clinical focus
Little condition leads to big problems
How nurses can help in
spotting and managing
dysphagia in patients.
Sebastian Doeltgen interviewed
by Megan Tran
D
ysphagia is a little recognised
medical problem with a significant
cost to our health system.
Researchers Dr Stacie Attrill and Dr Sebastian
Doeltgen, head of Flinders University’s
Swallowing Neurorehabilitation Research
Lab, say their analysis of 23 cohort studies
from Europe and North America found
that patients with dysphagia, regardless of
their diagnosis, stay in hospital longer, and
subsequently cost the healthcare system
more, than patients without dysphagia.
More than 100,000 Australians have
dysphagia, which is often a consequence
of health conditions such as stroke
and Parkinson’s disease. It can lead to
choking, lung infection, malnutrition and
dehydration – but why is it hard to spot?
26 agedcareinsite.com.au
Doeltgen says there aren’t as many overt
signs, so the subtle signs are the ones to
watch for, such as someone not finishing
their meal or starting to drink less because
it’s uncomfortable. In particular, it is hard
to spot in the elderly as their ability to
swallow naturally declines as they age.
He says nurses can play a vital role
in spotting and managing the signs of
dysphagia by screening and identifying
patients that pose a greater risk.
Doeltgen adds that nurses are in
a position to consult with speech
pathologists and encourage patients to
maintain oral hygiene standards.
He stresses that this condition is not
limited to the larger hospital setting, but
is also present in home and residential
environments.
Aged Care Insite spoke with Doeltgen
to find out more about dysphagia and the
role of nurses in caring for people with
the condition.
ACI: How do you define dysphagia?
SD: Dysphagia is a swallowing impairment.
When we swallow, we use 32 pairs of
muscles that move food from the mouth
down into our stomach. As humans, we
have a particular challenge because our
air passage and food passage cross over
in the throat, so at any given point we
have to close one or the other. During
swallowing, the airway needs to be
closed so that food or drink don’t end
up in the lungs, because if they do, it can
lead to choking or coughing episodes,
and at worst can lead to an infection of
the lungs, which we know as aspiration
pneumonia.
Dysphagia has a significant negative
impact on a person’s quality of life. If you
imagine not being able to eat or drink,
you can understand that someone with
dysphagia would not be able to have a cup
of coffee with a colleague or a friend or a
meal with friends and family. Most of our
social interactions occur over food and
drink, so not being able to partake in that
often leads to social isolation.
What did the research show?
We know that dysphagia has a significant
impact on quality of life across many
different domains, and anecdotally we
knew that patients with dysphagia tend to
stay longer in hospital and that their care is
very complex and therefore costly.
So, we brought together a team of
experts who systematically searched
though the international literature for
studies that have evaluated the cost of
dysphagia or data that shows the length of
stay of people with dysphagia in hospital.
We found that, on average, people with
dysphagia stay 3–4 days longer in hospital