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Dysphagia, Behavior, and Quality of Life

  • D. A. de Luis
  • Mick P. Fleming
  • Colin R. Martin
Chapter

Abstract

Oropharyngeal dysphagia is associated with high mortality, morbidity, and cost. Estimates of the prevalence of dysphagia among individuals older than 50 years ranges from 15% to 22%. The correct evaluation of a patient with dysphagia must not only take into account the neurological history, together with the use of imaging techniques, but also any and all the medications the patient is taking. The technique to make a more objective diagnosis of the impairment of swallowing is videofluoroscopy with barium. This technique is not only useful in determining the diagnosis of impaired swallowing, but also in planning the therapeutic strategy in these patients. The treatment of these patients must utilize a multidisciplinary approach involving radiologists, gastroenterologists, dieticians, nurses, social workers, and nutritionists to lead the group. Enteral nutrition has proven its usefulness in patients with dysphagia, such as patients afflicted with stroke. A decrease in mortality was detected at 3 months of using a polymeric formula after stroke. Patients with oral nutrition problems must make progress in successive stages by changing the texture of food. It should be noted that according to different international guidelines for patients with dysphagia, they should receive diets with a phased modification of the food texture. In the first phase, thick purees are administered, and the patients are not allowed liquids, including water. The second phase allows certain fruit drinks, but still no water. The third stage includes the previous purees, e.g., eggs, cooked fish and vegetables, while the fourth phase allows any fluid intake and solid foods except those which are granular. The fifth phase is intended to be the resumption of a normal diet. Taking into account the difference in the consistency of food in these stages, the utility of providing these products is clearly not only the advantage of nutrition, but also the benefit from the texture of the food. Quality of life is impaired in patients with dysphagia and nutrition problems. In some studies, low body mass index, indicating protein caloric malnutrition, was found to negatively influence the quality of life in older adults. In some studies, no benefit in quality of life of administering oral dietary supplements to patients was detected. However, other studies have detected benefit on quality of life in malnourished patients receiving oral supplementation. Further studies in this interesting and important health area are needed.

Keywords

Amyotrophic Lateral Sclerosis Enteral Nutrition Percutaneous Endoscopic Gastrostomy Aspiration Pneumonia Carbohydrate Intake 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

NGT

Nasogastric tube

PEG

Percutaneous endoscopic gastrostomy

QOL

Quality of life

TPT

Transpiloric tube

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • D. A. de Luis
    • 1
  • Mick P. Fleming
  • Colin R. Martin
  1. 1.Institute of Endocrinology and Nutrition, Medicine School and Unit of Investigation, Hospital Rio Hortega. Hospital ClinicoUniversity of ValladolidValladolidSpain

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