Explaining The ‘Why’ Behind the Common Safe Swallowing Strategies.

November, 2021
Safe Swallowing strategies for the aged

Have you ever seen the same recommendations provided after each Speech Pathology swallowing assessment and wondered ‘why?’

1: Here we breakdown the common Safe Swallowing or Aspiration Reduction Strategies:

Alert and upright at 90degrees for whole duration of meal and at least 20 mins after intake.

  • Alert: hopefully this is intuitive! But if someone is half asleep or not maintaining attention during the whole meal, the person is unable to engage in the experience and therefore be unable to swallow well leading to increased difficulty and increased risk of aspiration (food/fluids entering the lungs).
  • Upright at 90 degrees: body posture is critical for healthy swallowing. Research has shown that people report increased difficulty swallowing when lying supine and when seated with head/neck extended (chin reaching to sky). Sitting upright allows gravity to work its magic and reduce the risk of aspiration.
  • 20 minutes after intake: aspiration is not only a risk during swallowing or during the meal but can also be a risk after the meal due to reflux. When stomach acid comes up towards the throat area (reflux) that acidity can move into the airways, especially with our dysphagia population when lying down, straight after meals. That’s why sitting upright is also important after meals so that gravity can help keep the food/drinks in the stomach.

2: Regular mouthcare at least twice daily and check mouth is clear after meals

Mouthcare is the cornerstone of reducing aspiration pneumonia. Research has shown that it is typically food debris, liquid and saliva in combination with BACTERIA in the mouth due to poor oral hygiene that can be aspirated and leads to chest infections.

3: Minimise distractions and background noise during meals (e.g. turn TV/radio off, minimise conversations/talking with person during eating/drinking)

We all know that multitasking has its pros and cons, but for people with dysphagia, multitasking during mealtimes can be a recipe for disaster! When someone’s attention is divided between two or more activities whilst eating and drinking, it means they have less awareness on the swallowing mechanism. By removing distractions and supporting the person to focus on each bite you can help optimise their swallowing ability.

4: If signs of aspiration (throat clearing, coughing, wet voice, reduced chest status, increased temperature), or increased difficulty in swallowing, document and inform SP.

Prompt referrals at the first sign of increased difficulty or changes in swallowing is essential for dysphagia management. If left untreated and unmanaged the complications of swallowing difficulties can be distressing and life-threatening. Beyond choking and chest infections, dysphagia can result in malnutrition, dehydration, increased anxiety, reduced social engagement, among other factors.

If you’re not sure if someone would benefit from Speech Pathology input, we strongly encourage liaising with your clinical lead/manager or speaking with us. We are here to help and we’re on your team.

Dietitians Australia
Aged & Community Care Providers Association

Don’t let your residents or budget experience the side effects of malnutrition or dysphagia.
Call us on 1300 850 246 or email and request a call back.

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