A study carried out at a London teaching hospital has led to a new approach to reducing the risk of aspiration in people with dysphagia and dementia.
The study, carried out by Dharinee Hansjee, head of speech and language therapy at Queen Elizabeth Hospital, Lewisham and Greenwich Trust produced five key recommendations, known as the “5 Ms” aimed at improving safety and quality of life, all of which can be adopted by care homes.
As people age, the muscles involved in swallowing become weaker, which explains why swallowing difficulties are more common in older people Although many continue to manage a normal diet, others struggle with certain textures and consistencies of food and fluids, while others will choke on whatever they eat or drink. Dysphagia is particularly common in people with long-term conditions such as dementia and without effective management can lead to choking, aspiration pneumonia, malnutrition and dehydration.
Older people experience a number of physiological changes which affect their ability to swallow safely. These include:
- Diminished proprioception (the awareness of the position and movement of the body)
- Reduced muscle tone and bulk in the tongue and lips
- Altered saliva production
- Changes to the senses of taste and smell
- Reduced ability to adapt to physiological stressors eg infections and illnesses
- Poor oral health, painful teeth or ill-fitting dentures
The 5 Ms provide a framework that will help you to address these problems and reduce the risk of aspiration amongst your service users.
- MDT Involvement: Involving a speech and language therapist (SLT) can help to identify the safest and least-distressing foods and drinks for each individual. The SLT will work closely with the dietician to ensure oral intake is sufficient and that establish whether supplements are required.
- Maximising Posture: Wherever possible, when eating, people should be encouraged to sit in a chair rather than in bed, as sitting in a reclined position in bed can increases the risk of aspiration. Taking the time to optimise the person’s position before eating and drinking is essential. The aim should be for a 90° angle at the hips, knees and ankles with the person’s head, feet and arms appropriately supported.
- Mealtime Preparation: Planning meal times can help to ensure the best possible nutritional intake as well as reducing possible risks. Ensure that the appropriate level of support is available (including promoting self-feeding) and that any adaptations and aids are provided. Coloured crockery, non-slip mats and adapted cutlery can all be helpful.
- Mouth Care: Failing to ensure good mouth care, including twice-daily teeth brushing can exacerbate swallowing difficulties and increase the risk of aspiration and in turn, pneumonia. Training all staff in mouth care can significantly improve nutritional intake and reduce the risks to your service users.
- Medication Management: Swallowing difficulties may mean that some service users struggle to take prescribed medication and the risks of crushing or tampering with medicines is well-documented. Always consult with a pharmacist or GP if you have any concerns that a person may be struggling to take the medication prescribed for them.