Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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 NICE CG32. For those with acute stroke, swallowing should be screened by an appropriately trained healthcare professional before any oral food, fluid, or medication NICE NG128. If problems are indicated, a specialist assessment is required, preferably within 24 hours and no more than 72 hours NICE NG128.
- Modified Oral Nutrition Support: Healthcare professionals should consider the risks and benefits of modified oral nutrition support NICE CG32. This includes modifying fluid and food textures and flavours NICE NG62. People with dysphagia on modified food and liquid should be regularly monitored and reassessed until stable NICE CG32.
- 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) NICE NG128. A nasal bridle tube or gastrostomy may be considered if a nasogastric tube is not tolerated NICE NG128.
- Supportive Strategies: An individualised plan for managing eating, drinking, and swallowing difficulties should assess the role of postural management and positioning when eating NICE NG62. 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 NICE NG62.
- 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 NICE CG32. For those with acute stroke, oral medication should be reviewed to amend either the formulation or the route of administration NICE NG128.
- 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 NICE CG32.