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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 2004, more than 12% of the population in the United States was aged 65 years or older. This percentage is expected to increase to 20% of the population by 2030. The prevalence of swallowing disorders, or dysphagia, in older individuals ranges from 7% to 22% and dramatically increases to 40% to 50% in older individuals who reside in long-term care facilities. For older individuals, those with neurologic disease, or those with dementia, the consequence of dysphagia may be dehydration, malnutrition, weight loss, and aspiration pneumonia. Dysphagia can be a result of behavioral, sensory, or motor problems (or a combination of these) and is common in individuals with neurologic disease and dementia. Although there are few studies of the incidence and prevalence of dysphagia in individuals with dementia, it is estimated that 45% of institutionalized dementia patients have dysphagia. The high prevalence of dysphagia in individuals with dementia likely is the result of age-related changes in sensory and motor function in addition to those produced by neuropathology. The following article describes evidence based practices in caring for those individuals with dementia and dysphagia with guidelines for evaluation and management.
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PMID:Dementia and dysphagia. 1869 3

Prevention of complications is the primary goal in patients with dysphagia. The most common complications of dysphagia are aspiration pneumonia, malnutrition and dehydration; other possible complications, such as intellectual and body development deficit in children with dysphagia, or emotional impairment and social restriction have not been studied thoroughly. Pulmonary complications of dysphagia should be viewed as an impaired balance between defence mechanisms (cough and mucociliary action, lymphatic clearance and cellular immune defences) and food and secretions aspiration. The main pulmonary complications are aspiration pneumonia, toxic aspiration syndromes, bacterial infections and pulmonary fibrosis. The risk of aspiration pneumonia is increased by poor oral status and health status, dependency for oral care and oral feeding; nonetheless, compliance with feeding recommendations of the dysphagia team, may reduce the risk of pulmonary complications. Malnutrition and dehydration are common in patients with dysphagia; however, enteral nutrition may significantly impact on both. Even though a relationship between malnutrition, dehydration and dysphagia exists, the real impact of one on the others is not known.
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PMID:What we don't know about dysphagia complications? 1876 23

The aim of treating head and neck cancer is to eliminate the tumor and save functions as much as possible. Despite all efforts the vital (swallowing) and communicative (phonation, articulation) functions can be injured. The treatment of dysphagia is the most important in the rehabilitation, because it can lead to fatal complications: aspiration pneumonia (for example aspiration of saliva), dehydration, malnutrition. According to the localization of the lesion we distinguish oropharyngeal and esophageal dysphagia. The aspiration may be pre-, intra- and post-deglutition. The aspiration without coughing is called silent aspiration which is mainly seen in neurogenic dysphagia, but can also happen in head and neck cancer patients. There are different possibilities to compensate the failing functions in the phoniatric rehabilitation. The swallowing therapy includes causal, compensatory and dietary strategies. In addition to the swallowing therapy the treatment of communicative dysfunctions with articulation exercises will also improve the quality of life of the patients.
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PMID:[Phoniatrics in the rehabilitation for head and neck cancer]. 1884

Radiation-induced mucositis (RIM) is a common toxicity for head and neck cancer (HNC) patients. The frequency has increased because of the use of more intensive altered radiation fractionation and concurrent chemotherapy regimens. The extent of the injury is directly related to the mucosal volume irradiated, anatomic subsite exposed, treatment intensity, and individual patient predisposition. The consequences of mucositis include pain, dysphagia including feeding tube dependency, dehydration, micronutrient deficiencies, weight loss, and potentially life-threatening aspiration. Currently, there is no Food and Drug Administration-approved cytoprotective agent that reliably prevents RIM for HNC, but several are under investigation. Strategies to limit the extent of mucositis and to manage its symptoms include basic oral care and supportive medications. Limiting the use of aggressive treatments to truly high-risk cancers and special attention to radiation therapy planning techniques can also help restrict the scope of the problem. This review focuses on mucositis recognition, patient treatment selection, and RIM symptom-management strategies.
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PMID:Strategies for managing radiation-induced mucositis in head and neck cancer. 1902 43

Recently, many medical professionals become to realize eating problem affect deeply patient's quality of life (QOL), and they are very interested in dysphagia rehabilitation. I overviewed dysphagia rehabilitation along with the followings; (1) impact of dysphagia, (2) assessment of dysphagia, and (3) management of dysphagia. Eating is the most enjoyable activity. Dysphagia changes this enjoyable activity to the most fearful one. Dysphagia makes three major problems: risk of aspiration pneumonia and suffocation, risk of dehydration and malnutrition, and depriving enjoyable activity. As a recent conceptualization of eating, the Process model is the most important, that reveals eating (chew-swallow) is very different from just chewing plus swallowing in physiologically. In assessment, standardized functional tests such as the Repetitive saliva swallowing test, the Modified water swallowing test, and the Graded food test are used. The most important point in clinical assessment is identifying indication of direct therapy using food or starting period of oral feeding. Videofluorographic and videoendoscopic examinations are used as precise diagnostic and management-oriented assessment tools. In management, exercise, posture adjustment, and modification of food promote eating possibility. Oral care is essential in dysphagic patients. Surgical intervention is effective method if a patient has severe dysphagia.
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PMID:[Dysphagia rehabilitation]. 1919 4

The risk for disordered oropharyngeal swallowing (dysphagia) increases with age. Loss of swallowing function can have devastating health implications, including dehydration, malnutrition, pneumonia, and reduced quality of life. Age-related changes increase risk for dysphagia. First, natural, healthy aging takes its toll on head and neck anatomy and physiologic and neural mechanisms underpinning swallowing function. This progression of change contributes to alterations in the swallowing in healthy older adults and is termed presbyphagia, naturally diminishing functional reserve. Second, disease prevalence increases with age, and dysphagia is a comorbidity of many age-related diseases and/or their treatments. Sensory changes, medication, sarcopenia, and age-related diseases are discussed herein. Recent findings that health complications are associated with dysphagia are presented. Nutrient requirements, fluid intake, and nutrition assessment for older adults are reviewed relative to dysphagia. Dysphagia screening and the pros and cons of tube feeding as a solution are discussed. Optimal intervention strategies for elders with dysphagia ranging from compensatory interventions to more rigorous exercise approaches are presented. Compelling evidence of improved functional swallowing and eating outcomes resulting from active rehabilitation focusing on increasing strength of head and neck musculature is provided. In summary, although oropharyngeal dysphagia may be life threatening, so are some of the traditional alternatives, particularly for frail, elderly patients. Although the state of the evidence calls for more research, this review indicates that the behavioral, dietary, and environmental modifications emerging in this past decade are compassionate, promising, and, in many cases, preferred alternatives to the always present option of tube feeding.
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PMID:Senescent swallowing: impact, strategies, and interventions. 1948 69

Elderly people have an increased risk to suffer from dysphagia due to age-related physiological alterations and neurological disorders. The consequences of untreated dysphagia are malnutrition and dehydration and the aspiration of solid and liquid food into the respiratory tract, which can lead to life-threatening pneumonia. On this background the care of the elderly people in nursing homes is a challenge for nurses. The aim of this literature review is to identify suitable screening tools and to evaluate their practicability for nurses' everyday work. The database search was conducted in CINAHL, Ovid Medline and EMBASE. Ten screening tools fitted the selection criteria. Most of them are developed by speech and language therapists and physicians, only two tools are designed by nursing scientists. A swallowing test is part of all screening tools; the target population are stroke patients in their acute phase. Other relevant criteria besides the swallowing test are, e. g. the patients' health status, taking of psychotropic drugs, and posture. All instruments are described as simple to use. They are tested for validity, and sometimes for reliability, but the tools are mostly not appropriate for the use in institutional geriatric care settings. The two instruments developed by nurse scientists are only of limited use in nursing homes, because both instruments were not tested in nursing homes and only one of these tools shows acceptable values of interrater reliability and criterion-related validity. As a result, a screening tool for the target group and a training programme for nurses should be developed.
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PMID:[Risk for dysphagia screening tools - a review of the international literature]. 1949 32

This study reports the development of a simple Chinese Prognostic Scale (ChPS) for predicting survival in advanced cancer patients. Data relating to 1,019 advanced cancer patients referred to a palliative home care service were retrospectively analyzed. The records were divided into two sets using stratified random sampling: 80% as a "training set" for developing the scale and 20% as a "testing set" for validating it. Demographic data, symptoms/signs, Karnofsky Performance Status (KPS), quality of life (QOL), and survival time were statistically analyzed to create the scale. In the training set, a total of 10 prognostic factors were determined: weight loss, nausea, dysphagia, dyspnea, edema, cachexia, dehydration, gender, KPS, and QOL. The ChPS score was calculated for each case by summing the partial scores of prognostic factors, ranging from 0 (no altered variables) to 124 (maximal altered variables). The score for a cutoff point of three months' survival was 28 (95% confidence interval: 26.6, 28.9). When scores were more than 28, survival appeared to be usually less than three months. The accuracy rate was 69.4% in the training set and 65.4% in the testing set. In conclusion, it is possible with this prognostic scale to guide physicians in predicting more accurately the likely survival time of Chinese cancer patients, and to help policy makers in establishing appropriate referral for hospice care.
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PMID:Prediction of survival time in advanced cancer: a prognostic scale for Chinese patients. 1960 78

Swallowing disorders (or dysphagia) are common in the elderly and their prevalence is often underestimated. They may result in serious complications including dehydration, malnutrition, airway obstruction, aspiration pneumonia (infectious process) or pneumonitis (chemical injury caused by the inhalation of sterile gastric contents). Moreover the repercussions of dysphagia are not only physical but also emotional and social, leading to depression, altered quality of life, and social isolation. While some changes in swallowing may be a natural result of aging, dysphagia in the elderly is mainly due to central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors. To be effective, management requires a multidisciplinary team approach and a careful assessment of the patient's oropharyngeal anatomy and physiology, medical and nutritional status, cognition, language and behaviour. Clinical evaluation can be completed by a videofluoroscopic study which enables observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. The treatment depends on the underlying cause, extent of dysphagia and prognosis. Various categories of treatment are available, including compensatory strategies (postural changes and dietary modification), direct or indirect therapy techniques (swallow manoeuvres, medication and surgical procedures).
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PMID:[Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly]. 1962 4

Oropharyngeal dysphagia, or inability to swallow liquids and/or solids, is one of the less well known geriatric syndromes, despite its enormous impact on functional ability, quality of life and health in affected individuals. The origin of oropharyngeal dysphagia can be structural or functional. Patients with neurodegenerative or cerebrovascular diseases and the frail elderly are the most vulnerable. The complications of oropharyngeal dysphagia are malnutrition, dehydration and aspiration, all of which are serious and provoke high morbidity and mortality. Oropharyngeal aspiration causes frequent respiratory infections and aspiration pneumonias. Antibiotic therapy must cover the usual microorganisms of the oropharyngeal flora. Oropharyngeal dysphagia should be identified early in risk groups through the use of screening methods involving clinical examination of swallowing and diagnostic confirmation methods. The simplest and most effective therapeutic intervention is adaptation of the texture of the solid and the viscosity of the liquid.
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PMID:[Oropharyngeal dysphagia and aspiration]. 1991 46


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