Psychological Aspects of Dysphagia

Jennifer Mae B. Robles

Define what Dysphagia and what conditions cause Dysphagia physically

What emotions the patient may feel dealing with Dysphagia

Assuring, understanding and educating the patient with Dysphagia

What is Dysphagia?

Break it down:Dys- difficult

phagia- swallowingRemember the Phagocytes? - literally means “eating cells”

Definition of Dysphagia:

“Having difficulty swallowing, it is a symptom that accompanies a number of neurological disorders. The problem can occur at any stage of the normal swallowing process as food and liquid move from the mouth, down the back of the throat, through the esophagus and into the stomach.”

National Institute of Neurological Disorders and Stroke. (2008, July). NINDS

What is involved with swallowing?

The Human Body Book, p,175

Swallowing Stages:

The Human Body Book, p.174

The Human Body Book, p.174

View of the Larynx:

The pale leaflike flap of the epiglottis is visible at the top of this image, Below it is the inverted “V” of the vocal cords.

The Human Body Book, p.174

Class: What is so important about the Epiglottis?

Breathe or Swallow-

Dual Intake:Breathing occurs

through the nose or the mouth. Their

passageways meet at the throat, and air

flows into the trachea.

The Human Body Book, p.174

Causes of Dysphagia:

Medications: ACE inhibitors Alpha adrenergic blockers Antibiotics Anticholinergic agents Antihistamines Anti psychotics Nitrates Nonsteroidal antiinflammatory drugs Potassium chloride

Medical Conditions: Achalasia Amyotrophic lateral sclerosis Caustic solution ingestion Cerebral palsy Dementia Diffuse esophageal spasm Gastroesophageal reflux disease

(GERD) Head and neck cancer Head injury Immune disorders Multiple sclerosis Parkinson's disease Post-polio syndrome Spinal cord injury Stroke

Nowlin, A. , RN (magazine), June 2006

Who is Vulnerable?

The Very Young and the Very Old usually: Babies-Children: prenatal

development with bones, muscles and throat-craniofacial anomalies, cleft lip or palate, tumors, large tonsils or tongue, sensitivity in the esophagus, foreign objects (example: coin).

The Old Residents: (conditions mentioned earlier), additionally dentures, NPO with tubing No oral hygiene oral flora + immunocompromised= NOT GOOD NEWS

Logsdon, B. , Nursing Home Magazine, 2004Google Images

What’s the Big Deal?

Patients can lose weight, lose muscle mass/ muscle atrophy, hence, insufficient nutrition and dehydration and lose the ability to swallow.

Trouble in swallowing, signs and symtpoms: elevated respiratory rate, fever, chills, pleuritic chest pain, and crackles, can result of Aspiration pneumonia, if not watched closely.

In a study of “82 nursing home residents with eating problems, 55% had symptoms of dysphagia, but fewer than ¼ of those had received a formal swallowing evaluation”

Palmer, J.& Melhany, N.. American Journal of Nursing,2008

Google Image, Also found in Kozier ,Chapter 16. Maslow's Hierarchy of Needs, Abraham Maslow

Dysphagia Affects Patients Quality of LifePeople with Mental Disorders, they suffer from Depression, “it

may cause changes in appetite and be accompanied by weight gain or loss. Weight loss may be caused by anorexia nervosa, stimulant abuse, dementia, or infectious conditions.” (The Nurse Practitioner, May 2004).

Negative emotions can also affect a person’s health like for Cerebral Artery Stenosis and stroke. Study showed: “approximately 30% of stroke patients reported anger, fear, irritability, nervousness, a sudden change in body position, or a response to a startling event in the 2 hours preceding the stroke. Because anger and other negative emotions may trigger ischemic stroke, stress reduction may help your patient decrease the risk ”(PALMIERI, R., Nursing2006).

Eating is not longer enjoyable… The participants’ treatment [ for oesophangeal cancer ]…”resulted in

exhaustion and tiredness as well as loss of weight. Meals became time-consuming and eating mainly turned into a necessary source for nutrition intake and they lost the pleasure earlier associated with eating:

I can’t eat the same food as I used to eat and I have no appetite right now. Cooking is no fun. Nothing tastes good anymore. I try to eat sour milk, but I keep vomiting. I have an enormous amount of phlegm and it really bothers me. I have no energy…and it is really hard for me to eat anything. Where I used to eat two potatoes, I can only eat one now and even that can be too much. Eating makes me so tired that I have to lie down, even though I haven’t eaten a whole lot.”

( Andreassen. S., et al., Journal of Clinical Nursing, 2006).

Personal Feelings and their Quality of Life: In the UK 4 out of 10 enjoyed their meals.

Out of 360 people from the UK, Germany, France and Spain, 36% avoided eating with others because of their dysphagia.

Also “4 out of 10 suffered anxiety or panic during mealtimes, primarily because of food sticking in the throat or feeling that they were chocking.”

(Ekber, O., Hamdy, S.,Woisard, V., et a;Dysphagia, 2001)

Handicapped from Life:

Dysphagia “ can destroy the social opportunities and pleasure of mealtimes, affect the quality of the patient’s relationship with his/her caregiver and family, undermine health an confidence. Patients with dysphagia can become isolated, feel excluded by others, and be anxious and distressed at mealtimes…affects a patient’s dignity, self-esteem, and regard of others.

…can be ranked as a handicap, defined as a reduction in functional capacity that limits the individuals’ ability to attain his or her physical goals.”

Dysphagia affects all aspects of life.

(Ekber, O., Hamdy, S.,Woisard, V., et al;Dysphagia, 2001)

Prevention, Treatment, Interventions: From a Swedish study, “the results of this study suggest that special

attention should be paid to patients who use escape-avoidance (i.e., avoiding people, wishing the situation would go away) as a means of coping. This coping strategy was associated with emotional distress and such patients may be in need of special support.”

Studies suggest…”the patients’ function could indicate the need of social support and family support. There was also a significant relationship between impaired observed function and loss of appetite. Change in appetite/weight is common in patients with brain tumor. Appetite loss can stem from altered taste, nausea, dysphagia, depression, fear of eating or effects of treatment . [Intervention is needed, so] Health care staff needs to find the reason for appetite loss to prevent malnutrition.”

(Gustafsson, M, Edvardsson, T. & Ahlström, G. ,2006)

“If patients are psychologically isolated and do not believe they can be helped, they will not complain vigorously to health professionals…then patients will not be offered appropriate solutions to their eating problems. By educating the patient, assessing him/her in the contact of other illnesses and problems, and offering th patient appropriate treatment for dysphagia, health professionals could avoid the insidious psychological , social and physical damage to the patient that would otherwise occur.”

In the study, they “found that only 36% of patients acknowledged that they had received a confirmed diagnosis of dysphagia , and only 32% acknowledged receiving professional treatment for it. …showed that unless asked by their caregiver to explain their swallowing problems, patients were unlikely to take the initiative themselves and inform healthcare professionals or even relatives of their difficulties.”

(Ekber, O., Hamdy, S.,Woisard, V., et al;Dysphagia, 2001)

Information is Power

Options=Cooperative Patient

“They experienced that the informational issues about treatment …and the following decision makings were tiring. However, they trusted in the physicians’ recommendations [one patient states]:

I have confidence in the doctor. I trust that he’s doing what’s best for me. Because I think if there had been alternative treatments, he would have suggested them.”

( Andreassen. S., et al., Journal of Clinical Nursing, 2006).

Activity:

Drink some juice and observe the swallowing reflex. Place the food in your mouth and let it sit, then swallow (if

you can, try NOT TO CHEW). Place the food in your mouth and drink some water/juice. Noticed anything? Note: “The glossopharyngeal nerve(IX) is responsible for

taste on the back part of the tongue, somatosensory information from, tonsil, pharynx; controls some muscles used in swallowing ” and the vagus nerve (X) is responsible for your glands and digestion).

Chudler, E., Washington Univ., 2009

Recommendations for Feeding the Elderly with Dysphagia

Look at Handout(s)

What’s your point? When in doubt Assess and Evaluate the patient with

the diseases/conditions which can be related to dysphagia. Why? Because you never know, they can get aspiration pneumonia.

Be considerate, be understanding and acknowledge their emotions.

Educate the patient’s of their options and treatments Ekber and his colleagues “recommend that healthcare resources be allocated to the training of healthcare

professionals and to providing management and treatment options.

Collaborative Team needs to help the patient not just nurses but other health professionals to provide physical needs and psychosocial and emotional needs with the help of family and friends for support.

(Ekber, O., Hamdy, S.,Woisard, V., et al;Dysphagia, 2001)

Thank you!