II. Indications: Dysphagia with aspiration risk
- Cerebrovascular Accident
- Dementia
- Head and Neck Cancer
- Parkinsonism
III. Management: General Dietary Guidelines for Aspiration Pneumonia prevention
- Patient should sit upright (>45 degrees) for eating
- Place food well into mouth
- Encourage patient to gently cough after each swallow
- Patient should swallow several times after each bolus
- Bolus size is controversial
- Bolus size of 20 ml appears to be most appropriate bolus size
- Refutes old recommendations that each bolus should be less than one teaspoon
- Bolus size >20 ml is required to open the upper esophageal sphincter
- Impossible to assist patient with enough 5 ml boluses/day to sustain nutrition
- Liquid consistency is controversial
- Thickened liquids appear to have greater risk than benefit
- Refutes old recommendations of thickened liquids in most restrictive Dysphagia Diets
- Thickened liquids do not prevent aspiration more than thin liquids
- Thickened liquids are more likely to result in Aspiration Pneumonia
- Thickened liquids cause early satiety and risk Dehydration and Anorexia
- Specific Protocols
- References
- Logemann (2007) Protocol 201, American Speech Hearing Association Meeting Lecture
- Dodds (1988) AJR Am J Roentgenol 150:1307-9 [PubMed]
IV. Management: Oral Medication Modification in Dysphagia
- Review medication list to evaluate for Polypharmacy and consider Deprescribing
- Attempt to eliminate or limit agents that worsen Dysphagia (e.g. Anticholinergic Medications)
- Consider alternative routes of drug delivery (rectal, sublingual, topicals)
-
Swallowing Evaluation (speech therapy) to determine consistency of medications (e.g. pills, thin or thick liquids)
- See above regarding food related aspiration prevention
- Consult with pharmacist on medications that can be crushed or sprinkled into soft foods (e.g. pudding)
- Exercise caution in tilting head to one side to swallow (may increase aspiration risk)
- References
- (2020 )Presc Lett 27(8): 47
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| Concepts | Therapeutic or Preventive Procedure (T061) |
| English | diet for dysphagia (treatment), diet for dysphagia |
