Estimating the prevalence of dysphagia is a difficult task. A secondary condition, it is a common symptom of a number of disorders and diseases and can occur at varying severities. Dysphagia can be caused by neurological conditions such as dementia, stroke and motor neurone disease, congenital and development conditions such as cerebral palsy, muscular conditions and learning difficulties, or by obstructions resulting from cancers or GORD. This makes calculating the number of cases a challenge, but it is clear dysphagia is becoming a more common problem, which can affect people of any age. 

However, it is the older population who are most susceptible. Up to 30 per cent of over 65s are living with some form of dysphagia and there are a number of reasons behind this.[1] It is this age group which is most likely to suffer from the most common underlying causes of dysphagia; dementia, stroke and multiple sclerosis for example.  Furthermore, the muscles used for swallowing can become weaker with age, so much so that older adults often struggle to eat. It is no surprise then, that between 50 and 75 per cent of nursing home residents in the UK are living with the swallowing condition.[2] 

Considering the demographic profile of the UK, these percentages will undoubtedly rise. The population aged 65 and over grew by 47 per cent between mid-1974 and mid-2014, to make up nearly 18 per cent of the total population. The number of people aged 75 and over had increased by 89 per cent over this period, now making up 8 per cent of the total population.[3] The ageing population will result in a higher occurrence of the underlying causes of dysphagia; dementia, Parkinson’s and strokes to name a few, and so the prevalence of dysphagia will proportionately increase.

 This means dysphagia will continue to rise on the dietitian’s agenda. Older patient’s nutritional intake is a concern under normal circumstances, but when swallowing difficulties arise, this can be particularly challenging. Changes in swallowing can lead to loss of appetite and enjoyment in eating, this subsequently resulting in malnutrition and dehydration. In serious cases, aspiration can occur, leading to aspiration pneumonia and other infections. Whilst a speech and language therapist can identify the specific problem and make recommendations on posture, exercises, techniques and food texture, the nutritional value of meals is of upmost importance.  Food needs to be appealing, satisfying, safe and nutritious. Yet texture modification, a common treatment of dysphagia, can raise challenges in meeting these criteria.

The dietitian is often the professional in the best position to advise on each of these important elements. It is therefore essential that dietitians work collaboratively with SLT’s, recognising their own work as a vital constituent of the management and treatment of dysphagia, a condition which will have an increasing prevalence in coming years.

 

[1] https://www.qcs.co.uk/patient-safety-alert-when-inappropriate-nutritional-care-may-prove-deadly/

[2] Swallowing Problems in the Nursing Home: A Novel Training Response (O’Loughlin G, Shanley C) Dysphagia 1998; 13,172-183

[3] The Knowledge Issue One: Dysphagia, The Hard to Swallow Truth, apetito 2016