Dysphagia, difficulty swallowing liquid and/or solid food, is one reason that people stop eating, and this is a serious problem that occurs in up to 60 percent of nursing facility residents, according to JAMDA. It can cause weight loss, dehydration, aspiration pneumonia, and even death.

According to physician and author Antonio Cherubini, MD, PhD, “Providers should see dysphagia as a core issue of nursing home care, considering the population of very frail and sick patients in this setting.” 

The American Speech-Language-Hearing Association says that “swallowing screening is a pass/fail procedure to identify individuals who require a comprehensive assessment of swallowing function or a referral for other professional or medical services.” Screening, the organization says, doesn’t provide a detailed description of the swallowing function. Instead, it identifies those patients who are likely to have swallowing problems.

Protocols for screenings may include an interview or questionnaire, observation of signs or symptoms of swallowing difficulties, observation of a routine mealtime situation, and administration of a three-ounce Water Swallow Test. The results of the swallowing assessment should be communicated to the care team, patient, and family members, depending on the results, and whether further action is deemed necessary.

If further assessment is needed, the physician will work with the speech therapist to determine the next steps. According to the World Health Organization, the assessment should identify and describe: 

  • Typical and atypical parameters of structures and functions affecting swallowing;
  • Effects of swallowing impairments on the individual’s activities and participation in daily life; and
  • Contextual factors that serve as barriers to or facilitators of successful swallowing.

Assessment may lead to recommendations for intervention and support, referral to specialists or other professionals, plus counseling, education, and training for the patient and caregivers. 

Pureed food and thickened liquids are an option to enable some patients with dysphagia to eat without fear of choking or aspirating. However, these often are unappealing, and staff need to find a way to balance patient choice and safety. “If you have a patient on pureed food and thickened liquids who really wants a piece of toast, you can employ a ‘mince and moisten’ technique to the toast to soften it,” dietitian Marcie Rittenhouse says. A follow-up speech therapy consultation could help determine whether the diet could be upgraded. 

“We can do other things, such as offering the Frazier Free Water Protocol—which is allowing unthickened water before the meal or 30 minutes after eating but use of thickened liquids during the meal,” she says. There are ways to make pureed foods more appealing. However, Rittenhouse notes that these can be time consuming and aren’t always practical. 

Cherubini stresses that dysphagia, while a serious illness, isn’t necessarily an end-of-life condition. “It becomes one when it is extremely severe and prevents any oral intake. At this point, there are difficult decisions to make regarding nutrition and hydration in the context of end-of-life care,” he says.​