Difficulty with chewing and swallowing, a potentially serious medical condition known as dysphagia, is very common in the elderly. This condition may result from the gradual weakening of the aging person’s swallowing muscles or, in the case of dementia patients, as the result of the patient’s forgetting to swallow. Dysphagia can lead to choking and/or aspiration pneumonia. Aspiration pneumonia occurs when food or foreign object gets into the lungs and can also be the result of vomiting.
Doctors will often recommend that the person diagnosed with dysphagia eat pureed foods and drink liquids thickened with a commercially available thickener to help ensure that the food: 1) does not require chewing; and 2) the food and liquids remain within the digestive system upon swallowing. Medication in the form of pills may need to be crushed and delivered in a soft food item such as apple sauce. Obviously the nutritional status of such persons can also be difficult to manage.
What does this all have to do with nursing homes and assisted living facilities (ALFs)? If a nursing home or ALF does not adhere to the resident’s food/liquid consistence requirements, the resident may end up in the hospital or never even make it to the hospital. According to the CDC, 500 nursing home residents die each year as the result of dysphagia.
As discussed in many of our other nursing home negligence and abuse related blogs, vigilance by a family member(s) is still the best way to help ensure that the loved one is being properly taken care at the facility home (e.g., frequent turning to prevent bedsores). As it applies to dysphagia, this vigilance includes verifying that the loved one is receiving the proper diet in the correct form (e.g., pureed food as opposed to solid food and thickened liquids, including water).
In addition, family members should verify that staff members are properly supervised in feeding the loved one with dysphagia by asking plenty of questions and observing. The dysphagia patient may be unable to feed himself or herself unassisted. Untrained or improperly supervised staff members may not realize that such patients need to eat slowly and not have the food shoved into their mouths one spoonful right after the other to speed up the process. Staff members should also alert his/her supervisors to any observed coughing problems while the resident is eating or drinking so that the patient’s doctor can be notified. An observant staff member will also be on the alert for coughing problems during eating or drinking with an aging resident who has been at the facility for a while. For example, dysphagia may develop gradually as the result of aging and weakening “swallowing” muscles, worsening dementia where the resident forgets how to swallow, etc.
Failure of a nursing home facility or ALF to properly handle a “dysphagia” resident may well constitute negligence. Indeed, dysphagia is a well-documented condition and these facilities should be well-versed in the challenges a “dysphagia” resident faces.[1] This means among other things ensuring that the staff is caring and well-trained.
THE FOREGOING IS FOR INFORMATIONAL PURPOSES AND DOES NOT CONSTITUTE LEGAL ADVICE. IF YOU ARE CONTEMPLATING AN ACTION WHICH MAY HAVE LEGAL CONSEQUENCES, YOU SHOULD CONSULT WITH AN ATTORNEY OF YOUR CHOOSING.
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- 1. See, e.g., Dysphagia in the Elderly: Management and Nutritional Considerations by Livia Suria, et al., Clinical Interventions in Aging, 7: 287-298 (2012).
