Recognizing and treating malnutrition in older adults with dysphagia
Intervention, monitoring and dietary changes are essential for care
By Medline Newsroom Staff | September 30, 2021
Dysphagia, a common condition affecting up to 33% of older adults and 70% of nursing home residents, is significantly and independently associated with malnutrition, according to recent research. Left untreated, malnutrition can cause weight loss, dehydration, a weakened immune system, poor wound healing or skin tears, muscle weakness, fatigue and confusion.
As October 4-8 is Malnutrition Awareness Week, the Medline Newsroom spoke with a registered dietitian and a speech pathologist on the rise in dysphagia and associated malnutrition in older adults, and the importance of early intervention, treatment, monitoring and dietary changes for these patients. Evelyn Phillips, MS, RD/LDN, CDE, is a clinical nutrition manager at Magee Rehab Hospital in Philadelphia. David Hutchings, MD, is a licensed speech-language pathologist and chief operations officer of Spectramed, a leading provider of electrotherapy and education courses with a focus on dysphagia.
Medline Newsroom: How common is malnutrition in patients with dysphagia?
Phillips: Dysphagia, or difficulty swallowing, is under recognized in the general, elderly population, especially among those who live independently. Often, these individuals end up in the hospital or post-acute care setting, and eventually, in a long-term care facility. It often then that they are diagnosed with dysphagia. Many of these patients also struggle with eating and nutrition.
Dr. Hutchings: Dysphagia is an incredibly common symptom of so many illnesses, and malnutrition is a common, often hidden and undiagnosed symptom of dysphagia. We often associate aspiration with dysphagia, but we forget about the other clinical symptoms that can lead to additional co-morbidities, such as weight loss and dehydration.
Medline Newsroom: Are there any co-conditions or co-morbidities that place patients with dysphagia at greater risk of malnutrition?
Phillips: Most co-morbidities can impact nutrition status, and people living with diabetes, obesity, cancer, cardiovascular disease and/or dysphagia are at greatest risk. In addition, food insecurity, including an inability to shop or prepare food, can cause malnutrition. And the impact can be cyclical. For example, dysphagia can lead to malnutrition, which causes fatigue and lead to continued poor nutrition intake. A malnourished individual may also grab soup, cereal or another mixed consistency liquid with solids because they are easy to prepare. And yet, these are among the hardest for dysphagia patients to manage.
Dr. Hutchings: Dysphagia and malnutrition are especially common in dementia patients, as changes in the brain, as well as external stimuli – loud noises, for example — can impact an individual’s ability to eat, drink or swallow. I would say that 100% of our dementia patients – whatever type of dementia they have – will have dysphagia and weight loss associated with malnutrition.
Medline Newsroom: What are the signs of malnutrition in patients with dysphagia?
Phillips: Standard screening tools in a hospital or long-term care setting that look at body mass index (BMI), food intake, weight changes, vitamin deficiencies and muscle wasting can help to identify malnutrition. I’m also a big proponent of looking at a patient’s oral cavity, checking to see how thick their saliva is. If the patient is trying to talk, and they have bands of secretions, this may indicate that they are not getting enough fluids. They also may be too weak to talk. In the hospital, without intervention, these patient will continue to decline.
Dr. Hutchings: Weight loss, dehydration, skin breakdown, muscle atrophy, tears and development of wounds, are all signs of malnutrition in dysphagia patients, and may be exacerbated if the patient has a terminal illness. We also may see increased confusion in these patients. Sometimes the symptoms of malnutrition are misdiagnosed as a urinary tract infection.
Medline Newsroom: How are patients with dysphagia and malnutrition diagnosed and treated?
Phillips: In the hospital, a speech pathologist and dietitian should both be involved in creating and overseeing the dysphagia assessment and treatment plan. Typically, patients are monitored during meals. An oral, nutritional supplement may be recommended. The person will be assessed for which level thickness of food and liquids they are safely able to swallow. The International Dysphagia Diet Standardization Initiative (IDDSI) consists of a continuum of eight levels that assess the thickness of foods and drinks. The nutritional supplement consistency should match the individual’s ability to swallow. In addition, we must take into consideration the temperature of the supplement and whether or not it supplement will melt in a person’s mouth, which can be dangerous for someone with dysphagia. Supplements should stay the same consistency the entire time the person is eating/drinking.
Dr. Hutchings: All dysphagia patients – in a long-term care facility or at home with a caregiver – should have their weight checked each week, and their food and liquid intake should also be monitored. It’s also important to manage any related symptoms, including anxiety, depression or malnutrition. For dysphagia with malnutrition, a speech pathologist and dietician should work together to manage and address the patient’s dysphagia and nutrition.
Because of the high risk of malnutrition in dysphagia patients, early diagnosis and treatment of dysphagia is important to preventing malnutrition and other associated conditions.
Medline and Spectramed have partnered to sell Spectramed’s dysphagia therapy devices, utilizing neuromuscular electrical stimulation (NMES), surface electromyography (SEMG) and biofeedback, to provide individualized treatment for patients.
Learn more about Medline’s comprehensive therapy and rehabilitation solutions.