Dysphagia is impairment of the swallow process during transition of solids or liquids from the mouth to the stomach. It varies in severity from not being able to safely swallow at all to having chewing and or swallowing problems in the mouth throat or in the oesophagus.
With potential or ongoing malnutrition due to inability to meet nutrition needs orally, the hospital dietitian will need to be involved. Appropriate nutrition supplementation such as enteral feeding or oral supplementation is best managed with a team approach of available clinicians.
Another important role for dietitians is to be involved in menus for modified texture meals served to clients with dysphagia. The Australian Standardised Terminology and definitions for texture modified foods and fluids have been in place since 2007, (1) developed by consensus approach with Speech Pathologists and Dietitians. Some general principles for texture modified meals:
•Ensure food looks as appetising as possible
•Process meat and vegetables separately so they look appetising
•Use different coloured vegetables
•Serve food at the appropriate temperature to maximise taste
•Ensure a variety of foods from all food groups
•Cut food into appropriate mouthfuls changing it according to personal needs. This will be prescribed by the speech pathologist
•Provision of fluids thickened again as prescribed by the speech pathologist.
Community Dietitians as consultants to residential care homes or working with patients after discharge from hospital need expertise in managing dysphagia. As experts dealing with malnutrition they will become involved in advising on dietary aspects of modified texture meals but also during counselling may be made aware of chewing and swallowing issues with the patient. These may include:
•Frequent coughing and spluttering during or after eating or drinking
•Needing several attempts to swallow or persistent throat clearing
•Feeling of food sticking in the throat or chest
•Difficulty chewing and food falling out of the mouth when eating or drinking
•Unplanned weight loss.
It is essential for these symptoms to be checked out by the doctor who may arrange some tests (eg barium swallow) to aid in diagnosis and who will refer to a specialist.
The introduction of modified texture meals whether in the care home or in the patients home will be prescribed by the speech pathologist. The dietitians’ skill in counselling for the patient and family to come to terms with the changes in meals, food preference etc. is a much needed conversation. Material to help with this conversation is available as booklets on the DAA Diner website called “The Kitchen Manual for Modified Texture Diets” (mainly directed at kitchens that prepare meals) and “Super Foods for Small Appetites “ directed at home carers. Available from www.familyconcernpublishing.com.au.
1. Nutrition & Dietetics 2007; 64 (Suppl. 2): S53–S76