Texture-modified meat and carrot products for elderly people with dysphagia: preference in relation to health and oral status

Background : Reduced taste and smell, chewing problems and swallowing dysfunction are common among elderly people and affect perception, food choice and the ability to eat. Objective : To study the preference for texture-modified carrot and meat products in elderly people aiming to meet the needs of people with impaired chewing and/or swallowing. Design : Data were collected using questionnaires focusing on health, oral status and preference for the products. Altogether, 108 elderly people in ordinary housing (OH) and 50 living in special housing (SH) in Malmouml (SH-M) and Goumlteborg (SH-G) participated. Results : 19% had a body mass index ≤22, predominantly in SH (24%). Stroke was reported by 20% of the subjects in SH. Among those with subjectively experienced difficulties in swallowing (12%), 58% reported coughing, 21% a gurgly voice in association with food intake and 50% obstruction during swallowing. Only 20% with subjective swallowing difficulties had been specifically examined regarding this problem. All the tested products were easy to masticate and swallow. Compared with OH, people in SH-M found the meat products easier to masticate and swallow. Compared with OH, subjects in SH found the carrot products easier to masticate Conclusions : There is a need to develop tasty texture-modified nutritious food products for people with mastication and/or swallowing problems. Possible factors for differences in preference between groups, in this study OH and SH, may be related to health status in general and specifically mastication and swallowing functions

Objective and quantitative definitions of modified food textures based on sensory and rheological methodology

Introduction: Patients who suffer from chewing and swallowing disorders, i.e. dysphagia, may have difficulties ingesting normal food and liquids. In these patients a texture modified diet may enable that the patient maintain adequate nutrition. However, there is no generally accepted definition of ‘texture’ that includes measurements describing different food textures. Objective: Objectively define and quantify categories of texture-modified food by conducting rheological measurements and sensory analyses. A further objective was to facilitate the communication and recommendations of appropriate food textures for patients with dysphagia. Design: About 15 food samples varying in texture qualities were characterized by descriptive sensory and rheological measurements. Results: Soups were perceived as homogenous; thickened soups were perceived as being easier to swallow, more melting and creamy compared with soups without thickener. Viscosity differed between the two types of soups. Texture descriptors for pâtés were characterized by high chewing resistance, firmness, and having larger particles compared with timbales and jellied products. Jellied products were perceived as wobbly, creamy, and easier to swallow. Concerning the rheological measurements, all solid products were more elastic than viscous (G′>G″), belonging to different G′ intervals: jellied products (low G′) and timbales together with pâtés (higher G′). Conclusion: By combining sensory and rheological measurements, a system of objective, quantitative, and well-defined food textures was developed that characterizes the different texture categories

Dysfagi

Dysfagi är ett symptom på en onormal sväljningsförmåga. Problemen kan finnas i munnen, svalget eller matstrupen. Symptomen är ofta varierande, från en känsla av upphakning i samband med ätande och drickande till allvarliga kvävningsanfall på grund av felsväljning. Att drabbas av sväljningssvårigheter kan innebära att livet förändras drastiskt. Ätande och drickande kan bli mödosamt eller kanske helt omöjligt. Inte sällan framkommer olika etiska och psykologiska aspekter. Olika sjukdomstillstånd kan göra att det krävs olika typer av anpassningar

Videofluoroscopic swallow study: techniques, signs and reports.

Management of oropharyngeal swallowing dysfunction often requires both a clinical and an instrumental examination. A videofluoroscopic swallowing study is an instrumental examination that often could be a good option and a very useful tool for the swallowing clinician. At Skåne University Hospital, Malmö, Sweden, the name of such examination is therapeutic videoradiographic swallowing study (TVSS). A TVSS examination should always be performed in collaboration between a speech language pathologist and a radiologist. During the examination, the patient is seated in an upright position, but the examination can also be performed with the patient lying down. The TVSS examination can be performed both in frontal and lateral projection. Test material with varied consistencies as well as different therapeutic strategies can be tested during the examination. Any oral and/or pharyngeal dysfunction can be defined, for example a delay in the initiation of the pharyngeal swallow or an absent pharyngeal swallow, pharyngeal retention, penetration, and silent aspiration. After the examination, an analysis is performed, and it is studied how different textures affect the physiology of swallowing. A report is then written in which the actual dysfunction is described in detail, and recommendations regarding modified textures and swallowing techniques are given

Therapeutic aspects of oral and pharyngeal swallowing dysfunction. Videoradiographic and videomanometric analyses of adult healthy volunteers and dysphagic patients.

In this study simultaneous videoradiography and intraluminal manometry (videomanometry) have been used in combination in three studies to analyze how different therapeutic strategies affect the physiology of swallowing in healthy volunteers and in patients with pharyngeal dysfunction. Analyses of healthy volunteers showed few significant measurable effects on the pharyngeal swallow. Some decreased movements of anatomical structures and some differences in intraluminal pressure were found. In patients with pharyngeal dysfunction the major findings concerned the radiological variables. The depth of contrast penetration into the larynx and the trachea was significantly reduced, but the techniques did not reduce the number of misdirected swallows. The intrabolus pressure when measured at the level of the inferior pharyngeal constrictor did not alter when the three techniques were performed. Videoradiography was used in three other studies to evaluate how different therapeutic strategies affect the physiology of swallowing, and nutritional parameters in dysphagic patients. Survival times and therapeutic recommendations were compared in two groups of dysphagic patients, one group with an absent pharyngeal swallow (APS) and one group with a pharyngeal swallow (WPS). When dysphagic patients who aspirated on thin liquids were given carbonated liquids they had a significantly reduced penetration/aspiration, pharyngeal transit time and pharyngeal retention compared to both thin liquids and thickened liquids. An association between dysphagic treatment and improved nutritional conditions was found. APS is associated with high mortality. When APS and WPS were compared it was found that the majority of APS patients who died, did so within a short period of time after entering the study. In the WPS group most patients died after 12 months. The APS group were recommended no oral intake and the WPS group oral nutrition together with diet modification and different therapeutic strategies. Conclusion: Results from some of these studies contribute new knowledge applicable to the treatment of dysphagic patients, thereby improving management routines. Dysphagic patients must be individually evaluated. The dysfunction must be defined according to its etiology. However, it is the pathophysiology that guides the choice of swallowing management

Validation in Swedish of sydney swallow questionnaire.

The aim of this study was to translate and adapt the Sydney Swallow Questionnaire to Swedish conditions and to evaluate the validity and test-retest reliability of the Swedish translation in patients with oropharyngeal dysphagia and in healthy controls

'What about swallowing?' Diagnostic performance of daily clinical practice compared with the Eating Assessment Tool-10

In daily clinical practice, patients are frequently asked about their swallowing as part of the patient-clinician interview. This study compares the diagnostic performance of a single open question 'What about swallowing?' (usual care) with the Eating Assessment Tool (EAT-10) as reference test in screening for oropharyngeal dysphagia (OD). 303 outpatients at risk of OD were recruited at three university hospitals: 162 men and 141 women with a mean age of 70 years. All data were retrieved by phone. To identify patients at risk of dysphagia, two different cut-off scores for the EAT-10 total score were retrieved from the literature. The diagnostic performance of the single question was determined by comparing dichotomized answers to the single question (no problems versus difficulties in swallowing) with the EAT-10 as reference test. Sensitivity, specificity, positive and negative predictive values ranged between 0.75–0.76, 0.75–0.84, 0.93–0.97 and 0.38–0.43, respectively. Mostly, the results of this exploratory study indicate a sufficient diagnostic performance of the single question in identifying patients who are at risk of dysphagia when using the EAT-10 questionnaire as a reference test. Further research, is, however, necessary to provide additional psychometric data on Functional Health Status (FHS) questionnaires including the single question using either FEES or VFS as gold standard or reference test

Supraglottic swallow, effortful swallow, and chin tuck did not alter hypopharyngeal intrabolus pressure in patients with pharyngeal dysfunction.

Simultaneous videoradiography and solid-state manometry (videomanometry) were performed in 8 patients (4 women, 4 men; age range = 46-81 years, mean age = 70 years) with pharyngeal dysfunction in order to disclose any changes in intrabolus pressure during swallowing maneuvers. Five of the patients had severe pharyngeal dysfunction with frequent misdirected swallows. Three of the patients had moderate pharyngeal dysfunction with delayed initiation of pharyngeal swallow. Three different swallowing techniques were applied: supraglottic swallow, effortful swallow, and chin tuck. Pharyngeal intrabolus pressure was analyzed at the level of the inferior pharyngeal constrictor. Supraglottic swallow, effortful swallow, and chin tuck did not alter peak amplitude or duration of the intrabolus pressure