OPINION
Helen Willis BSc, RD apetito Dietitian Helen Willis is a member of the British Dietetic Association and National Association of Care Catering. She previously worked in the NHS in both Acute and Community Dietetics.
WHY DYSPHAGIA SHOULD BE CAREFULLY CONSIDERED BY DIETITIANS Estimating the prevalence of dysphagia is a difficult task. A secondary condition, it is a common symptom of a huge number of disorders and diseases and can occur at varying severities. Dysphagia can be caused by neurological conditions such as dementia, stroke and motor neurone, congenital and development conditions such as cerebral palsy, muscular conditions and learning difficulties, or by obstructions resulting from cancers or GORD. This makes calculating the number of cases a challenge, but it is clear that dysphagia is a common problem, which can affect people of any age. However, it is the older population who are most susceptible. Up to 30% of over 65s are living with some form of dysphagia and there are a number of reasons behind this. It is this age group which is most likely to suffer from the most common underlying causes of dysphagia; dementia, stroke and multiple sclerosis, for example. Furthermore, the muscles used for swallowing can become weaker with age, so much so that elderly people often struggle to eat. It is no surprise then, that between 50 and 70% of care home residents in the UK are living with the swallowing condition. Considering the demographic profile of the UK, these percentages will undoubtedly rise. The population aged 65 and over grew by 47% between mid-1974 and mid-2014, to make up nearly 18% of the total population. The number of people aged 75 and over had increased by 89% over this period, now making up 8% of the total population. The ageing population will result in a
higher occurrence of the underlying causes of dysphagia; dementia, Parkinson’s and strokes, to name but a few, and so the prevalence of dysphagia will proportionately increase. This means that dysphagia will continue to rise on the dietitian’s agenda. Older patient’s nutritional intake is a concern under normal circumstances, but when swallowing difficulties arise, this can be particularly challenging. Changes in swallowing can lead to loss of appetite and enjoyment in eating, subsequently resulting in malnutrition and dehydration. In serious cases, aspiration can occur, leading to aspiration pneumonia and other infections. Whilst a speech and language therapist (SLT) can identify the specific problem and make recommendations on posture, exercises, techniques and food consistency, the nutritional value of meals is of upmost importance. Food needs to be appealing, satisfying, safe and nutritious. Yet texture modification, a common treatment of dysphagia, can raise challenges in meeting these criteria. The dietitian is often the professional in the best position to advise on each of these important elements. It is, therefore, essential that dietitians work collaboratively with SLTs, recognising their own work as a vital constituent of the management and treatment of dysphagia, a condition which will have an increasing prevalence in coming years. www.NHDmag.com October 2017 - Issue 128
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