II. Indications: Dysphagia with aspiration risk

III. Management: General Dietary Guidelines for Aspiration Pneumonia prevention

  1. Patient should sit upright (>45 degrees) for eating
  2. Place food well into mouth
  3. Encourage patient to gently cough after each swallow
  4. Patient should swallow several times after each bolus
  5. Bolus size is controversial
    1. Bolus size of 20 ml appears to be most appropriate bolus size
    2. Refutes old recommendations that each bolus should be less than one teaspoon
      1. Bolus size >20 ml is required to open the upper esophageal sphincter
      2. Impossible to assist patient with enough 5 ml boluses/day to sustain nutrition
  6. Liquid consistency is controversial
    1. Thickened liquids appear to have greater risk than benefit
    2. Refutes old recommendations of thickened liquids in most restrictive Dysphagia Diets
      1. Thickened liquids do not prevent aspiration more than thin liquids
      2. Thickened liquids are more likely to result in Aspiration Pneumonia
      3. Thickened liquids cause early satiety and risk Dehydration and Anorexia
  7. Specific Protocols
    1. National Dysphagia Diet
    2. International Dysphagia Diet
  8. References
    1. Logemann (2007) Protocol 201, American Speech Hearing Association Meeting Lecture
      1. http://www.dysphagassist.com/major_randomized_studies
    2. Dodds (1988) AJR Am J Roentgenol 150:1307-9 [PubMed]

IV. Management: Oral Medication Modification in Dysphagia

  1. Review medication list to evaluate for Polypharmacy and consider Deprescribing
  2. Attempt to eliminate or limit agents that worsen Dysphagia (e.g. Anticholinergic Medications)
    1. See Medication Causes of Dry Mouth
  3. Consider alternative routes of drug delivery (rectal, sublingual, topicals)
  4. Swallowing Evaluation (speech therapy) to determine consistency of medications (e.g. pills, thin or thick liquids)
    1. See above regarding food related aspiration prevention
  5. Consult with pharmacist on medications that can be crushed or sprinkled into soft foods (e.g. pudding)
  6. Exercise caution in tilting head to one side to swallow (may increase aspiration risk)
  7. References
    1. (2020 )Presc Lett 27(8): 47

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