding Tube feeding is done by inserting a tube into the stomach, feeding a nutritional drink and water directly. This is done either
This will take into account the nutritional and hydration requirements, any feelings of hunger and thirst, risks of related-illnesses, acceptance, and social well-being within the range of treatment options.
Tips for safer swallowing • Sit your loved one in an upright position • Feed your loved one on his/her stronger side • Feed one small mouthful at a time and make sure it is chewed well • Wait for the first mouthful to be swallowed before feeding the next one • Prepare food and drink in the correct texture and consistency. If necessary, cut or crush tablets if it is not in a syrup form • Do not use a straw unless advised by a speech therapist • Do not let your loved one be distracted • Prompt your loved one to swallow when needed
After finishing a meal • Remain in an upright position for at least 30 minutes • Remove any lumps of food that has not been swallowed • Clean the mouth, teeth and tongue of any food debris • Keep the mouth clean to discourage any bacteria growth
Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.
IP.PE.09.0620