BY COLETTE ELLIS M.ED., CCC-SLP, BCS-S
Dysphagia, or having difficulty swallowing, can affect upwards of 15 million adults in the United States alone. Research has demonstrated that as many as 1 in 25 individuals will experience some form of dysphagia in their lifetime, including 22% of those 50 years of age and older (ASHA 2018; Bhattacharyya, 2014). In the elderly, these percentage may be as high as 30% receiving inpatient medical treatment (Lane, Losinski, Zenner, & Amet, 1989). 68% of residents in long-term care setting may experience dysphagia according to the National Institute on Deafness and Other Communication Disorders (NIDCD, n.d.; Steele, Greenwood, Ens, Robertson, & Seidman-Carlson, 1997). In the “healthy elderly,” dysphagia may occur between 13-38% among those living independently.
Dysphagia does not discriminate, rich or poor, young or old. If a swallowing problem occurs in the teen population, it is typically a continuation of a feeding/swallowing problem which was present as a younger child, such as the growing child with cerebral palsy. New onset dysphagia in teens or younger children may be related to specific choking episodes or a sudden onset such as a traumatic brain injury (TBI) (Swigert, NFOSD, 2015). Second only to children 0-4 years of age, teenagers and young adults ages 15-24 experience the most TBI injuries, which can also present with dysphagia (http://www.cdc.gov/traumaticbraininjury/data/). Dysphagia has been estimated to occur in 13% of those individuals suffering a TBI, with gunshot wounds that cause TBI, producing dysphagia upwards of 37% of the time.
This medical condition can often be neglected or misdiagnosed, despite the significand prevalence across all ages. Education and timely referrals are potential keys to successful recovery or management of dysphagia. Including the above, dysphagia can be a consequence of stroke, head and neck cancer, neurological disease onset, Alzheimer’s dementia and other dementias, Parkinson’s disease, and congenital onset conditions. Speech-language pathologists are highly trained in head and neck anatomy/physiology, and can, with collaboration with the patient’s physician, evaluate and treat many forms of swallowing disorders or dysphagia.
But what does all this mean? What are the consequences of dysphagia? In children, dysphagia can lead to failure to meet nutritional and hydration needs, including failure to thrive in infants (Vivanti, Cambell, Suiter, Hannen-Jones, Hulcomb, 2009; Hays & Roberts, 2006). Severe consequences of dysphagia can include asphyxiation and death across all ages (Berzlanovich, et al, 2005), depression and isolation with negative impact on social well-being (Ekberg, et. al, 2002), as well as potential delayed or disordered development of oral and communication skills (Barbosa, Vasquez, Parada, Carlos, Gonzalez, Jackson, 2009; Morris & Klein, 2000). Another obvious, or maybe not so obvious consequence of dysphagia is pneumonia.
In order to evaluate and treat dysphagia, the speech-language pathologist must know how, when and why the symptoms are occurring. After a thorough case history is reviewed, a clinical swallow examination would be in order; in other words, watch the infant, child or adult eat and drink, regardless of their physical setting. If choking or coughing symptoms are noted, along with other risk factors such as recent hospitalizations, poor weight gain, change in current function, pneumonia onset, dehydration with urinary tract infection (UTI), a swallow instrumentation study may be necessary. These studies (the modified barium swallow study MBSS or the fiberoptic endoscopic examination of swallowing, FEES) would identify the anatomy and physiology of that individual’s current status and swallow, while enabling the skilled SLP to trial maneuvers, compensation or exercise while the swallow is “in view,” and aid in treatment planning.
If you or someone you care about has been experiencing swallowing problems, encourage them to relay this to their physician and seek an evaluation from a speech-language pathologist skilled in evaluating and treating swallowing disorders. Eating and drinking have many social significances and being deprived of this basic pleasure would be detrimental. Think of this the next time you take that big drink of cool, refreshing water.
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Here are a few resources to get more information:
- Colette gives live workshops and webinars on this subject with TalkTools. Check out the event calendar for the next dates!
- The American Speech & Hearing Association has many resources available on the topic of dysphagia.
- Patient support and education can be found on the Swallowing Disorder Foundation website.
- To find individuals who are board certified in swallowing & swallowing disorders in your area, visit the Swallowing Disorders website.
REFERENCES
ASHA, (2002). Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders, Position Statement
ASHA, End-of-Life Issues in Speech-Language Pathology, https://www.asha.org/slp/clinical/endoflife/
Barbosa,C., Vasquez, S., Parada, M.A., Carlos, Gonzalez, J.C., Jackson, C., Yanez, N.D., Gelaye, B., Fitzpatrick, A.L.(2009). The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers. BioMed Central Pediatrics, Oct 21;9:66. doi: 10.1186/1471-2431-9-66.
Berzlanovich, A.M., Fazeny-Dorner, B., Waldhoer, T., Fasching, P., Keil, W. (2005). Foreign body asphyxia: a preventable cause of death in the elderly, American Journal of Preventative Medicine, Jan;28(1):65-9.
Bhattacharyya, N. (2014). The prevalence of dysphagia among adults in the United States. Otolaryngology-Head and Neck Surgery, 151, 765-769.
Vivanti, Cambell, Suiter, Hannen-Jones, Hulcomb. (2009). Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalized patients with dysphagia. Journal of Human Nutritional Diet, Apr 22 (2)148-155.
Layne, K., Losinski, D., Zenner, P., & Ament, J. (1989). Using the Fleming Index of Dysphagia to establish prevalence. Dysphagia, 2, 216-219.
Morrison, et al., (2004). Palliative Care, NEJM, 350:2582-2590
Steele, C., Greenwood, C., Ens, I., Robertson, C., & Seidman-Carlson, R. (1997). Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia, 12, 43-50.
Swallowing Disorders Foundation: http://swallowingdisorderfoundation.com/dysphagia-in-teens-adults/ published 03-29-2015.