A lot of us look forward to eating food and enjoying our mealtimes every single day. For some, eating food is more than just fuelling the body – it is about the entire experience that a mealtime can bring into someone’s life. For example, the pleasure of eating your favourite soup on a cold day, sitting with friends and family over mum’s infamous roast, or celebrating a big life event over cocktail food and drinks.
Our lives can sometimes revolve around food and drinks, and it makes up a considerable portion of our day, including deciding what and when to eat or drink. So what happens when something goes wrong?
Dysphagia and Speech Pathologists
You start to notice that your loved one is coughing more with their food, or perhaps they are taking longer than usual to eat their food. ‘Dysphagia’, the clinical term for swallowing difficulties, is surprisingly common amongst the Australian population. Speech Pathology Australia indicates that, ‘a significant proportion (16-22%) of Australians over the age of 50 years’ experience dysphagia (difficulty swallowing, either solids and/or liquids).’
Dysphagia can be caused by several age-related health conditions including stroke, neurological-progressive conditions such as Parkinson’s Disease, Dementia, as well as a consequence of normal ageing. Additionally, it is not isolated to the elderly population, as many individuals with life-long disabilities will also experience swallowing difficulties.
Speech Pathologists are highly trained to work with individuals across the lifespan and all populations to diagnose and manage dysphagia. There are several steps they will take to thoroughly assess, diagnose and treat swallowing difficulties.
It is important that if you, or someone that you know is experiencing swallowing concerns, that they are individually assessed and treated by a qualified Speech Pathologist. This is because every individual will have unique circumstances that will inform the clinician’s decisions and advice with managing your concerns. It is also critical that your family members, close support systems or staff members and carers working with a person are well-informed of the person’s dysphagia management plan.
What does a swallowing and mealtime assessment look like?
Regardless of the individual’s age, health conditions, or prognosis, the general steps that your Speech Pathologist will follow to assess, diagnose, and treat dysphagia will mostly follow a similar framework.
The Swallowing and Mealtime assessment process:
Someone – i.e. the individual themselves, a family member, support worker or carer identifies a swallowing concern. You can find our ‘Dysphagia Checklist’ here, which outlines the key signs to look out for with regards to a potential swallowing concern.
If one or more of these key signs of dysphagia are identified, please seek support from a Speech Pathologist. You can do this by enquiring on our website, looking on the Speech Pathology Australia website, speaking with your NDIS case manager/coordinator, or General Practitioner.
The Speech Pathologist will gather ‘case history information’ regarding the individual’s personal circumstances – such as age, medical history, current concerns and more. This background information is important, as the Speech Pathologist only sees the individual for a short assessment time, compared to others who spend most of their time/day with the person experiencing the difficulty.
The Speech Pathologist (with your consent) will complete a mealtime assessment – observing the person with a meal and drink, to observe what challenges they are experiencing.
The SP may also request to complete an ‘Oral Peripheral Examination’, or an ‘OPE’ for short. This is a short assessment that looks at the strength, range of movement, and symmetry of oral and facial structures that are involved in the swallowing process, and may be contributing to difficulties.
The Speech Pathologist will inform the patient and their supports of the assessment findings – i.e. what are the person’s strengths and difficulties with mealtime participation and swallowing. The SP will make clinical recommendations, based on these assessment findings. The SP will write-up these findings as a case note, mealtime assessment report and/or handout for the patient and close others to refer to.
The Speech Pathologist will provide education on food and fluid modifications and safe swallowing strategies to the patient and their family supports.
Recommendations made by the SP are not necessarily just eliminating difficult foods – there is a lot more to consider than this!
The patient and their support will follow the recommendations. The therapist will check in and reassess within 1-2 weeks of the mealtime assessment to see how the implemented changes are going.
Our Speech Pathologists understand not just the physical difficulties that come with dysphagia, but also the mental and social aspects. We want to work closely with you and your family to help you manage your dysphagia in a way that honours your physical needs, but also consider your choice and control over your mealtime decisions.
Need a mealtime assessment?
Has anybody come to mind when reading this article that might need a mealtime or swallowing assessment? We’re here to help. Book an assessment with our Speech Pathology team today. We have Speech Pathologists available within Aged Care Homes, In-Home Services, and through our Clinic.
Assessments can be made face-to-face or via telehealth.
Our Dysphagia Checklist
Coughing or choking episodes on any food or fluids
Unexplained weight loss or reduction in appetite, such as not finishing all of their meals consistently
‘Wet’ sounding or gurgilness in the voice during or after mealtimes and drinking
Food or fluids getting stuck in the oral cavity, remaining in parts of the mouth after swallowing referred to as ‘residue’
Re-occurring chest infections or fever
Increased mealtimes, slower eating compared to the person’s usual pace during meals
Taking multiple swallow attempts to get food or fluids down
Having dentures that do not fit properly, or a patient who does not want to wear their dentures at all (will significantly impact chewing abilities)
Any other changes to behaviours during mealtimes such as ‘picking’ at food, refusing to eat, becoming frustrated or aggressive during meals, impulsive eating
Download our Dysphagia Checklist here.