What are the evidence-based interventions for managing dysphagia in elderly patients?

Managing dysphagia in elderly patients involves a range of evidence-based interventions, beginning with a thorough assessment and referral to specialists.

• Assessment and Referral: People with indicators of dysphagia should be referred to healthcare professionals with relevant skills and training in the diagnosis, assessment, and management of swallowing disorders ². For those with acute stroke, swallowing should be screened by an appropriately trained healthcare professional before any oral food, fluid, or medication ³. If problems are indicated, a specialist assessment is required, preferably within 24 hours and no more than 72 hours ³.
• Modified Oral Nutrition Support: Healthcare professionals should consider the risks and benefits of modified oral nutrition support ². This includes modifying fluid and food textures and flavours ¹. People with dysphagia on modified food and liquid should be regularly monitored and reassessed until stable ².
• Enteral Tube Feeding: If individuals are unable to take adequate nutrition, fluids, and medication orally, tube feeding with a nasogastric tube should be considered within 24 hours of admission (unless thrombolysis) ³. A nasal bridle tube or gastrostomy may be considered if a nasogastric tube is not tolerated ³.
• Supportive Strategies: An individualised plan for managing eating, drinking, and swallowing difficulties should assess the role of postural management and positioning when eating ¹. Other strategies include modifying fluid and food textures and flavours, adjusting feeding techniques (such as pacing and spoon placement), using specialised feeding equipment, and optimising the mealtime environment ¹.
• Medication Review: People with dysphagia should have a drug review to ascertain if the current drug formulation, route, and timing of administration remain appropriate and without contraindications for the feeding regimen or swallowing process ². For those with acute stroke, oral medication should be reviewed to amend either the formulation or the route of administration ³.
• Key Considerations: Before modifying nutrition support and hydration, healthcare professionals should consider factors such as recurrent chest infections, mobility, dependency on others for assistance to eat, perceived palatability and appearance of food or drink, level of alertness, compromised physiology, poor oral hygiene, compromised medical status, metabolic and nutritional requirements, vulnerability, and comorbidities ².