Case Study Dysphasia

Carly Lehmann
FN4360
June 17, 2016

Table of Contents
Introduction...3
Causes of Dysphagia..3
Health Risks4
Dysphagia Treatment...4
Case Study...5
Methods5
Results...6
Discussion9
References11

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Introduction
Dysphagia is a condition that interferes with the swallowing process and makes it
more difficult to do so (1). Dysphagia is common among the elderly population; especially
those with dementia, but it is not limited to only dementia patients (2). This is also a
commonly seen condition in people who have suffered from a stroke; however, its effects
can potentially be reversed in these cases (3). Dysphagia can oftentimes go undiagnosed for
an extended period of time because it can start out very mildly (4). However, it is important
to be aware of the signs and symptoms of dysphagia so other potential problems can be
avoided. Dysphagia can lead to serious complications such as poor nutritional status,
dehydration, malnutrition, weight loss, and aspiration pneumonia (4). There is a tendency
of dysphasia patients to choose foods that they know they do not have difficulty
swallowing, which can lead to nutrient deficiencies (5). Indicators of dysphagia can include
coughing or choking while eating or drinking, a gurgling sound in the persons voice;
especially after eating or drinking, difficulty swallowing, and pocketing food on one side of
the mouth (4).
Causes of Dysphagia
There are a number of factors than can contribute to dysphagia; most are other
health conditions. As a person ages, their risk for dysphagia increases due to normal
deterioration of the esophagus (6). Age also puts a person at a higher risk for certain health
conditions such as stroke, Parkinsons, as well other types of dementia (6). People who
suffer from certain neurological or nervous system disorders are also at a higher risk of

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developing dysphagia (6). Salivary flow in the mouth also decreases with age so with less
lubrications in the esophagus, swallowing can become more difficult (1).
Health Risks
As previously mentioned, dysphagia can lead to serious adverse health conditions
such as poor nutritional status, dehydration, malnutrition, weight loss, and aspiration
pneumonia (4). A person with dysphagia may choose to eat only foods they know that they
can swallow (5). If a person is only choosing foods that are easy to swallow, they are likely
not getting adequate nutrients to meet their needs. A person who has difficulty swallowing
may also simply choose not to eat, which can not only lead to nutrient deficiencies, but to
dehydration, malnutrition, and subsequent weight loss, as well. The biggest concern of
dysphagia, however, is aspiration pneumonia; it is also the most common cause of death
among dementia patients (2) as well as the most life threatening risk factor (4). Aspiration
occurs when food or liquid enters into the lungs by mistake, which can be fatal (4).
Dysphagia Treatment
In the case of a patient who suffered from a stroke and developed dysphagia as a
result, there is a higher chance of reversing the effects with the proper treatment (3).
Following a stroke, if the patient is suffering from dysphagia, they typically undergo
treatment to help with the problem. An intervention following a stroke is crucial in
reversing the effects of dysphagia (3). The usual treatment of dysphagia in a stroke patient
includes swallowing therapy by a speech-language pathologist (3). These treatments
include compensatory and rehabilitative methods (3). Compensatory methods can include
enteral nutrition, food consistency modification, correction of posture, slowing the rate of

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eating, and oral hygiene (3). Rehabilitative methods can include oral motor exercises to
help improve the swallowing muscles and Shaker exercises (3). Shaker exercises are for
patients with decreased function of the hyoid and larynx lifting and moving forward in a
way that is required to open the upper esophageal sphincter (7). Food modification can
include puree and mechanical soft foods as well as thickened drinks that can be nectar,
honey, or pudding consistency (2, 4). The reversal of dysphagia in a patient who has not
suffered a stroke is not as likely; however, the adverse effects of the swallowing difficulties
can be treated with the previously mentioned items. Modifying food and drink consistency
seems to be the most effective at reducing the tendency to have aspiration in association
with dysphasia (2).
Case Study
A case study was performed on an elderly male who suffered a stroke and is now
living with diagnosed dysphagia. This was done to determine whether or not the research
on dysphagia is consistent with someone living with the condition. If the research is
consistent, the patient will experience signs of coughing and/or choking while eating or
drinking, difficulty swallowing, weight loss, poor nutritional status, and/or aspiration.
Methods
Patient FF is an 84-year-old male who was diagnosed with dysphagia following a
stroke. He was interviewed and asked a series of questions regarding his dysphagia and his
current dietary intake. Patient FF is a resident at a nursing home and was determined to be
a good fit for this case study; specifically, because he is not suffering from dementia and
was therefore able to easily partake in the interview with only minor assistance from his

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wife. He was asked several questions including his height, weight, and his usual body
weight before his diagnosis. These values were used to determine his % UBW, IBW, % IBW,
BMI, % weight change, energy, protein, and fluid needs. He was also asked about the
medications he is on, other medical conditions, family history of medical conditions,
current problems he is having associated with his dysphagia, how long he has had it, and
the severity of it. He was also asked about his appetite, snacking habits, food preferences,
and current diet order based on his dysphagia. Patient FF was asked to keep a 3-day food
record so his nutrient breakdown could be analyzed using SuperTracker. He asked if it
would be okay if he kept his menus for 3 days as his food record since they receive a menu
at each meal. This request was made because he has a difficult time writing; he did,
however, cross off the items he did not consume and added anything he ate that was not on
the original menu. The data collected from his 3-day food record was entered into
SuperTracker to analyze whether or not he was meeting his nutrient recommendations.
Results
Patient FF is 5 feet 8 inches tall and currently weighs 250 pounds. He reported that
he used to be 5 feet 10 inches tall and that his usual body weight was 260 pounds. From the
interview, it was determined that he is currently taking three medications; two are for his
type two diabetes and one is for his hypothyroidism. He was also asked about other current
medical conditions; these include, type two diabetes, lung cancer, and a stroke four years
ago. His family history is very short with the only known condition being his father having
a stroke when he was 80; the same age that Patient FF had his. When asked about any
current problems he has that are associated with dysphasia, his answers were not

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surprising. He reports that he chokes easily and coughs a lot, sometimes even turning
bright red. His wife also stated that he has trouble keeping his mouth closed now and
drools more often; however, she was not sure if this was associated with the dysphasia. He
was asked how long he has had dysphagia and he stated that it started after his stroke and
has gotten progressively worse over the past four years. He was then asked about his
appetite and oral intake. He reports having a good appetite and that he eats about 100% of
every meal with very little snacking throughout the day. He stated that his favorite foods
are all meats and pizza, while he dislikes most vegetables. Patient FF was also asked what
his diet orders are due to his dysphagia. He reported that he eats a regular consistency diet,
however he typically needs things to be cut up into bite size pieces. He is supposed to be on
a mechanical soft diet, but when he was asked why he does not follow it, he stated that he
does not think that it helps and simply does not want to. He also reported that his drinks
are a nectar thick consistency, but they do not taste as good as regular liquid.
FF also reported that he recently had a videofluroscopy (swallow test) done. The
results from his swallow test showed that during the oral phase of swallowing, he had
prolonged mastication (chewing) and in the pharyngeal phase he had delayed swallowing
and slight aspiration. He was recommended a modified texture diet of mechanical soft
foods and nectar thick liquids, speech therapy, 90 sitting position while eating, and to not
talk while he is eating (his wife stated that when he eats he has a tendency to talk and that
is when he typically begins to choke and cough). FF, however, declines some of these
recommendations. He declines the mechanical soft diet because he has tried if before and it
did not seem to help. He also stated that due to his lung cancer (which is terminal), he

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would rather just eat what he enjoys while he can. He also refuses the speech therapy but
did not really give a reason as to why.
Patient FFs weight status changes are presented in Table 1. It can be seen that he
has been obese for most of his life (even when factoring in the two inches of height he has
lost) and that the weight loss that he has experienced over the past couple of years has not
been significant and should not be a concern. While he is obese, that is not the focus of this
case study.
Table 1. Weight Status.
UBW

260 lbs

% UBW

96%-not significant

IBW

154 lbs

% IBW

162%

BMI (kg/m2)

38-obese class II

% weight change

3.85% in 2 years

Patient FFs nutrient needs were also calculated and his food record was entered
into SuperTracker to determine whether or not he was meeting his needs, since a common
problem in dysphasia patients is being nutrient deficient. His energy needs were calculated
out to be 2,567 kcal/d, protein needs to be 136 g/d, and fluid needs to be 3,409 cc/d. Based
on the SuperTracker results, he is under his recommendations in all of these areas at 90%
of his energy needs, 61% of his protein needs, and 43% of his fluid needs (8). He should
also be consuming about 45-65% of his calories from carbohydrates and 20-35% from fat.
He is within normal limits on carbohydrates at 51% and slightly over on fats at 36% (8). He

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is also under his recommendations in most other nutrients, including vegetables, whole
grains, fiber, calcium, potassium, phosphorus, vitamins A, D, E, and K, and choline (8). His
nutrient breakdown can be seen in Table 2.
Table 2. Nutrient Breakdown.
Nutrient

Needs

Consumed

% of Needs

Interpretation

Energy

2567 kcal/d

2322 kcal/d

90%

Under Needs

Protein

136 g/d

83 g/d

61%

Under Needs

3409 cc/d

1479 cc/d

43%

Under Needs

Carbohydrate

45-65% kcals

298 g/d

51%

WNL

Fat

20-35% kcals

36%

Over Needs

Fluid

Discussion
Dysphagia is a common problem among the elderly population and can cause
numerous other adverse health conditions (4). The results from this case study show that
Patient FF experiences or has experienced many of the adverse effects of dysphagia. These
include, choking and coughing while eating and drinking, trouble swallowing, poor
nutritional status, aspiration, and weight loss (although this is not a huge concern in this
case). He consumes the recommended nectar thickened drinks but does not follow the
modified texture diet of mechanical soft. His poor nutritional status may very well be linked
to the fact that he is not following the recommended diet for his condition; it may also be
linked to his dislike of vegetables with his low levels of the fat-soluble vitamins. Even
though he is consuming the nectar thickened drinks, he does not consume nearly enough to

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meet his recommended needs. Patient FF should follow his diet orders, but there is a fine
line between quality and quantity of life. In normal circumstances, following the
recommended diet would improve his quality and quantity of life; but the modified
textured diet decreases the enjoyment of eating. Patient FFs circumstances are different
since he is fully aware that he has terminal cancer. It is no surprise that he wants to be able
to eat the foods that he enjoys while he still can. Even though stroke patients can
potentially have their dysphagia effects reversed, Patient FF did not get that lucky.

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References
1. Paik NJ. MedScape [Internet]. New York (NY): WebMD Health Professionals
Network; Dysphasia: Practice Essentials; [updated 2014 May 2; cited 2016 Jun 16].
Available from: http://emedicine.medscape.com/article/2212409-overview.
2. Rosler A, Pfeil S, Lessmann H, Hoder J, Befahr A, von Renteln-Kruse W. Dysphagia in
dementia: influence of dementia severity and food texture on the prevalence of
aspiration and latency to swallow in hospitalized geriatric patients. JAMDA. 2015
Aug; 16(8):697-701.
3. Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, et al. Effects of early intervention of
swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol.
2015 Feb; 14(3):119-124.
4. Keller M. Todays Dietitian [Internet]. Spring City (PA): Great Valley Publishing
Company, Inc; 2011 Oct [cited 2016 Jun 16]. Available from:
http://www.todaysdietitian.com/newarchives/100111p24.shtml.
5. Poisson P, Laffond T, Campos S, Dupuis V, Bourdel-Marchasson I. Relationships
between oral health, dysphagia and undernutrition in hospitalized elderly patients.
Brit Soc Gerodontology. 2016 Jun; 33(2):161-168.
6. Mayo Clinic [Internet]. Scottsdale (AZ): Mayo Foundation for Medical Education and
Research; Dysphagia; 2014 Oct 15 [cited 2016 Jun 16]. Available from:
http://www.mayoclinic.org/diseases-conditions/dysphagia/basics/definition/con20033444

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7. Swigert N. Speech Pathology [Internet]. Houston (TX): EBS Healthcare; 2009 Oct 26
[cited 2016 Jun 16]. Available from: http://www.speechpathology.com/ask-theexperts/use-shaker-technique-for-dysphagia-742
8. SuperTracker [Internet]. Alexandria (VA): SuperTracker; 2016 [cited 2016 Jun 16].