Dysphagia Care Plan

Creating a Dysphagia care plan is needed for up to 68% of the long term care population¹.  Ensuring that a nutrition care plan is up to date and accurate is a very important job for all Dietitian’s.  Here we’ll take a closer look at creating a Dysphagia care plan.

Dysphagia and Nutrition

Dysphagia and nutrition go hand in hand, so it’s important to build a care plan that reflects optimising safety. 

Dysphagia affects nutrition by¹:

– Increased pneumonia risk
– Difficulty swallowing food and fluids
– Increased risk of Malnutrition
– Increased risk of mortality and morbidity
– Dehydration
– Poor long term health outcomes
– Increased health care costs

Developing a Dysphagia care plan that manages the risks, Dietitian’s can reduce the above risks.  We as Dietitian’s may never be able to resolve a Dysphagia diagnosis.  But we can make eating and drinking comfortable and appealing with the right care plan.  

Causes of Dysphagia

Dysphagia can have a few different causes, some are age related decline and others are disease related.

Age Related Dysphagia

Age affects a person’s ability to chew/swallow as the muscle and connective tissue weaken as we age.  It also requires increased oral preparation to prepare food to swallow.  Dysphagia occurs as food and fluids enter into the airway.  This can lead to aspiration pneumonia, another complication.

In addition to muscle and connective tissue weakening, sensory changes can lead to Dysphagia.  Decreased sense of smell, salivation, and taste, can lead to decreased swallowing ability.  

In the elderly, age related chewing and swallowing decline is the most significant primary factor leading to Dysphagia.

Disease Related Dysphagia

There are diseases that can cause Dysphagia in the elderly.  Advanced age increases the risk of these diseases.  This list is not exhaustive of causes in elderly Dysphagia, but these are common ones¹:

Stroke
Cerebrovascular Accident
Traumatic Brain Injury
Cancer affecting head and/or neck
Dementia
Parkinson’s Disease
Severe Breathing Disorders

Elderly individuals may have one or more of their above conditions, putting them at a high risk of Dysphagia³.  

Dysphagia Diet Levels

I won’t get into here, but I will in a future blog post… I do not support a 100% transition to the IDDSI framework.  But for the purposes of this blog, I’ve listed the names in the Dysphagia diet levels/IDDSI levels.

Building a Dysphagia care plan, which can also be called an ‘Impaired Swallowing Care Plan.’  We need to build into the care plan the diet levels.  So now let’s move on to building a Dysphagia care plan/Impaired Swallowing care plan.

Building a Dysphagia Care Plan

An elderly person will be diagnosed with Dysphagia by either the Speech Language Pathologist or the Physician.  If you know there is an issue (Dietitian’s do have some level of education regarding Dysphagia but not like an SLP).  We as RD’s cannot diagnose with Dysphagia, but we can have a nutrition diagnosis of Swallowing Difficulty.

Once there is a diagnosis, we can now build it into their nutrition care plan and MDS.

Nutrition Diagnosis:

Swallowing Difficulty related to post stroke complications as evidenced by coughing during and after meals, patient complaints of difficulty and food pocketing.  

Nutrition Goals:

Here you will state what you want the expected nutrition outcomes for Dysphagia to be?  We need to be realistic in this population.  Many patients regain their swallowing ability within the first month after a stroke, some continue beyond 6 months⁴.

If the Dysphagia is age related, it is unlikely that it will resolve⁵.  The Dietitian’s focus will be focused on managing the symptoms of Dysphagia.  

Here are a few examples of what your Nutrition Goals/Outcomes could look like for Dysphagia management:

1. Mrs X. will have reduced signs and symptoms of swallowing difficulty.
2. Mrs X. will have eased ability to chew and swallow through altered diet texture.
3. Mrs X will have optimal food and fluid intake through altered diet texture and fluid viscosity.  
4. Mrs X. will have reduced risk of aspiration through altered diet texture and fluid viscosity.

Nutrition Interventions

The Dietitian’s nutrition interventions will be individualised for the patient.  In the nutrition interventions section the RD will list out the diet level/IDDSI diet texture depending on what you have prescribed.  

Here’s a few examples of what your nutrition interventions will look like:

1. Mrs X. will remain sitting for 30 minutes after each meal.
2. Mrs X. will receive a minced & moist texture diet with mildly thick fluids.
3. Mrs X. will be educated on proper chewing and swallowing techniques.
4. Nursing staff will ensure that Mrs X. is seated in a 90 degree position to optimise safe eating and swallowing techniques.  
5. Mrs X. will eat in the main dining room to ensure staff can monitor closely safe eating strategies.

Nutrition Evaluation

The Dietitian’s nutrition evaluation will include monitoring and evaluating the nutrition goals/outcomes that were expected.  The nutrition interventions will be adjusted based on whether the goals/outcomes were achieved.

Dysphagia and Nutrition Care Plan Wrap Up

The Dietitian always wants to ensure that the nutrition care plan accurately reflects the care the patient is actually receiving.  Your Dysphagia care plan should allow any staff member to look at it and know exactly how to care for that patient.  

A Dysphagia patient is at extremely high risk of nutrition complications, as a Dietitian, make sure that you optimise every nutrition intervention possible.  

Dysphagia patients are also one of those ‘high risk patients’ that you should be tracking!  If you want to know exactly who your high risk patients are (exact conditions/diseases), how often you should be tracking them, and how you should keep your records, you should get your copy of our pocket guide!

Just click the picture to view it!

If you have any questions or have a different Dysphagia care plan, drop it in the comments!  

• Michelle