Chapter 10 Etiology and Risks of Swallowing Disorders

BOX 10.6 Twenty-Six Influencing Factors for Predicting Aspirational Pneumonia

1. Mixed tube and oral feeding 2. Poor mobility 3. Age in years 4. Dependency for feeding 5. Only oral feeding 6. Dysphagia 7. Number of medical conditions 8. Bedfast 9. COPD

10. Number of medications 11. CVA 12. Alcohol abuse 13. Male 14. GI disease 15. Dental disease 16. Chronic heart failure 17. Any feeding tube 18. Good oral care 19. Smoker 20. Mechanically altered diet 21. Moves with assistance 22. Cancer 23. Weight loss 24. Dry mouth 25. Medications causing a dry mouth 26. Tracheostomy

Source: Hibberd J, Fraser J, Chapman C, McQueen H, Wilson A. Influencing factors to predict aspiration pneumonia in the United Kingdom? Multidiscip Respir Med. 2013;8(1):39.

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Sato et al determined that routinely performing a simple water swallow and rinse test was successful at detecting the presence of dysphagia for individuals with Alzheimer’s disease. Sato also found that though videoendoscopic swallowing study and videofluoro- scopic swallowing study are considered the gold stan- dard for diagnosing dysphagia, both are not always reflective of daily function (25).

The Nestlé Nutrition Institute developed the Eat-10: Swallowing Screening Tool (Figure 10.2, page 157), a validated self-administered screening tool that successfully determines the presence of dysphagia in many swallowing disorders (47). The use of the Eat-10 tool in community-based settings quickly identifies a swallowing problem, allows for early intervention, avoids unnecessary nutrient compromise, improves health outcomes, and reduces health care costs.

TREATMENT OF DYSPHAGIA The role of the RDN in treating dysphagia will vary, depending on the care setting and available resources. Once dysphagia has been determined, understanding the type of dysphagia can facilitate earlier interventions that are more specific and effective (48). The RDN should first address the individual’s initial hydration status and nutrient adequacy. Next, the RDN should ensure that the individual be provided the diet consis- tency that will best meet his or her needs, taking into consideration current nutritional status, diet acceptance, quality of life, and prognosis.

person and the use of quick, noninvasive, cost-effective screening tools and questionnaires (41). Rofes et al (20) describe a variety of dysphagia screening tools, available to clinicians, validated in the older adults:

● ● ●

the Mini Nutritional Assessment (MNA) (42) water swallow test (43)

3 oz water test developed in the Burke Rehabilitation Center (43)

● timed swallow test (44) ●

●

standardized bedside swallow assessment (SBSA) (45,46)

volume-viscosity swallow test (V-VST) (20)

Compensatory strategies, including proper posi- tioning, swallow maneuvers, adaptive equipment, and diet modification, are all used to reduce dysphagia symptoms to improve immediate swallow function and maintain nutrition and hydration until the person’s swallow is improved (26). Rehabilitative therapy, typi- cally done by speech-language pathologists, should improve long-term swallow function and safety and allow for the least restrictive diet (10). Box 10.7 (see page 158) lists recommendations the RDN should incorporate or suggest in the evaluation to maximize the individual’s ability to consume food and fluids. Modified cups, such as those with cutout rims placed over the bridge of the nose or those that restrict volume to 5 to 10 mL per drink, may be helpful. In some instances, straws may be used to prevent a back- ward head tilt when drinking to the bottom of the cup. Spoons with narrow, shallow bowls or glossectomy spoons may help facilitate appropriate swallow in indi- viduals who require assistance in placing food in certain locations in the mouth. These devices also promote independence in eating and drinking and can be suggested by some members of the health care team