clinical focus
and their care costs about 40 per cent
more than people who’ve had a life in
hospital with a similar underlying illness
but without dysphagia.
This finding was very significant and
very consistent across different healthcare
systems across the world, and also
very consistent for different underlying
illnesses, so no matter whether you
come in with a stroke, motor neurone
disease, Parkinson’s disease, or head and
neck cancer, if a person presents with
dysphagia on top of their underlying
condition, the care will cost significantly
more and they will stay in hospital for a
few days longer.
Dysphagia is a common consequence of
health conditions like stroke and neck
cancer, to name a few, but why is this
condition so little known?
That’s a good question. I’m not sure I have
a perfect answer, but if you mention not
being able to swallow, having frequent
episodes of choking, not being able to
manage your own saliva, perhaps even
being fed through a tube that is placed
through the nose or directly into the
stomach, for many people, this can lead
to social isolation because they’re not very
keen to openly talk about it. Perhaps that’s
one of the reasons, that as a community
we’re not really talking much about
swallowing problems.
For us as healthcare professionals, of
course, we respect the individual case,
but as the healthcare profession as a
whole, we of course play an important
role in raising awareness for dysphagia
and looking into opportunities to do more
research and improve clinical care for
people who have dysphagia.
What are some of the signs of this
condition?
Some of the common signs that are overt
are coughing or choking during a meal, or
presenting with a wet, gurgly voice after
eating. If there is persistent dysphagia,
then the person might also present with
a raised temperature as an early sign of a
developing lung infection or pneumonia.
What is important to remember, though,
is that there are also subtle signs that aren’t
as overt as coughing and choking. It could
be that a person with swallowing problems
doesn’t finish their meal, or they start
drinking less because it’s uncomfortable,
and we also know that in the otherwise
healthy elderly population, swallowing
function slowly but steadily declines.
People are good at accommodating
those changes. For example, they stop
eating steak because it’s harder to chew
and more difficult to swallow, so they don’t
necessarily present with overt swallowing
impairment, but they’ve accommodated
to a certain degree to manage those
emerging difficulties.
It’s important that we raise the
awareness for dysphagia, but also work on
early identification of those that present
with it so we can provide intervention and
management as early as possible.
How can nurses help patients with
dysphagia recover?
Nurses play an important and central role
in the care of people with dysphagia in
different ways. Primarily, being aware of the
prevalence and the impact of dysphagia is
critical. Nurses play a very important role in
monitoring the changes within the patient
– any episodes of choking, any changes in
temperature, any changes in the patient’s
behaviour – because really the nurses are
at the coal face of patient care and can
liaise between the patient and other health
professions. If they’re unsure, there’s always
the opportunity to consult with speech
pathologists, who are specifically trained
in the management and assessment of
swallowing.
Critically important is the nurse’s role in
oral hygiene. If food falls into the lungs,
the risks for developing a lung infection
are significantly higher than if oral hygiene
has been maintained, and nurses play an
important role in that.
Lastly, trained nurses also play a big
role in screening and identifying patients
at risk, so they can receive early speech
pathology assessments. Research shows
that in systems where nursing screens
have been implemented, it has led to early
identification of patients with dysphagia,
and that significantly reduces the risk of
these patients dying in hospital because of
aspiration pneumonia. So, it really affects
people’s lives, and nurses play a big part in
managing it.
How can nurses help in greater
dysphagia awareness?
Being aware themselves is a big part. Being
aware that dysphagia is critically important,
and that we have to identify it early and
treat it early. Also, being aware that it
occurs across the board, not just in those
big conditions like stroke, motor neurone
disease and Parkinson’s, where we expect
dysphagia to happen, but also in conditions
we see in general in nursing homes and
home health settings.
Also, talking to colleagues about it. If
the people reading this would say to one
or two of their colleagues, “Wow, imagine
what it would be like not being able to
swallow,” then we would spread the word
and raise awareness in the profession as
to how dysphagia affects patient care and
quality of life, and also how much it costs
the healthcare system.
Finally, where to from here?
In Australia, we’re very good at screening
for dysphagia in those high-risk
populations, in people with stroke or
neurodegenerative conditions. But what
we can perhaps improve are the processes
to screen the more general medical
population, and it’s important to raise the
awareness there.
So, one of the things from here
we would like to do is to continue to
raise awareness for the importance
of dysphagia, but from a research
perspective, the swallowing research
teams here at Flinders University are
leading research in different areas of
Critically important
is the nurse’s role in oral
hygiene. If food falls into
the lungs, the risks for
developing a lung infection
are significantly higher than
if oral hygiene has been
maintained.
dysphagia care. There are groups looking
at novel assessment methods that give us
very patient-specific objective measures of
swallowing function, and with increasing
that diagnostic specificity, we’re able to
really target interventions to the specific
patient to increase their health outcomes.
Then, there are also groups that look
at novel interventions that broaden our
ability to help those who are affected by
dysphagia in really novel and innovative
ways that may include brain stimulation
or neuroplasticity-based approaches,
but also behavioural changes and
behavioural interventions that can help
improve swallowing biomechanics
and ultimately health outcomes and
participation in everyday life and, with that,
quality of life. ■
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