The impacts of swallowing disability on nutrition – making the connection

Dr Sayne Dalton, Senior Policy Officer, Dietitians Australia

As an Accredited Practising Dietitian, and Senior Policy Officer for Dietitians Australia, I think it’s important that people really start to draw the connection between dysphagia or swallowing dysfunction and malnutrition. I don’t think that’s a connection that people immediately make when they think about dysphagia and swallowing disability. We know that swallowing disability can lead to aspiration and choking, but it can also lead to a real fear of eating which can impact on a person’s ability to eat the food that they enjoy and their participation in mealtimes. So there’s the social side that is impacted by dysphagia, and there’s also the food and oral intake that can be impacted by dysphagia and swallowing disability. And that can impact on a person’s ability to consume the foods that they enjoy and get the variety of foods and nutrients they need to meet their nutritional requirements. So if they’re not meeting their nutritional requirements, that impacts on their health as a whole, their ability to function at their optimum physical and mental health.

So, on the one hand we’ve got swallowing dysfunction and the impact on nutrition, but then a person’s nutrition status can actually impact on their swallowing function. And that may not be a connection that people necessarily make immediately, but say for example if you have malnutrition and you’re not getting enough energy and protein, that can impact on your muscle mass. You might think about the muscles being in the arms and the legs, but they’re actually also in your mouth and your pharynx or your throat, and that loss of muscle mass can impact on your ability to chew and swallow, and that can exacerbate your choking risk and your aspiration, and it becomes this complex interaction between dysphagia and nutrition.

One of the important connections made through the Enjoy Safe Meals training is that increased awareness about dysphagia and malnutrition and how they co-occur and that bidirectional relationship. Also, being aware of it and knowing how to respond to it, as a person who is working with or supporting a person with dysphagia. It’s important to know how to do some basic activities such as screening for both dysphagia or risk of swallowing issues as well as nutrition risk and then bringing the appropriate people into the team to support a person. So an Accredited Practising Dietitian would play the role of supporting a person to meet their food and fluid or nutrition needs as well as achieve an eating pattern that addresses their social needs. And of course we have speech pathologists and a whole range of other health and food service professionals that come into the mix, as well as the family and the person themself who are really at the centre. Let’s keep that person at the centre, and make sure both their nutrition and swallowing needs can be met.