Psychological Aspects of

Dysphagia

Jennifer Mae B. Robles

 Define what Dysphagia and what conditions
cause Dysphagia physically
 What emotions the patient may feel dealing
with Dysphagia
 Assuring, understanding and educating the
patient with Dysphagia
What is Dysphagia?

 Break it down:
Dys- difficult
phagia- swallowing
Remember the
Phagocytes?
- literally means
“eating cells”
Definition of Dysphagia:

 “Having difficulty swallowing, it is a symptom

that accompanies a number of neurological
disorders. The problem can occur at any
stage of the normal swallowing process as
food and liquid move from the mouth, down
the back of the throat, through the esophagus
and into the stomach.”

National Institute of Neurological Disorders and Stroke. (2008, July). NINDS

 Whatis involved with
swallowing?
The Human Body
Book, p,175
Swallowing Stages:

The Human Body Book, p.174

The Human Body Book, p.174
 View of the Larynx:

The pale leaflike flap of the

epiglottis is visible at the top
of this image, Below it is the
inverted “V” of the vocal
cords.

Class: What is so important about the Epiglottis?

The Human Body Book, p.174

  Breathe or
Swallow-
Dual Intake:
Breathing occurs
through the nose or
the mouth. Their
passageways meet
at the throat, and air
flows into the
trachea.

The Human Body Book, p.174

Causes of Dysphagia:
Medical Conditions: Medications:
 Achalasia  ACE inhibitors
 Amyotrophic lateral  Alpha adrenergic blockers
 sclerosis  Antibiotics
 Caustic solution ingestion  Anticholinergic agents
 Cerebral palsy  Antihistamines
 Dementia  Anti psychotics
 Diffuse esophageal spasm  Nitrates
 Gastroesophageal reflux disease  Nonsteroidal antiinflammatory drugs
(GERD)  Potassium chloride
 Head and neck cancer
 Head injury
 Immune disorders
 Multiple sclerosis
 Parkinson's disease
 Post-polio syndrome
 Spinal cord injury
 Stroke

Nowlin, A. , RN (magazine), June 2006

Who is Vulnerable?
 The Very Young and the Very Old
usually:
 Babies-Children: prenatal

development with bones,

muscles and throat-craniofacial
anomalies, cleft lip or palate,
tumors, large tonsils or tongue,
sensitivity in the esophagus,
foreign objects (example: coin).
 The Old Residents: (conditions

mentioned earlier), additionally

dentures, NPO with tubing No
oral hygiene oral flora +
immunocompromised= NOT
GOOD NEWS

Logsdon, B. , Nursing Home Magazine, 2004

Google Images
What’s the Big Deal?
 Patients can lose weight, lose
muscle mass/ muscle atrophy,
hence, insufficient nutrition and
dehydration and lose the ability to
swallow.
 Trouble in swallowing, signs and
symtpoms: elevated respiratory
rate, fever, chills, pleuritic chest
pain, and crackles, can result of
Aspiration pneumonia, if not
watched closely.
 In a study of “82 nursing home
residents with eating problems,
55% had symptoms of dysphagia,
but fewer than ¼ of those had
received a formal swallowing
evaluation”

Palmer, J.& Melhany, N.. American Journal of Nursing,2008

Google Image, Also found in Kozier ,Chapter 16. Maslow's
Hierarchy of Needs, Abraham Maslow
 Dysphagia Affects Patients
Quality
People with Mental Disorders, of Life
they suffer from Depression, “it
may cause changes in appetite and be accompanied by weight gain
or loss. Weight loss may be caused by anorexia nervosa, stimulant
abuse, dementia, or infectious conditions.” (The Nurse Practitioner, May 2004).

Negative emotions can also affect a person’s health like for Cerebral
Artery Stenosis and stroke. Study showed: “approximately 30% of
stroke patients reported anger, fear, irritability, nervousness, a
sudden change in body position, or a response to a startling event
in the 2 hours preceding the stroke. Because anger and other
negative emotions may trigger ischemic stroke, stress reduction
may help your patient decrease the risk ”
(PALMIERI, R., Nursing2006).
Eating is not longer
enjoyable…
 The participants’ treatment [ for oesophangeal cancer ]…”resulted in
exhaustion and tiredness as well as loss of weight. Meals became
time-consuming and eating mainly turned into a necessary source
for nutrition intake and they lost the pleasure earlier associated with
eating:

I can’t eat the same food as I used to eat and I have no

appetite right now. Cooking is no fun. Nothing tastes good
anymore. I try to eat sour milk, but I keep vomiting. I have an
enormous amount of phlegm and it really bothers me. I have no
energy…and it is really hard for me to eat anything. Where I used to
eat two potatoes, I can only eat one now and even that can be too
much. Eating makes me so tired that I have to lie down, even
though I haven’t eaten a whole lot.”

( Andreassen. S., et al., Journal of Clinical Nursing, 2006).

Personal Feelings and their
Quality of Life:
 In the UK 4 out of 10 enjoyed their meals.
Out of 360 people from the UK, Germany,
France and Spain, 36% avoided eating with
others because of their dysphagia.
 Also “4 out of 10 suffered anxiety or panic
during mealtimes, primarily because of food
sticking in the throat or feeling that they were
chocking.”

(Ekber, O., Hamdy, S.,Woisard, V., et a;Dysphagia, 2001)

Handicapped from Life:
 Dysphagia “ can destroy the social opportunities and pleasure of
mealtimes, affect the quality of the patient’s relationship with his/her
caregiver and family, undermine health an confidence. Patients with
dysphagia can become isolated, feel excluded by others, and be
anxious and distressed at mealtimes…affects a patient’s dignity, self-
esteem, and regard of others.
 …can be ranked as a handicap, defined as a reduction in functional
capacity that limits the individuals’ ability to attain his or her physical
goals.”
 Dysphagia affects all aspects of life.

(Ekber, O., Hamdy, S.,Woisard, V., et al;Dysphagia, 2001)

Prevention, Treatment,
Interventions:
 From a Swedish study, “the results of this study suggest that special
attention should be paid to patients who use escape-avoidance (i.e.,
avoiding people, wishing the situation would go away) as a means
of coping. This coping strategy was associated with emotional
distress and such patients may be in need of special support.”
 Studies suggest…”the patients’ function could indicate the need of
social support and family support. There was also a significant
relationship between impaired observed function and loss of
appetite. Change in appetite/weight is common in patients with brain
tumor. Appetite loss can stem from altered taste, nausea,
dysphagia, depression, fear of eating or effects of treatment .
[Intervention is needed, so] Health care staff needs to find the
reason for appetite loss to prevent malnutrition.”

(Gustafsson, M, Edvardsson, T. & Ahlström, G. ,2006)

Information is Power
 “If patients are psychologically isolated and do not believe they can
be helped, they will not complain vigorously to health
professionals…then patients will not be offered appropriate
solutions to their eating problems. By educating the patient,
assessing him/her in the contact of other illnesses and problems,
and offering th patient appropriate treatment for dysphagia, health
professionals could avoid the insidious psychological , social and
physical damage to the patient that would otherwise occur.”

 In the study, they “found that only 36% of patients acknowledged

that they had received a confirmed diagnosis of dysphagia , and
only 32% acknowledged receiving professional treatment for it. …
showed that unless asked by their caregiver to explain their
swallowing problems, patients were unlikely to take the initiative
themselves and inform healthcare professionals or even relatives of
their difficulties.”

(Ekber, O., Hamdy, S.,Woisard, V., et al;Dysphagia, 2001)

Options=Cooperative Patient
 “They experienced that the informational issues
about treatment …and the following decision
makings were tiring. However, they trusted in the
physicians’ recommendations [one patient
states]:
I have confidence in the doctor.
I trust that he’s doing what’s best
for me. Because I think if there
had been alternative treatments,
he would have suggested them.”

( Andreassen. S., et al., Journal of Clinical Nursing, 2006).

Activity:
 Drink some juice and observe the swallowing reflex.
 Place the food in your mouth and let it sit, then swallow (if
you can, try NOT TO CHEW).
 Place the food in your mouth and drink some water/juice.
 Noticed anything?
 Note: “The glossopharyngeal nerve(IX) is responsible for
taste on the back part of the tongue, somatosensory
information from, tonsil, pharynx; controls some muscles
used in swallowing ” and the vagus nerve (X) is responsible
for your glands and digestion).

Chudler, E., Washington Univ., 2009

 Recommendations for Feeding
the Elderly with Dysphagia
Look at Handout(s)
What’s your point?
 When in doubt Assess and Evaluate the patient with
the diseases/conditions which can be related to
dysphagia. Why? Because you never know, they
can get aspiration pneumonia.
 Be considerate, be understanding and acknowledge
their emotions.
 Educate the patient’s of their options and treatments
 Ekber and his colleagues “recommend that healthcare resources be allocated to the training of healthcare
professionals and to providing management and treatment options.
 Collaborative Team needs to help the patient not just nurses but other
health professionals to provide physical needs and psychosocial and
emotional needs with the help of family and friends for support.

(Ekber, O., Hamdy, S.,Woisard, V., et al;Dysphagia, 2001)

Thank you!