Dysphagia refers to any difficulty which disrupts the normal swallowing process. It is a prevalent condition, especially amongst the older population.
Swallowing is a complex process involving a high degree of neurological control and coordination. There are many conditions which impact the structure or function of the mouth, throat, or oesophagus, that can result in a swallowing dysfunction. An issue may occur at any stage of the swallowing process.
A safe swallow ensures that food, drink and medication is successfully transferred between the mouth and the stomach, ensuring material does not enter the lungs. Aspiration of material into the lungs can increase the chances of chest infections or pneumonia. Dysphagia is reported to occur in up to 50% of the elderly, up to 75% of care home residents and 50% of patients with neurological conditions.
The older population are more prone to swallowing difficulties due to the loss of muscle tone, along with a reduction in saliva production. They are also more likely to have medical conditions which have the potential to cause dysphagia.
Symptoms of dysphagia
Some signs and symptoms which may indicate that a patient may have difficulty swallowing include:
- Difficult or painful chewing or swallowing
- Dry mouth
- Difficulty controlling food or liquid in the mouth
- Coughing/choking before, during or after swallowing
- Hoarse/wet voice quality
- Feeling of obstruction
- Unexplained weight loss
- Regurgitation of undigested food
- Recurrent chest infections (resulting from aspiration)
Ask patients about their ability to swallow
Research by the World Health Organisation suggests that only half of people take their medication as prescribed, with many patients being unwilling to raise issues they are experiencing with their healthcare professionals. Guidelines suggest patients should be asked whether they have difficulty swallowing tablets before prescribing medicine, but in 72% of cases, this doesn’t happen.
The older population are more prone to swallowing difficulties due to the loss of muscle tone, along with a reduction in saliva production.
Getting the right form of medication
Oral solid dose medication can present a significant challenge to patients with swallowing difficulties, impacting the safe administration of oral medication.A survey found that a high proportion (almost 60%) of older people are unable to swallow their tablets or capsules.
A common patient response to a swallowing difficulty is to chew, crush tablets or open capsules to make the medicine easier to take. Often, these patients are unaware of the negative consequences that this can have on the activity of the drug. The outcome of medicines manipulation can be emphasised in older people due to age-related differences in pharmacokinetics.
Know what to do next
Rosemont provides education on the topic of swallowing difficulties to healthcare professionals. They have also recently launched the Understanding Dysphagia website (liquidmedicine.co.uk). This platform supports patients and carers with the information they need to help them understand dysphagia and what it means for them.
DTM447 DOP Dec 2022