Say goodbye to the difficulty of swallowing and rebuild swallowing function - home rehabilitation guidance for patients with sarcopenia dysphagia

The human body has more than 600 muscles throughout the body, allowing us to blink, smile, stand, run and jump, and even eat, breathe and have a beating heart. In recent years, sarcopenia has gradually attracted attention, and you may think of thin arms and thin legs. Sarcopenia refers to a syndrome characterized by progressive, systemic, widespread decrease in skeletal muscle mass (content) and strength (intensity), including a decrease in the strength and mass of muscles involved in swallowing.

Swallowing refers to a series of continuous actions that occur when food passes through the mouth, pharynx and esophagus to the stomach, which requires the coordination of multiple muscles in the mouth, pharynx and esophagus. If any of these actions fails and food cannot smoothly reach the stomach from the mouth, it is called dysphagia. If dysphagia is caused by a decrease in muscles throughout the body and muscles related to swallowing, it is called sarcopenic dysphagia (sarcopenic dysphagia for short) . It should be noted that sarcopenia caused by neuromuscular diseases does not belong to sarcopenic dysphagia.

Take a test to see if you have swallowing difficulties

Eating and drinking are things we have to do every day. Almost everyone has experienced choking while drinking water or eating, but generally people don’t pay much attention to it. Little do they know that this seemingly ordinary little thing, if it happens frequently, especially in the elderly, must be taken seriously. It can cause a series of complications and may even be life-threatening.

The elderly may not know that they have swallowing problems. If they experience the following signs, they should be alert and seek medical attention immediately.

1. Long meal time;

2. Eating is particularly laborious;

3. Frequent coughing during or after eating;

4. The voice changes after eating;

5. Frequently clearing your throat after eating:

6. Frequent fever or lung infection.

If you find any of the above symptoms, you can do a simple test at home

Pour 30mL of warm water into a cup and drink water as usual, sit down and finish, record the time it takes to drink water, and observe whether there is choking or coughing. Refer to this table to know whether the swallowing function is abnormal. For people with grades 3 to 5, it is recommended to go to the hospital for professional examination.

In addition to the water drinking test, you can also take a screening questionnaire, answer the questions on the form one by one, score according to the actual situation, and finally calculate the total score. If it is ≥3 points, it means that you have problems with your swallowing function and you need to go to the hospital for further evaluation .

Dysphagia is also a risk factor for malnutrition in elderly patients. The mechanism behind sarcopenic dysphagia is thought to be a decrease in swallowing-related muscle mass and strength. Dysphagia increases the risk of malnutrition due to reduced oral intake. Patients who can achieve full oral intake without additional nutritional support are able to obtain a higher energy content from food compared to those who cannot obtain additional nutritional support through parenteral routes. Reduced nutritional support also leads to weight loss and interrupted skeletal muscle synthesis, which leads to further development of sarcopenia. Therefore, the vicious cycle of sarcopenia and dysphagia eventually becomes inevitable.

In addition, patients may also experience other malnutrition symptoms such as dehydration and weight loss, as well as resulting psychological and social interaction disorders in patients, affecting their quality of life, increasing medical costs and poor prognosis.

So, how do patients with sarcopenia dysphagia manage their diet?

In addition to daily intake of adequate energy and protein, effective means of preventing and treating sarcopenia dysphagia include adjusting the properties of food and providing appropriate dietary management plans based on the evaluation results of the patient's swallowing function. For patients who easily choke when drinking water, it is recommended to add an appropriate amount of thickener to the liquid to increase the viscosity of the liquid, slow down the flow rate of the liquid in the oropharynx, and prevent accidental swallowing; for patients who easily choke when swallowing solid food, it is recommended to cut the ingredients into small pieces, cook them soft, or use a blender to crush them into a puree, as puree foods have strong adhesion; for patients who easily leave residues in the pharynx, it is recommended to add an appropriate amount of gelling agent to reduce the adhesion of the food, making the food smooth and easy to swallow, and able to pass smoothly through the mouth, pharynx, and esophagus.

In addition, patients with sarcopenia dysphagia need to pay attention to the following points when eating:

1. Eat while being conscious;

2. Eat in a sitting or semi-sitting position, and place the food in the position in your mouth where you can feel the food best;

3. Eat in appropriate bite sizes;

4. Control your eating speed and eat the next bite after you finish swallowing the previous one to avoid eating two bites of food at the same time.

5. Patients with dentures should eat with them on;

6. For patients with cognitive impairment, appropriate password prompts can be given to them;

7. If choking or coughing occurs, stop eating;

8. Keep your mouth clean;

9. Stay in a sitting or semi-sitting position for more than 30 minutes after a meal.

Author: Wu Yunfeng Gao Caiping

Unit: Neurorehabilitation Center, Yangzhi Rehabilitation Hospital, Tongji University, Shanghai

Chief Judge: Zhai Hua (Shanghai Yangzhi Rehabilitation Hospital Affiliated to Tongji University, Vice Chairman of the Science Popularization Working Committee of the Chinese Rehabilitation Medicine Association)