Screening for dysphagia: this is part two in a series on dysphagia.

• Jurisdiction: Australia
• Author: Murray, Jo
• Date: 01 June 2011

Background

Many patients in our hospitals and health care facilities present with dysphagia, which is defined as difficulty swallowing food, fluids or secretions.

Australia has an ageing population. As people age they are more likely to develop conditions that pre-dispose them to dysphagia. Neurological conditions such as stroke, brain injury and dementia often result in dysphagia, as do neurodegenerative diseases.

Head and neck cancers frequently result in dysphagia either from the disease itself or its subsequent treatment with surgery, radiotherapy or chemotherapy.

Other conditions that are less well known to result in dysphagia are respiratory disorders such as chronic obstructive pulmonary disease, pneumonia or the presence of a tracheostomy, cardiac conditions and surgery, gastro-oesophageal reflux disorder, autoimmune disorders, certain psychiatric conditions, some medications, critical illness and general debility.

It is estimated that 10-30% of all adults over 65 years have dysphagia. About 25-40% of patients in an acute hospital setting experience dysphagia and 15-30% of patients will have dysphagia that leads to aspiration. Up to 60% of institutionatised elderly people will have dysphagia (Steele et al 1997).

Effects

Severe dysphagia can lead to aspiration and pneumonia, choking or complete airway obstruction, hypoxia and death.

Unrecognised dysphagia that is left untreated can lead to malnourishment, weight toss and dehydration. Malnutrition and dehydration in the elderly further impairs physical and cognitive function and quality of life. Patients may be more susceptible to low blood pressure, falls, pressure ulcers and infection.

Dysphagia can result in patients being unable to swallow medications required to treat an underlying medical condition or comorbidities which puts them at greater risk.

Dysphagia has a significant impact on hospital resources and length of stay (LOS). The presence of dysphagia is associated with a 40% increase in LOS in all age groups. In the rehabilitation setting, patients with dysphagia have a 13-fold increased risk of mortality during their hospitalisation (Altman and Yu 2010). If elderly patients develop aspiration pneumonia, even if identified and treated, their mortality rates range from 40% to 71% (Kayser-Jones and Pengilly 1999).

Screening

Early identification and treatment is the key to minimising the risk and effects of dysphagia. Studies show that dysphagia screening reduces pneumonia...