e st
sing B
U
s
h
t
y My
are
e Fogg
h
t
Term C
h
g
g
n
u
o
o
L
r
s in
g Th
Cuttin
ideline
u
G
e
c
Practi
Volume 7, Issue 2
Summer
2012
Inside this issue:
BP Blogger
Myth 1: Swallowing
is easier when
chairs are tipped
1
Dysphagia is a medical
term used for people who
have difficulty swallowing
food or drink. It could be
due to weakened mouth and throat muscles or because of a lack of coordination in
those muscles. This increases the chance of food or drink entering into the lungs
instead of going into the stomach.
Myth 2:
Mixing textures
is safe
1
Myth 3:
Drinking fluids with
straws is best
2
Myth 4:
Regular fluids are
safe for all
2
Myth Busting: Dysphagia
(Swallowing) Issue
Myth 1:
Swallowing is
easier when
chairs are tipped
See BP Bloggers July-Aug
2007 & Fall 2010
The resident’s position for eating or
drinking is very important to ensure safe swallowing. When eating or drinking, the resident must sit up as straight as possible at 90 degrees with support behind the shoulders. The neck must be flexed so that they are looking toward their
plate. Also, the resident’s chin must be tucked down to 45 degrees.
This upright position allows gravity to help in the swallowing process.
Plus, this position will help prevent food or liquid from going into the
throat too early, and so avoiding choking and food entering the nasal
cavity. The chin tuck slows down the speed of food going down the
throat, helping the throat muscles to work properly and reduce the
chance that food will go to the lungs. Tipping the head backward
when eating is dangerous because it makes the airway less protected and increases
the chance of food entering it. If the resident is paralyzed or weak on one
side of their body, turn their head toward the weak side. This
will close off that side of the throat and will ensure the food
goes to the stomach and not to the lungs.
Myth 2: Mixing textures is safe
When assisting a resident with swallowing disorders, the texture of the food is
important to consider. Avoid feeding solid food and liquids in the same mouthful, as one
texture is easier to swallow than multiple texture foods like vegetable soup or canned
fruit with juice. The resident should not be given liquids to “wash down” any left over
food in the throat. To make food safe to eat, mix solid foods with sauces, condiments
and gravies. This will help prevent small food particles from entering the lungs. For
some residents it may be safe to
The RIA, RGPc &
alternate fluids and solid foods.
SHRTN Library
Services
BPGs and
Resources
2
Contacts for
Information
1&2
More information
on This and Other
Best Practices
• Contact your Regional
LTC Best Practices
Coordinator. They can
help you with Best
Practices Info for LTC.
Find them at:
• www.rnao.org
Click on Nursing Best
Practice Guidelines and
select LTC BP Initiative
• www.shrtn.on.ca
Click on Seniors Health
• Check out
Long-Term Care and
Geriatric Resources at
www.the-ria.ca &
www.rgpc.ca
• Surf the Web for
BPGs, resources and
sites are listed on pg 2.
• Review back issues of
the BP Blogger
for related topics
www.the-ria.ca
© Copyrighted
All Rights Reserved
MLvanderHorst
Cutting
CuttingThrough
Throughthe
the
Foggy
FoggyMyths
MythsUsing
UsingBest
Best
Cutting Through the
Practice
PracticeGuidelines
Guidelinesin
in
Foggy
Myths Using
Best
Long
LongTerm
TermCare
Care
Practice Guidelines in
CONTACTS
Editor:Long
Mary-Lou
vanCare
der Horst
Term
Editor
Seniors
Health
Project
Consultant
CONTACTS
Mary-Lou van der Horst
Editor
Schlegel
Learning,
GeriatricCentre
Nursingfor
/Knowledge
Research
Innovation
Mary-Louand
van
der
Horst in
Translation
Consultant
Long-term
Care at/Knowledge
The Schlegel
Geriatric
Nursing
Regional Geriatric
Program - University
of Waterloo
Translation Consultant
Central
Research
Institute
for Aging
Regional
Geriatric
Program
St. Peter's
Hospital
325
Max Becker
Drive,
Central
88 Maplewood
Hamilton,
Kitchener
ONAve,
N3E
4H5 ON.
St. Peter's
L8M
1W9 Hospital
[email protected]
88
Maplewood Ave, Hamilton, ON.
[email protected]
L8M
Doris 1W9
Nussbaumer
[email protected]
Information
Specialist
SHRTN Library Services
Élisabeth Bruyère Research Institute
43, rue Bruyère
Ottawa ON. K1N 5C8
[email protected]
Web
Find it on the a.ca
-ri
at www. the n.ca
rtn.o
rgpc.ca or sh
Myth 4:
Regular fluids
are safe for all
Using equipment to eat
and drink can help place, Myth 3: Dr
inking fluids
direct and control the
with straws is best
food in the resident’s
mouth and throat. A straw can be bene
ficial when drinking from the
bottom of a cup because it prevents
backward head tilt which should
always be avoided as backward head
tilts can cause food going into the lung
s. USE
STRAWS WITH CAUTION. Straws
increase air swallowing and add to the
steps
needed to drink. If residents place
the straw too far back into their mou
ths
and
the liquid shoots to the back of the
tongue, it can cause
choking. A more safe approach is to
Nosey Cups use spoons that are
narrow and shallow that allow the resi
dent or caregiver to
place food in certain locations in the
mouth. Also, using
these
smaller
spoons means that a smaller
amount of food is eaten which
is easier for the resident to
swallow. Residents can use
cups with a “V” cut (also called
a ‘nosey cup’). These cups can
be helpful for residents and
allow them to drink from the
cup without tilting their head
because their noses have space.
Making sure residents with dysphagia have
enough fluids in their diet is important.
However, thin liquids such as water, tea or
coffee are very difficult to control and swallow. For that
reason, to make sure residents drink enough fluids,
thickened liquids may be ordered by the Speech-Language
Pathologist or Registered Dietitian. Thickening liquids makes
them move more slowly, which gives the resident’s throat
muscles more time to respond and ensures the liquid will go to
the stomach. Be careful not to add too much thickener to the
fluids as it may make it more difficult to swallow as they are
dense and sticky. Make sure
to follow the thickener
mixing instructions carefully.
Fluids that are over-thickened
may cause the resident to
become dehydrated.
Note: Always follow specific
individualized guidelines given by a
Speech Language Pathologist or
Registered Dietitian before using
general recommendations.
Special thanks to Elizabeth Ursu (HHNS Graduate Student, University of Guelph), core working
members of SHRTN’s Nutrition Community of Practice ( L. Whittington-Carter, D. Nussbaumer, H. Dunn
& H. Keller) and Schlegel Centre for Learning, Research and Innovation in Long-Term Care, Regional
Geriatric Program Central & Seniors Health Research Transfer Network (SHRTN)
Check out these Best Practices, Guidelines & Websites
Answers to the Myths came from them. Find out more!
Rofes L, Arreola V, Almirall J, Cabre M, Campins L, Garcia-Peris P,
Speyer R, Clave P. Diagnosis and Management of Oropharyngeal
Dysphagia and Its Nutritional and Respiratory Complications in
the Elderly. Gastroenterology Research and Practice. 2011, 1-13.
Garcia J.M, Chambers E, Clark M, Helverson J, Matta Z. Quality
of care issues for dysphagia: modifications involving oral fluids.
Journal of Clinical Nursing. 2010, 19:1618-1624.
Ney D, Weiss J.M., Kind M.J.H., Robbins J. Senescent Swallowing:
Impact, Strategies, and Interventions. Nutrition in Clinical
Practice. 2009, 24(3):395-413.
Robbins J, Kays S, McCallum S. Team Management of Dysphagia
in the Institutional Setting. Nutrition and the Institutionalized
Elderly. 2007, 26(3/4):59-104.
Cook I. J., Kahrilas P.J. AGA technical review on management of
oropharyngeal dysphagia. Gastroenterology. 1999, 116(2):455–478.
Campbell-Taylor I. (1990). Hand to Mouth: A Guide to Feeding
the Dysphagic Geriatric Patient 2nd ed. Athena Associates,
Toronto, ON.
Specialty Board on Swallowing and Swallowing Disorders
www.swallowingdisorders.org
National Foundation of Swallowing Disorders
www.swallowingdisorderfoundation.com
Dysphagia Resource Centre www.dysphagia.com
Page 1 Dysphagia diagram:
www.dysphagia.org.uk/about-dysphagia/information-for-patients/
swallowing-diagrams
Page 2 Nosey Cups diagram:
www.dysphagiaplus.com/clear-nosey-cutout-tumblers-p-346.html
For more information about the SHRTN Nutrition Community of Practice,
go to their website at www.shrtn.on.ca
.©MLvanderHorst