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  • DIFFICULTY IN SWALLOWING OR CHEWING? DO YOU KNOW THAT DYSPHAGIA EXISTS?
    dysphagia

    Have you ever, in interaction with your parents or grandparents, witnessed a moment when someone choked during a meal? Or has this happened several times? This problem exists and may have a name: dysphagia. And no, it is not normal for a member of your family to have difficulty swallowing while having their meal. Let’s understand a little better what Dysphagia is?

    It is estimated that 10 to 20% of seniors have difficulties in swallowing drinks or food, that is, moving the bolus from the mouth to the esophagus. They tend to change their food choices to ones that are easier to chew, but nutritionally poorer and more monotonous, contributing to unintended weight loss.

    This symptom is defined as dysphagia, and is characterized as an alteration in the swallowing of liquid and/or solid food, encompassing all motor, behavioral, sensory, and preliminary swallowing acts. Thus, dysphagia represents an important commitment to the well-being and social aspects associated with the individual’s diet.

    Know some factors that negatively influence swallowing:

    • Advanced age
    • cognitive alterations
    • neurological diseases
    • oncological diseases
    • Sensory deficits (visual, gustatory, olfactory)
    • Compromised oral health
    • Dependence for food
    • Taking some drugs
    • Apraxia, that is, inability to normally perform coordinated movements

    Dysphagia is particularly prevalent in individuals with neurological diseases such as Parkinson’s disease and Alzheimer’s disease, both of which are especially prevalent in older adults. However, it is an underdiagnosed disease, with approximately 75% of dysphagia cases remaining undiagnosed.

    Dysphagia, if not identified, diagnosed, and treated, can cause: involuntary loss of weight and muscle mass, malnutrition, and dehydration due to a decrease in intake.

    Dysphagia is a determining factor for a poor clinical prognosis, causing decreased functional capacity, episodes of aspiration pneumonia, and, consequently, frequent and prolonged hospital stays.

    These are signs of dysphagia and warning signs of difficulty in swallowing:

    • Choking episodes during and outside meals;
    • The need to make several attempts to swallow; 
    • Cough during or after a meal;
    • Between others.

    Thus, choking on food, water, or other liquids is not understood as “normal” in seniors. And they can cause respiratory infections or aspiration pneumonia because instead of swallowing food, the individual inhales and passes it to the lungs.

    The severity of dysphagia can range from moderate difficulty to complete impossibility of swallowing.

    The modified texture diet is indicated in situations where there are recurrent episodes of choking, lack of teeth, and cognitive deficit. This type of diet reduces the risk of choking, by reducing motor and oral processing. Furthermore, it promotes greater and better food intake, combating fatigue associated with the eating process. However, artisanal-confection modified texture diets can compromise nutritional intake, particularly in seniors, so ready-to-use meal versions, such as Meritene® adapted basic food solutions, can and should be considered in nutritional intervention and dysphagia rehabilitation, as well as Resource® oral nutritional supplements and thickeners with adapted texture, according to the doctor’s advice.

    Often, individuals with dysphagia have a water intake that is frankly lower than their needs, and they also need to resort to the use of thickeners to adapt the viscosity of the liquids to be ingested. It is essential to emphasize the importance of hydration in the proper consistency, using traditional drinks such as water, or flavored waters, infusions, and diluted juices.

    Adaptations to the texture of the diet and liquids can be achieved, in an artisanal way, through practical solutions:

    • Crush food using a fork, ensuring a soft and smooth texture;
    • Grind food using a blender, ensuring a homogeneous texture;
    • Add cooking sauces, milk, cream, butter to crushed foods to provide greater creaminess;
    • Avoid fruit with seeds (e.g. kiwi, strawberry) or juicy (e.g. citrus fruit, pineapple, plum), fibrous foods (e.g. green beans, sprouts, cod, mango, pineapple) or dishes with two consistencies, that is, solid and liquid (eg, soup with pasta or rice, gelatin) as they make it difficult to form a cohesive food cake.

    To facilitate swallowing, you can use a dessert spoon to eat meals and control the volume of food in the oral cavity, avoiding the use of straws and syringes. The approach to the dysphagic patient should be carried out by a multidisciplinary team, which includes the nutritionist and the speech therapist, who can assess them in their various dimensions and enhance their rehabilitation.

Thanks for reading.

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