Dysphagia facts in USA
It affects 18 million people
Up to 68% of elderly nursing home residents
Up to 30% of elderly admitted to the hospital
Up to 64% of patients after stroke
13%–38% of elderly who live independently
Dysphagia has been associated with increased mortality and morbidity
The Importance of Taste
When we say "This tastes good", what we're really talking about is not just taste itself, but a whole collection of sensory information, including: taste, aroma, texture and the "looks" of prepared food.
It is because of taste that eating is considered a pleasurable experience—one that we like to repeat several times a day—instead of a boring chore!
One reason that taste sensations are important is that they prepare our bodies for digesting food. For example, tasting and smelling food trigger our salivary glands and digestive "juices". Without them, our stomachs wouldn't be ready for food, and we'd have trouble digesting food and making use of the nutrients we get from food.
When our food is not appetizing or does not taste good, we just don't have the desire to eat as much as we usually do: weight loss, impaired immunity, poor nutritional status and the worsening of some diseases.
Modifying the consistency of solid food and/or liquid is a mainstay of compensatory intervention for patients with dysphagia.
The use of thickened liquids is one of the most frequently used compensatory interventions in hospitals and long-term care facilities and generally accepted by clinical intuition.
A primary concern with the overuse of thickened liquids is the risk of dehydration in elderly patients with dysphagia. Patient compliance with thickened liquids is often reduced. A recent survey of SLPs suggested that honey thick liquids were strongly disliked by their patients but even nectar thick liquids were poorly accepted by patients.
Percutaneous Endoscopic Gastrostomy
While non-oral feeding methods provide direct benefit in many clinical situations, they do not benefit all elderly patients with dysphagia or nutritional decline. A study of 80,000 Medicare beneficiaries over the age of 65 years indicated that presence of a percutaneous endoscopic gastrostomy (PEG) tube in hospitalized patients had a high mortality rate (23.1%). Mortality increased to 63% in 1 year. The presence of alternate feeding methods can also promote a cascade of negative psychosocial features including depression and loss of social interaction associated with feeding.
" Patients who require soft or puréed foods are rarely happy with the choices they are offered. Even if the foods taste like the foods they have eaten all of their lives, the altered texture makes the food unappetizing to them. As a result, they tend to eat less or rely primarily on sweets such as ice cream, puddings, and milkshakes for nutrition. This can result in a dangerously inadequate and imbalanced diet that may compromise a patient’s ability to heal, hasten disease processes, and/or cause undesirable weight loss, which can become life threatening in older patients."
Sandra Woodruff, MS, RD, LDN, ACSM-CPT, coauthor of The Soft Foods for Easier Eating Cookbook.
" Many healthcare professionals rush to put older patients on a puréed diet as a cure-all, which it isn’t. They get too much liquid, cough, and this places them at risk for aspiration. Remember, your mouth is the first and last frontier. It’s the way we, as infants, explore the world around us. It’s also the last decision-making experience for many. Others can decide when you will go to bed, when you will be changed, and what you will eat, but no one can make another person swallow. Eating is one of life’s pleasures. Quality of life should be the guiding force in all decision making."
Susan I. Wranik, MS, MA, CCC-SLP, President of Susan I. Wranik Associates, LLC in Chevy Chase, Md.