Perspectives on Swallowing and Swallowing Disorders (Dysphagia)

Editor's Corner

Brobeck, T. C. — 2008-03-01

Frailty, Functional Reserve, and Sarcopenia in the Geriatric Dysphagic Patient

Murray, J. — 2008-03-01

In this review the interaction of senescence and dysphagia are discussed with attention to normal changes in bodily homeostasis that occur with aging and the acceleration of decline observed in frail individuals. The concepts of functional reserve, symmorphosis and sarcopenia are discussed in a way to aid the speech-language pathologist providing dysphagia services to the elderly. It is important for the practicing speech-language pathologist to realize the vital importance of compromised functional reserve and to be able to identify elders who are at risk of the spiral of poor nutrition and frailty as they present themselves in daily clinical practice.

Dysphagia in the Elderly and in Dementia: Helping the Helper

Sullivan, P. A. — 2008-03-01

In order to explore the literature on the role of family in dysphagia intervention, key search terms were identified and literature was reviewed from Pub Med since 1999. Much of the literature dealing with dysphagia in the elderly, and in persons with dementia, focuses primarily on the patients. Limited attention is often focused on the needs of family. Families should be a focus during planning, as well as during treatment of dysphagia, in order to optimize outcomes. This article addresses the role of the family in this process, strategies for improving the involvement of family in decision-making, and also discusses issues related to caregiver burden and burnout.

Oral Care and the Elderly

Ashford, J. R., Skelley, M. — 2008-03-01

The purpose of this report is to review the normal environment of the oropharyngeal cavity, examine its potential role in the development of pneumonia, and examine the beneficial effects of oral care in the prevention of pneumonia among the sick and elderly. The oropharynx is a very diverse environment of structures, functions, and ecology. Normal bacterial florae existing in this environment are limited in their efforts to colonize in the moist oral tissues by immune properties present in saliva and mucous. Lack of oral maintenance or the occurrence of a severe illness may provide an opportunity for these pathogens to colonize and multiply. Aspiration of certain oral pathogens into the lower respiratory tract has been associated with the development of pneumonia leading to illness complications and death in some elderly or sick persons. Oral care using brushes and oral rinses have been shown to significantly reduce pneumonia development and fever in the sick and elderly populations. An important new role of speech-language pathologists is to assert themselves as practitioners and advocates of better oral health with these populations.

Dysphagia: Legal and Ethical Issues in Caring for Persons at the End of Life

Wagner, L. C. B. — 2008-03-01

Speech-language pathologists (SLP) who treat patients with dysphagia may at some point work with persons who are dying. The purpose of this article is to provide a legal and ethical framework for the participation of the SLP in the care of persons at the end of life. The skills of the SLP can be critical to enhancing the dying experience of patients by preparing them to deal with symptoms of dysphagia and by maintaining or facilitating their communication abilities to meet functional needs in the final stages of life.

Food for Thought: How Do Patients With ALS Decide About Having a PEG?

Leslie, P. — 2008-03-01

Dysphagia is a distressing problem in amyotrophic lateral sclerosis. Patients and caregivers must decide whether to use supplementary non-oral feeding. The deliberations and timing of this decision may be haphazard. The optimum time for this choice, in terms of residual (quality) life expectancy and decision competency, is unknown. Health-care workers may fear that even the offer of enteral feeding might be construed as an unwelcome landmark on the disease deterioration. This paper provides a qualitative report on the subjective experiences of 2 patients deciding whether to have a PEG or not. Semi-structured interviews were conducted with each patient and transcripts are provided for the reader to review.