Dysphagia is a term used to describe difficulty or discomfort in swallowing food, fluids and even saliva. It is usually caused by another health condition, such as stroke, head injury or dementia, and can affect people of all ages. Nurses play a key role in identifying and managing dysphagia and screening for malnutrition. A multidisciplinary approach is required to guide appropriate interventions and achieve the best outcomes. This article discusses the prevalence of dysphagia, as well as the signs and risk factors, before taking a closer look at management strategies to help ensure good nutritional status.
There are a number of clinical conditions that result in dysphagia (difficulties swallowing food and drink). Sometimes dysphagia can resolve, however, for many it can be long term and also continue to deteriorate over time as the disease progresses. Successful management of dysphagia requires provision of differing levels of texture modification to an individual’s food and fluid consistency. It is important that this is assessed correctly so that the individual receives the appropriate consistency to swallow safely. If an inappropriate consistency is given, this can result in aspiration pneumonia, which can have fatal consequences. If individuals are given a consistency which has been over modified so that it is softer or thicker than required, their pleasure in food and drinks can be reduced unnecessarily, risking malnutrition and dehydration. This article introduces the differing consistencies which are recommended and the consequences that can result from incorrect consistencies being given. It also discusses suitable foods and fluids to meet both the requirements of the differing texture modifications and nutritional components of these consistencies.
The importance of nutricion for hostpital patients cannot be overestimated; it aids wound healing, helps reduce falls due to loss of strength/muscle mass, reduces incidences of pressure ulcers and helpds to reduce length of stay1. However, achieving adequate nutrition in hospital can be challenging with many different obligations vying for priority on a hospital ward2. In addition, certain medical conditions
Eating well in later life is an essential part of enabling older people to live independently at home for longer. However, with increasing funding cuts to community care services in the context of an ageing society, is enough being done to encourage good nutrition in later life? This article discusses the importance of nutrition for older people and explores how community practitioners are ideally placed to spot the early warning signs of malnutrition and encourage patients to take better care of their diet.
Helen Willis, Dietitian, Wiltshire Farm Foods
In 2012 a national working party consisting of experts in the care of patients with learning disabilities and the management of swallowing difficulties (dysphagia) was convened to develop guidelines to assist with the identification of at-risk patients. The aim was to improve the diagnosis and management of dysphagia in this patient population. The guidelines were also designed to improve the protection of such patients by ensuring that they are treated in a fair and equitable manner. This article provides an overview of the guidelines (Wright et al, 2012) for the community nurse.
David Wright, Professor of Pharmacy Practice, School of Pharmacy, University of East Anglia, Norwich
Tom Howseman, GP and Clinical Director of LD Commissioning, Nene and Corby CCG, St Luke’s Primary Care Centre, Northampton
Community provision of nutritional support to patients who are unable to meet their nutritional requirements through oral intake alone is increasing. These patients often have complex clinical and social needs due to their diagnosis and social circumstances, and thus require input and support from a number of different healthcare professionals. This article, from a winner of the JCN Writing Awards, outlines how concerted team working can provide a seamless service for patients requiring home enteral nutrition.
Acknowledgements:
The author wishes to acknowledge the support provided by the staff of the Home Enteral Nutrition Service of Lewisham Healthcare NHS trust.
Dr Omorogieva Ojo BSc MSc PhD RPHNutr. Senior Lecturer in Primary Care, Department of Acute and Continuing Care, School of Health and Social Care University of Greenwich
Ileen Patel BSc Service Lead, Home Enteral Nutrition Team, Lewisham Healthcare NHS Trust
Gaye Kyle discusses the nurse’s responsibility for administrating medication in a safe and acceptable manner to patients with dementia and makes recommendations for practice in the light of current evidence.
Gaye Kyle RGN, BA(Hons), Dip Ed, MA, is an Independent Lecturer
Article accepted for publication: October 2011
Joanne Wright gives an overview of the assessment of dysphagia and its management
Joanne Wright RGN, RM is a Practice Nurse in Brighouse, West Yorkshire
Article accepted for publication: June 2006
