Swallowing & dehydration


Chewing and swallowing problems can be life threatening for the elderly and for people with conditions such as cerebral palsy, Parkinson’s disease, muscular dystrophy, multiple sclerosis and dementia, as well as for stroke patients. The muscles of the mouth and throat may no longer be working properly, so bits of food and liquid can be aspirated or drawn into the lungs, causing recurrent respiratory infections or pneumonia, malnutrition and increasing risk of mortality.
Chewing problems may be related to missing teeth and poor fitting dentures. Better dentures, proper oral hygiene before and after meals, and regular visits to the dentist may help minimize the problem.
Dehydration is often associated with dysphagia as patients have difficulties in swallowing liquids, it increases mortality and morbidity in elderly people, complicates recovery, accelerates general decline and alters many metabolic functions.
What is dysphagia?

Dysphagia refers to any disorder in the swallowing process that does not allow fluid or food to pass safely from the mouth to the stomach. The oropharynx and tongue play a vital role in the swallowing process. If the muscles in the oropharynx or tongue become weaker or uncoordinated, food or drink can end up in the lungs rather than in the stomach.
Dysphagia is generally a sign of underlying diseases that can be associated with varied diagnoses related to physical or mental disorders. It affects many patients, especially elderly people. Neurological disorders, cancer and age-related physiological changes are the major primary diagnoses associated with swallowing disorders.

Dysphagia affects:

  • 40-50 % of the elderly population1
  • 35-50% of stroke patients2
  • 35% of patients with Parkinson’s disease3
  • 80% of patients with Alzheimer’s disease4

Dysphagia has a huge impact on the quality of life of the patient and can potentially be fatal. It must be carefully treated to avoid any risk of aspiration, malnutrition or dehydration.

  • Respiratory consequences
    • Aspiration: 51% of patients with dysphagia5
    • Congestion
    • Cough – apnea
    • Pneumonia / infection
    • Choking
  • Nutritional consequences
    • Anorexia
    • Malnutrition: 48% of patients with dysphagia6
    • Dehydration: 75% of patients with dysphagia7

How to detect dysphagia?

Warning signs and symptoms:

  • Difficulty in swallowing
  • Frequent throat clearing
  • Coughing while or after swallowing
  • Breathing in food or saliva while swallowing
  • Inadequate lip closure and drooling
  • Weight loss
  • Presence of food residue on the tongue or mouth
  • Regurgitating liquid through the nose
  • Voice changes after swallowing, or a weak voice
  • Repeated respiratory infections

Diagnosis: by clinical examination and videofluoroscopy.

How to treat dysphagia?

The objective of dysphagia treatment is to achieve safety and efficacy of swallowing. There are different ways to manage dysphagia depending on its severity and the underlying diseases:

  • Dietary modifications
    • Adaptation of food texture and liquid viscosity, in order to:
      • Lower the speed at which food passes through the pharynx
      • Assist the patient in swallowing
      • Reduce the risk of aspiration
      • Ensure optimum nutrition and hydration
    • Supplementation of diet (use of oral complements)
    • Modifying the rhythm of food intake
  • Swallowing re-education and compensation strategies in order to:
    • Train specific muscles involved in swallowing
    • Learn new ways to swallow, such as changing the position of the head
  • Medical management: choice of feeding route (enteral/parenteral), medication and/or surgery.

Generally, the use of a thickener is needed to improve swallowing ability. In patients with dysphagia, the increase of fluid viscosity and the modification of the texture of solids lead to a significant improvement of the deglutition function. Depending on the underlying disease and the severity of dysphagia, the optimal viscosity and volumes of food and liquid that patient is able to swallow may vary. Appropriate management of patients with dysphagia involves a multidisciplinary team including dieticians, speech therapists, radiologists and medical specialists (geriatricians, neurologists or gastroenterologists).

Laboratoires Grand Fontaine offers a complete range of nutritional options with different levels of viscosity.

References
1 Easterling C, Robbins E. Dementia and dysphagia. Geriatric Nursing 2008;29(4):275-285.
2 Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia. 2001. 16(1):7-18.
3 Volonte MA, Porta M, Comi G. Clinical assessment of dysphagia in early phases of Parkinson disease. Neurological Sciences. 2002; 23 Suppl 2:S121-122.
4 Kalia M. Dysphagia and aspiration pneumonia in patients with Alzheimer’s disease. Metabolism. 2003 Oct;52(10 Suppl 2):36-8.
5 Lundy DS, Smith C, Colangelo L, et al., Aspiration: cause and implications. Otolaryngol Head Neck Surg. 1999;120(4):474.
6 Felt P. Nutritional Management of Dysphagia in the Healthcare Setting. Healthcare Caterer. 2006; 2006.
7 Leibovitz A, Baumoehl Y, Lubart E, Yaina A, Platinovitz N, Segal R. Dehydration among long term care elderly patients with oropharyngeal dysphagia. Gerontology. 2007;53(4):179-83.

Chewing or mastication is an essential part of the digestive process. By breaking the food down into smaller particles, the food can be swallowed and passed lower down the bowel where the digestion takes place and the nutrients will be absorbed into the bloodstream.
Oral health problems and edentulism are common in the elderly: they affects more than a quarter of older adults living in the community.1,2
These conditions are responsible for chewing disabilities that can lead to alteration in nutrient intakes, and poor nutritional status.3 These alterations in dietary intake may cause weight loss and increase the risk of systemic diseases such as cancer and cardiovascular disease. In addition, it is reported that low nutrient intake (especially proteins) is associated with poor muscle strength and physical performance, leading to disability in basic activities of daily living.4,5

Causes of chewing problems

Chewing problems arise due to frequent conditions of the elderly such as:

  • Tooth decay, broken and missing teeth
  • Poorly fitting dentures
  • Dry mouth
  • Mouth sores or infections
  • Mouth cancer
  • Fractured jaw
  • Temporomandibular joint (TMJ) disorders
  • Stroke
  • Chronic diseases such as Parkinson’s disease, myasthenia gravis and multiple sclerosis

How to cope with chewing problems?

Dietary management can bring some relief to patients. Measures should depend on the type of underlying problem and the severity of the condition:

  • Adapt the texture and consistency of the diet:
    • Eat softer foods that are cut into small pieces.
    • Slowly chew as much as possible before swallowing.
    • Replace foods by meals of semi-solid to fluid consistency for one or two meals in the day.
  • Mouth care: better dentures, proper oral hygiene before and after meals, regular visits to the dentis

Laboratoires Grand Fontaine offers a complete range of nutritional options with different levels of viscosity

References
1 Osterberg T, Carlsson GE, Sundh V. Trends and prognoses of dental status in the Swedish population: Analysis based on interviews in 1975 to 1997 by statistics Sweden Acta Odontologica Scandinavica. 2000;58:177–182.
2 Vargas CM, Yellowitz JA, Hayes KL. Oral health status of older rural adults in the United States. Journal of the American Dental Association. 2003;134:479–486.
3 Lee JS, Weyant RJ, Corby P et al. Edentulism and nutritional status in a biracial sample of well-functioning, community-dwelling elderly: The health, aging, and body composition study. American Journal of Clinical Nutrition. 2004;79:295–302.
4 Cesari M, Pahor M, Bartali B et al. Antioxidants and physical performance in elderly persons: The Invecchiare in Chianti (InCHIANTI) study. American Journal of Clinical Nutrition. 2004;79:289–294.
5 Semba RD, Blaum C, Guralnik JM et al. Carotenoid and vitamin E status are associated with indicators of sarcopenia among older women living in the community. Aging Clinical and Experimental Research. 2003;15:482–487.

What is dehydration?

Dehydration results from a negative balance between fluid availability in the body and functional requirements, due to insufficient intake or higher loss in the body. Dehydration increases mortality and morbidity in elderly people, complicates recovery, accelerates general decline and alters many metabolic functions.

Risk factors of dehydration

  • Aging
    • Physiological aging results in loss of water quantity in the body.
    • Aging is related to the decrease, or even disappearance of the thirst sensation (adispsia), as well as degradation of the renal function.
    • Swallowing disorders affect liquid intake through spontaneous hydric restriction.
  • Diarrhea and vomiting, due to illness or medication, increase loss of water in the body.
  • Certain medications for high blood pressure or anti-depressants are diuretic.
  • Poor access to water, related to dependency.

Recommendations for preventing dehydration

Liquid needs vary for each person due to age, physical activity and metabolism. However, the main recommendations for preventing dehydration are:

  • Encouraging the ingestión of 8 glasses of liquid / day, including after meals and snacks.
  • Ensuring hot and cold drinks are safely and freely accessible.
  • Diversifying drinks (tea, coffee, juices, milk) and favouring food with high water content (soups, jellies, ice creams, fruit)
  • Modifying texture and viscosity if dysphagia.

Laboratoires Grand Fontaine offers a complete range of nutritional options adapted to the patient’s condition:

Food for special medical purposes.
Use under medical supervision.