Swallowing disorders are not scary, home care can help

Dysphagia is one of the common geriatric syndromes. With the accelerated aging of my country's population, the number of patients with swallowing dysfunction caused by aging, degenerative changes, stroke, and postoperative pharyngeal and laryngeal tumors is increasing, becoming a major problem affecting the physical health and quality of life of the elderly.

Dysphagia is a common symptom in clinical practice. The incidence of dysphagia in neurological diseases is 64% to 78%. The overall prevalence of dysphagia in Chinese elderly people is 38.7%. The prevalence of dysphagia in the general community elderly population is 10.63% to 13.9%, and that in nursing institutions is 26.4% to 32.5%.

1. What is dysphagia?

Dysphagia refers to the process in which food cannot be safely and effectively transported to the stomach due to damage to the structure and/or function of organs such as the mandible, lips, tongue, throat or esophagus. Dysphagia has a high incidence and is prone to complications such as aspiration, aspiration pneumonia and malnutrition, increasing the risk of infection. In severe cases, it can lead to multiple organ failure and even endanger life.

2. What are the clinical manifestations of dysphagia?

1. Food is retained in the mouth and needs to be chewed repeatedly before it can be swallowed;

2. Frequent reflux from the mouth and nose, drooling or excessive sputum with food residues in the sputum;

3. There is a foreign body sensation in the throat and a burning sensation when swallowing;

4. Recurrent fever or aspiration pneumonia of unknown cause;

5. Hoarseness and turbidity of voice after eating; sudden difficulty breathing and wheezing;

6. Weight loss and decreased resistance.

When a patient has any of the above problems, it indicates possible swallowing disorder and further swallowing function examination is required.

3. Preliminary screening method for dysphagia - Kubota drinking test

In clinical practice, nurses conduct a preliminary screening for dysphagia on admission of such patients, using the Kubota water swallowing test. The WST (water swallowing test) was proposed by Japanese scholar Kubota Toshio in 1982 and is now a widely used classic initial screening method.

It is simple to operate, non-invasive and safe. It is a widely used preliminary screening method in clinical practice and is currently the most widely used method for early aspiration screening and dysphagia diagnosis in clinical practice. It is worth noting that patients who reach level III or above in the Kubota water drinking test are at high risk of aspiration and need to be taken seriously.

4.What are the dangers of swallowing disorders?

The occurrence of dysphagia can cause aspiration, suffocation, psychological disorders, aspiration pneumonia and even death, bringing heavy burdens to families and society. **Dysphagia rehabilitation treatment and care need to be carried out as early as possible to promote patient recovery and improve the quality of life.

5. Rehabilitation training for dysphagia

Rehabilitation training can be divided into indirect training (basic training) and direct training (feeding training) using food and compensatory means such as body position and food type.

1. Basic training (indirect training): sensory motor training techniques, airway protection techniques, electrical stimulation, magnetic stimulation, etc.

2. Feeding training (direct training) Feeding training starts after basic training.

(1) Body position: The patient lies in the supine position with the trunk flexed 30° and the head flexed forward, and the shoulder on the hemiplegic side is supported by a pillow.

(2) Food type: Food type should be selected based on the principle of easy first and then difficult, while taking into account the color, aroma, taste and temperature of the food.

(3) The amount of food you eat in each bite: A normal person’s mouthful is about 20 mL. If you eat too much in one bite, food may leak out of your mouth or cause food residue in the throat, leading to accidental swallowing. If you eat too little in one bite, it will be difficult to induce a swallowing reflex due to insufficient stimulation.

(4) Others: combined with acupuncture, hyperbaric oxygen, rehabilitation gymnastics for dysphagia, psychological rehabilitation, etc.

6. Prevention and treatment of aspiration

If aspiration is detected, check the oropharynx first. If a foreign body is found, remove it immediately. Quickly turn the patient's head to one side, immediately wrap the index finger with a towel or cloth, extend the finger from the entrance to the pharyngeal wall, feel the foreign body and quickly remove it until it is completely removed. If the foreign body is not removed, a negative pressure suction device can be used to directly suction it. Immediately perform intermittent positive pressure breathing, first with pure oxygen. If the aspiration time is long, positive end-expiratory pressure ventilation can be performed to expand the alveoli again.

7. Prevention and treatment of suffocation

The Heimlich maneuver is the recommended first choice for emergency treatment of suffocation. Key points of operation: impact the abdomen and soft tissue under the diaphragm of the person who has inhaled foreign objects, thereby generating upward pressure, which in turn squeezes the residual gas in the lungs to form an upward airflow, so that the foreign objects blocked in the trachea are impacted outward.

8. Health guidance for swallowing disorders

1. Provide patients with food that is easy to swallow. According to their chewing, swallowing function and consciousness, the food selection should gradually transition from full liquid food to semi-liquid food and normal food. When eating, patients should be placed in a sitting or semi-sitting position to maintain a comfortable position, and lie on the right side after eating.

2. Encourage patients to cough and expectorate and do breathing exercises to promote the recovery of protective physiological reflexes, assist patients in expectorating, and keep the airway open.

3. During home care, community nurses provide individualized dysphagia health education based on the specific circumstances of the patient and family members.

Instruct patients on compensatory eating methods and how to judge and deal with aspiration, educate patients on maintaining oral hygiene and explain the basic knowledge of dysphagia, how to cooperate with the screening and assessment of dysphagia, swallowing function training, feeding training, aspiration first aid and other related knowledge.

The rehabilitation of dysphagia is a systematic and holistic process. Through the "hospital-community-family" continuous rehabilitation care model, we can better manage the patient's food intake, improve dysphagia, prevent complications, and thus promote the recovery of the patient's swallowing function and return to family and society as soon as possible.

References

[1] Chinese Geriatrics Research Association, Elderly Health Services and Standardization Branch, Editorial Committee of Chinese Geriatrics Journal. Expert consensus on rehabilitation nursing and care for swallowing dysfunction in Chinese communities[J]. Chinese Geriatrics Journal, 2019, 17(4): 7-15.

[2] Rehabilitation Nursing Committee of the Chinese Rehabilitation Medicine Association. Expert consensus on rehabilitation nursing for dysphagia[J]. Journal of Nursing, 2021, 36(15): 1-4.

[3] Zheng Cai'e, Li Xiuyun. Practical rehabilitation nursing[M]. People's Medical Publishing House, 2020: 282-284.

[4] Zhang Mengmeng, Sun Jie, Chen Wei, et al. Effect of gag reflex function on the accuracy of Kubota drinking test in assessing dysphagia[J]. Chinese Journal of Rehabilitation, 2020, 35(10): 529-531.

[5] Wang Yongjun, Xu Anding, Dong Qiang, et al. Cerebrovascular Disease in China[M]. People's Medical Publishing House, 2019: 412-416, 445-465.

[6] Chinese Nursing Association - Group Standard on Aspiration in the Elderly (issued on January 31, 2023, implemented on May 1, 2023)

author:

Wu Yunfeng Gao Caiping Shanghai Tongji University Affiliated Yangzhi Rehabilitation Hospital

Shen Hongbin, Zhongshan Street Community Health Service Center, Songjiang District, Shanghai

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