Swallowing difficulties are common at the end of life and dysphagia, a severe swallowing difficulty, is a sign that a person's disease is at end stage.
Dysphagia can be caused by neurological conditions such as stroke, progressive conditions (such as Parkinson's disease and dementia), obstructive conditions (such as oesophageal stricture), and muscular causes (such as achalasia and sarcopenia).
Dysphagia is a poor prognostic sign in patients nearing the end of life, and for many patients with a life-limiting illness, the inability to swallow may represent a pivotal symptom that prompts the decision to consider end-of-life or hospice care.
Dysphagia can be classified into four categories, based on the location of the swallowing impairment: oropharyngeal, esophageal, esophagogastric, and paraesophageal (Figure 82.1).
In patients with significant dysphagia and dementia we know that survival is equally short with and without a feeding tube, around 6 months.
Benign strictures typically progress slowly (over a period of months to years) and are associated with minimal weight loss. Malignant esophageal strictures usually cause rapidly progressing dysphagia (over a period of weeks to months) with substantial weight loss.
Palliative care for dysphagia is aimed at maximizing swallowing function, maintaining pulmonary health, and supporting healthy nutrition despite the impaired ability to swallow.
Dysphagia can sometimes lead to further problems. One of the most common problems is coughing or choking when food goes down the "wrong way" and blocks your airway. If this occurs frequently, you may avoid eating and drinking because you fear choking, which can lead to malnutrition and dehydration.
Difficulty swallowing can lead to: Malnutrition, weight loss and dehydration.
The first organ system to “close down” is the digestive system. Digestion is a lot of work! In the last few weeks, there is really no need to process food to build new cells.
These include loss of consciousness, changes to skin colour, and changes to breathing. Read more on our page, final moments of life.
people's mouths are usually open at the very end of life. because it takes muscles to keep your mouth shut. all those muscles are relaxed so people's mouths hang open. they also sometimes have their tongue out.
Choking and aspiration are more likely to arise as a result of dysphagia; in turn, this may make people fearful of eating, reduce their enjoyment of food, further contributing to a reduced food intake and worsening of malnutrition, setting up a vicious circle.
Swallowing disorders, known as dysphagia, can hinder speech and eating.
Acid reflux disease is the most common cause of dysphagia. People with acid reflux may have problems in the esophagus, such as an ulcer, a stricture (narrowing of the esophagus), or less likely a cancer causing difficulty swallowing.
Being diagnosed with dysphagia (swallowing difficulties) can be frightening. Enjoying a full, meaningful life when you have trouble eating, drinking and swallowing might seem unrealistic, but many Australians can and do live successfully with dysphagia.
Will My Condition Improve? Outside of a few special cases, dysphagia is often temporary and most dysphagic stroke survivors recover fully. Working with experts, like dieticians and speech pathologists, can help survivors manage their dysphagia and improve their ability to swallow safely.
Appropriate supportive care is important because dysphagia can be life-threatening and last for a long time.
Pain management is a key part of end of life and palliative care. If pain is well managed, quality of life will be better. The person is likely to sleep better and have more energy during the day. If they feel less pain, they can be more active, which also reduces the risk of complications.
If a person stops eating or drinking because of their reduced appetite, this may be hard to accept, but it is a normal part of the dying process. If they stop drinking, their mouth may look dry, but this does not always mean they are dehydrated. It is normal for all dying people eventually to stop eating and drinking.
Palliative care is treatment, care and support for people living with a life-limiting illness. A life-limiting illness is an illness that can't be cured and that you're likely to die from. Life-limiting illnesses can include: cancer. motor neurone disease.
Consequences of dysphagia include malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death. Adults with dysphagia may also experience disinterest, reduced enjoyment, embarrassment, and/or isolation related to eating or drinking.