Swallowing without difficulty is necessary to easily and safely consume food, drink and medication.
Swallowing difficulties, medically known as dysphagia, are most apparent to an older person, their family and hospital staff when the person is eating, drinking or taking medication. Swallowing difficulties can have an acute onset during illness and may be short term in nature or they can be a symptom of severe illness and become more severe due to neurological diseases such as Parkinson’s disease or dementia.
Mild swallowing difficulties are common in older people, particularly in those over the age of 80. There are many strategies we can implement to optimise food and fluid intake to avoid the difficulties becoming more severe and avoid a series of cascading risks.
This topic provides an overview of swallowing difficulties. It recommends actions that we and our organisations can take, in addition to health service policy and procedures, to provide quality care to older patients with swallowing difficulties.
Swallowing process and its impact on health
Swallowing difficulties can cause problems with drinking, eating, chewing, saliva, medications and protecting the airway. An older adult with swallowing difficulties is at increased risk of pain, choking, dehydration and malnutrition, aspiration and chest infections.
Swallowing and ageing
Dysphagia is not considered a normal part of ageing; however, it can occur due to the physiological ageing process, especially in people over 80.
Identifying people at risk of swallowing problems
Screening older people for swallowing difficulties is vital to avoid choking, dehydration, malnutrition and extended hospital stays. We need to be aware of the signs and gather information from patients, families and carers.
Responding to swallowing difficulties
There are many things we can do to improve a patient’s food and fluid intake and help prevent functional decline. Nutrition is a priority for everyone.
Swallowing and discharge planning
The ability to swallow and eat and drink easily is important for our health and wellbeing. As clinicians, we can help patients make a smooth transition from the hospital to their home or care facility.
Further information - swallowing
Educational and information resources available on swallowing with older people in hospital.
All public and private hospitals are required to be accredited to the Australian Commission on Safety and Quality in Healthcare’s (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards. The primary aims of the standards are to protect the public from harm and to improve the quality of health service provision. Assessment to the second edition of the NSQHS Standards commenced in January 2019. The second edition comprises eight standards that provide a nationally consistent statement about the level of care consumers can expect from health services.
The Comprehensive Care Standard (Standard 5) aims to ensure that patients receive comprehensive health care that meets their individual needs, and considers the impact of their health issues on their life and wellbeing. It also aims to ensure that risks of harm for patients during health care are prevented and managed through targeted strategies. These include integrating patient care processes to identify patient needs and identifying actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care.
Information is presented in the Older People in Hospital learning topics that complements Standard 5 and other NSQHS Standards including the; Partnering with Consumers Standard (Standard 2), Medication Safety Standard (Standard 4), Communicating for Safety Standard (Standard 6) and Recognising and Responding to Acute Deterioration (Standard 8).
Reviewed 04 October 2015