Basics of Nutrition Therapy for Dysphagia
What is Dysphagia?
Dysphagia is a disorder of the swallowing mechanism, resulting in impairment of the safety and efficiency of eating and drinking. Stroke, head and neck cancer, Parkinson's disease and multiple sclerosis are examples of conditions, which can interfere with swallowing mechanisms. Swallowing difficulties may resolve within a few days or persist for months or years. Malnutrition itself is associated with increased morbidity and mortality and therefore malnutrition and dysphagia are both risk factors for poor outcome. Malnutrition has been linked with altering muscle and nerve function, thereby increasing swallowing impairment.
Texture Modified Diets
If dysphagia is suspected, a speech & language therapist should assess the patient and advise on the appropriate texture of the diet for that individual. Dysphagia diets are characterized by texture modification of solid foods or the thickening of fluids. The purpose of such a diet is to enable a person with dysphagia to eat and drink safely and efficiently with a texture most suited to their swallowing function. It may help decrease the risk of medical complications such as aspiration pneumonia in patients who can be nourished by the oral route. The ultimate aim is to help patients safely progress to as normal a level of food texture as possible. It should therefore be standard practice for each patient on a dysphagia diet to be assessed by the dietician in order to meet his or her nutritional requirements.
Dysphagia diets tend to include at least two levels of viscosity (a measure of thickness or thinness), for example, soft and pureed. Energy intakes often fail to meet requirements on texture- modified diets. Patients on texture-modified diets may only meet 45% of their energy requirements. In order to establish optimum nutritional intake, the following should be considered.
• Likes/Dislikes – Take into account the patient's food preferences including religious and cultural factors.
• Timing – Try to establish the optimum mealtime for the patient's main meal of the day. Swallowing difficulties may worsen if the patient is tired.
• Temperature – Temperature should be explored with each patient with dysphagia to determine optimal management. If patients have decreased oral sensation, foods and drinks should be served hot or cold rather than tepid or at room temperature. This may stimulate the swallowing reflex. Adding strong flavorings may also help.
• Quantity – Provide small and frequent meals of the correct consistency.
• Energy Content – Fortify foods with extra cheese, butter or cream. Use full fat products to increase the energy density. Liquidize food with gravy, sauces, cream or milk rather than water. Commercial energy and/or useful to add to food and drink. Texture modified diets are available to buy in bulk from catering companies. Check the energy content as these can differ between manufacturers.
• Commercial supplement drinks – In addition to nutrient fortification of the texture modified diet, commercial supplement drinks and puddings may need to be considered to meet a person's energy requirements. Supplement drinks (under dietitian's instructions) offered at least one hour before mealtimes may enhance calorie intake.
Improving the eating process
• How does the patient manage their utensils - To enable the patient to become more independent when eating, the occupational therapist can provide specialized advice on eating and drinking utensils, for example, angled fork.
• Swallowing recommendations – Including positioning, alertness and feeding strategies. Follow the advice of the speech & language therapist.
• Prompting – Some patients may find prompting and encouragement useful. Take into account other disabilities a person with dysphagia may have such as lip closure, arm movement