Swallowing Disorders in the Older Population

Colleen Christmas, MD; Nicole Rogus-Pulia, PhD, CCC-SLP


J Am Geriatr Soc. 2019;67(12):2643-2649. 

In This Article

The Importance of Collaboration in Dysphagia Management

Interprofessional team partnerships and engagement of families and caregivers in discussions regarding the diagnosis and recommended treatment for patients with dysphagia are necessary to achieve optimal care. One study demonstrated that involvement of a geriatrician in the discussion at the time a feeding tube was considered in the hospital setting resulted in a 50% reduction in the placement of feeding tubes.[45] Early involvement of an SLP will be critical to ensuring thorough assessment and follow-up for older patients with dysphagia, especially those who require proactive intervention to potentiate neural recovery (eg, stroke) or to maintain swallow function as long as possible into disease progression (eg, dementia). Caregiver education and training will be critical to the carryover of any recommendations, including the implementation of a rehabilitative approach. In one study, use of a video-guided tool to facilitate advanced care planning in patients with dementia reduced the use of feeding tubes in patient for whom comfort measures were the preference for care.[46]

The cultural values and emotional valence about feeding may have little to do with evidence or face validity when considering the evaluations and treatment plans for older adults with swallowing difficulties; all such values should be carefully explored and will weigh on challenging decisions of this sort. Whenever possible, it may be useful to engage trusted advisors, such as religious figures, family, friends, and long-term physicians, to contribute to discussions. Critically important is ensuring the healthcare team facilitates a collaborative and humble approach to care, acknowledging shared goals and approaching the limitations in our knowledge base with humility.