Outcomes of Oropharyngeal Dysphagia
The consequence of having oropharyngeal dysphagia may range from minor health consequences to death. This text will focus on issues associated with malnutrition and aspiration pneumonia.
Malnutrition
Malnutrition refers to the inability of an individual to receive adequate nutrients for needed body functions. The causes of malnutrition are varied. Common causes include a poor diet, perhaps due to an inadequate food supply or financial resources to purchase food, mental health issues that prevent a person from choosing or obtaining adequate nutrition, or dysphagia. Malnutrition may lead to weight loss, fatigue, and cognitive and physical impairment. Chronic malnutrition may result in greater than normal muscle loss as the body seeks to recover lost protein by breaking down muscle. Over time, malnutrition may lead to wasting syndrome (a.k.a. cachexia), failure to thrive, and frailty.
The presence of dysphagia increases the risk of malnutrition (Foley, Martin, Salter, & Teasell, 2009), particularly in the independent elderly population (Serra-Prat et al., 2011; Carrión et al., 2015). Treatment of dysphagia in individuals that are malnourished improves their nutritional status (Elmståhl, Bülow, Ekberg, Petersson, & Tegner, 1999).
Frailty
In adults, frailty can be a clinical sign of dysphagia or can result from long-standing dysphagia (van der Maarel-Wierink et al., 2011). Although definitions of frailty vary across sources, in general, it refers to increased vulnerability or a decline in functional reserve across multiple physical systems (Xue, 2011; Lee et al., 2014; Morley et al., 2013). Frail individuals are more vulnerable to environmental or physiologic stress. Therefore, frail individuals are more likely to have trouble with swallowing when new foods or textures are introduced. Further, when swallow deficits result in aspiration, frail individuals are more likely to have a negative response to even small amounts of aspiration.
Frailty is not always a direct result of reduced nutrition. It may result from changes in activity level. A sedentary lifestyle will reduce overall muscle function. Overtime, with continued decline in muscle function and aerobic activities, an individual may become frail.
Failure to thrive, a term that lacks a clear criteria in the aging population, may be used to define a frail individual or an individual with cachexia or muscle wasting syndrome. The terminology used in your facilty may vary by physician or cause of malnutriton. Although generally considered to be different, long term failure to thrive (malnutrition) and/or cachexia will result in frailty.
Clinical Note
As the term FAILURE to thrive may be misinterpreted by a parent or caregiver as an implication that they have not done their task, this term should be used with careful consideration.
Aspiration and Risk of Pneumonia
During swallowing, airway protection is the key aspect of a safe swallow. This happens in several ways: