CINXE.COM

<!DOCTYPE html>   <html class="no-js" lang="en" dir="ltr">  <head> <meta name="viewport" content="width=device-width, initial-scale=1"> <link rel="apple-touch-icon" sizes="180x180" href="/sites/all/themes/bgs/icons/apple-touch-icon.png"> <link rel="icon" type="image/png" href="/sites/all/themes/bgs/icons/favicon-32x32.png" sizes="32x32"> <link rel="icon" type="image/png" href="/sites/all/themes/bgs/icons/favicon-16x16.png" sizes="16x16"> <link rel="manifest" href="/sites/all/themes/bgs/icons/manifest.json"> <link rel="mask-icon" href="/sites/all/themes/bgs/icons/safari-pinned-tab.svg" color="#642f6c"> <meta name="msapplication-TileColor" content="#642f6c"> <meta name="theme-color" content="#642f6c"> <script src="https://use.typekit.net/qpa3efa.js"></script> <script>try{Typekit.load({ async: true });}catch(e){}</script>  <link rel="preconnect" href="//www.googletagmanager.com" /> <link rel="dns-prefetch" href="//www.googletagmanager.com" /> <meta charset="utf-8" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <script src="https://www.google.com/recaptcha/api.js?hl=en" async="async" defer="defer"></script> <meta name="description" content="Older patients frequently have dysphagia resulting from acute or chronic illnesses. Dysphagia management requires a collaborative approach because of the complexities of older patients' needs, and geriatricians have an important role to play in overseeing this condition." /> <meta name="abstract" content="Older patients frequently have dysphagia resulting from acute or chronic illnesses. Dysphagia management requires a collaborative approach because of the complexities of older patients' needs, and geriatricians have an important role to play in overseeing this condition." /> <link rel="canonical" href="https://www.bgs.org.uk/resources/dysphagia-management-for-older-people" /> <link rel="shortlink" href="https://www.bgs.org.uk/node/418" /> <meta http-equiv="content-language" content="en" /> <meta property="og:site_name" content="British Geriatrics Society" /> <meta property="og:title" content="Dysphagia Management for Older People | British Geriatrics Society" /> <meta property="og:description" content="Older patients frequently have dysphagia resulting from acute or chronic illnesses. Dysphagia management requires a collaborative approach because of the complexities of older patients' needs, and geriatricians have an important role to play in overseeing this condition." /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:url" content="https://www.bgs.org.uk/resources/dysphagia-management-for-older-people" /> <meta name="twitter:title" content="Dysphagia Management for Older People | British Geriatrics Society" /> <meta name="twitter:description" content="Older patients frequently have dysphagia resulting from acute or chronic illnesses. Dysphagia management requires a collaborative approach because of the complexities of older patients' needs, and" /> <title>Dysphagia Management for Older People | British Geriatrics Society</title> <style type="text/css" media="all"> @import url("/modules/system/system.base.css?sn052y"); @import url("/modules/system/system.theme.css?sn052y"); </style> <style type="text/css" media="all"> @import url("/modules/comment/comment.css?sn052y"); @import url("/sites/all/modules/date/date_api/date.css?sn052y"); @import url("/sites/all/modules/date/date_popup/themes/datepicker.1.7.css?sn052y"); @import url("/modules/field/theme/field.css?sn052y"); @import url("/sites/all/modules/fitvids/fitvids.css?sn052y"); @import url("/modules/node/node.css?sn052y"); @import url("/sites/all/modules/picture/picture_wysiwyg.css?sn052y"); @import url("/modules/search/search.css?sn052y"); @import url("/sites/all/modules/simpleads/simpleads.css?sn052y"); @import url("/modules/user/user.css?sn052y"); @import url("/sites/all/modules/extlink/extlink.css?sn052y"); @import url("/sites/all/modules/views/css/views.css?sn052y"); </style> <style type="text/css" media="all"> @import url("/sites/all/modules/ctools/css/ctools.css?sn052y"); @import url("/sites/all/libraries/photoswipe/dist/photoswipe.css?sn052y"); @import url("/sites/all/libraries/photoswipe/dist/default-skin/default-skin.css?sn052y"); @import url("/sites/all/modules/civicrm/css/crm-i.css?sn052y"); @import url("/sites/all/modules/civicrm/css/civicrm.css?sn052y"); @import url("/sites/all/modules/webform/css/webform.css?sn052y"); @import url("/sites/all/modules/hide_submit/css/ladda-themeless.min.css?sn052y"); @import url("/sites/all/modules/hide_submit/css/hide_submit.css?sn052y"); </style> <style type="text/css" media="all"> @import url("/sites/all/themes/bgs/css/magnific-popup.css?sn052y"); @import url("/sites/all/themes/bgs/css/bgs.css?sn052y"); @import url("/sites/all/themes/bgs/css/vedacustom.css?sn052y"); </style> <script type="text/javascript" src="/sites/all/modules/jquery_update/replace/jquery/1.9/jquery.js?v=1.9.1"></script> <script type="text/javascript" src="/misc/jquery-extend-3.4.0.js?v=1.9.1"></script> <script type="text/javascript" src="/misc/jquery-html-prefilter-3.5.0-backport.js?v=1.9.1"></script> <script type="text/javascript" src="/misc/jquery.once.js?v=1.2"></script> <script type="text/javascript" src="/misc/drupal.js?sn052y"></script> <script type="text/javascript" src="/sites/all/libraries/fitvids/jquery.fitvids.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/highcharttable/js/highcharttable.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/jquery_update/replace/ui/external/jquery.cookie.js?v=67fb34f6a866c40d0570"></script> <script type="text/javascript" src="/sites/all/modules/jquery_update/replace/misc/jquery.form.js?v=2.69"></script> <script type="text/javascript" src="/misc/ajax.js?v=7.74"></script> <script type="text/javascript" src="/sites/all/modules/jquery_update/js/jquery_update.js?v=0.0.1"></script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript" src="/sites/all/modules/admin_menu/admin_devel/admin_devel.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/fitvids/fitvids.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/simpleads/simpleads.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/spamspan/spamspan.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/extlink/extlink.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/iframe/iframe.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/views/js/base.js?sn052y"></script> <script type="text/javascript" src="/misc/progress.js?v=7.74"></script> <script type="text/javascript" src="/sites/all/modules/captcha/captcha.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/webform_conditional/webform_conditional.js?sn052y"></script> <script type="text/javascript" src="/sites/all/libraries/photoswipe/dist/photoswipe.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/libraries/photoswipe/dist/photoswipe-ui-default.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/google_analytics/googleanalytics.js?sn052y"></script> <script type="text/javascript" async="async" src="https://www.googletagmanager.com/gtag/js?id=UA-47703711-1"></script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript"> <![CDATA[//><!]]> </script> <script type="text/javascript" src="/sites/all/libraries/highcharts/js/highcharts.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/highcharttable/libraries/variants/jquery.highchartTable-patched.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/views/js/ajax_view.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/webform/js/webform.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/hide_submit/js/hide_submit.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/hide_submit/js/spin.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/hide_submit/js/ladda.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/jquery.smartmenus.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/jquery.matchheight.mod.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/slick/slick.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/js.cookie.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/resizesensor.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/jquery.navscroll.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/jquery.sticky-sidebar.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/jquery.magnific-popup.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/jquery.shorten.min.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/jquery.shorten.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/scripts.js?sn052y"></script> <script type="text/javascript" src="/sites/all/themes/bgs/js/bgs.behaviour.js?sn052y"></script> <script type="text/javascript"> <![CDATA[//><!]]> </script> </head> <body class="html not-front not-logged-in two-sidebars page-node page-node- page-node-418 node-type-resource sticky-sidebars i18n-en british-geriatrics-society bgs-org-uk role-anonymous-user menu-depth-2" > <script id="_informizely_script_tag" type="text/javascript"> var IzWidget = IzWidget || {}; (function (d) { var scriptElement = d.createElement('script'); scriptElement.type = 'text/javascript'; scriptElement.async = true; scriptElement.src = "https://insitez.blob.core.windows.net/site/d80f25f3-2290-42a7-a35f-837905591d26.js"; var node = d.getElementById('_informizely_script_tag'); node.parentNode.insertBefore(scriptElement, node); })(document); </script> <noscript><a href="https://www.informizely.com/">Informizely customer feedback surveys</a></noscript> <div role="document" class="page"> <header id="site-header"> <div class="header-outer-wrapper"> <div class="header-inner-wrapper"> <div class="wrapper-site-branding"> <div class="site-branding"> <h2 class="site-title"> <a href="/" title="Home" rel="home"><span>British Geriatrics Society</span></a> </h2> </div> </div> <div class="wrapper-region-header"> <section class="block block-menu"> <ul class="menu"><li class="first leaf"><a href="/about/become-a-member-of-the-bgs" title="">Join</a></li> <li class="leaf"><a href="/user/register" title="">Join</a></li> <li class="last leaf"><a href="/user/login?current=node/418" title="">Login</a></li> </ul> </section> <section class="block block-views"> <div class="view view-header-sections view-id-header_sections view-display-id-social view-display-grid view-dom-id-83a0e07010e94bada9035c5f99596365"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first views-row-last section-row -field-row -field-palette"> <div class="card-follow-us-on"> <div class="item-list"><ul><li class="first"><div class='card-links'><a href="https://facebook.com/BGS1947" rel="nofollow" target="_blank">Facebook</a> </div></li> <li><div class='card-links'><a href="https://twitter.com/GeriSoc" rel="nofollow" target="_blank">Twitter</a> </div></li> <li class="last"><div class='card-links'><a href="http://linkedin.com/company/british-geriatrics-society" rel="nofollow" target="_blank">LinkedIn</a> </div></li> </ul></div> </div> </div> </div> </div> </section> </div> </div> <div class="main-nav-wrapper"> <nav id="main-navigation" class="main-navigation"> <section class="block block-menu-block"> <div class="menu-block-wrapper menu-block-1 menu-name-main-menu parent-mlid-0 menu-level-1"> <input id="main-menu-state" type="checkbox" /><label class="main-menu-btn" for="main-menu-state"><span class="main-menu-btn-icon"></span> Toggle main menu visibility</label> <ul class="menu"><li class="first expanded menu-mlid-9196"><a href="/bgs-elearning">BGS elearning</a><ul class="menu"><li class="first leaf menu-mlid-9198"><a href="https://www.bgs.org.uk/elearning/delirium-in-older-people-elearning" title="">Delirium elearning</a></li> <li class="leaf menu-mlid-9197"><a href="https://www.bgs.org.uk/elearning/frailty-elearning-course" title="">Frailty elearning</a></li> <li class="last leaf menu-mlid-9216"><a href="/elearning/oncogeriatrics-elearning-0">Oncogeriatrics elearning</a></li> </ul></li> <li class="leaf menu-mlid-6697"><a href="/about/become-a-member-of-the-bgs" title="">Join BGS</a></li> <li class="leaf menu-mlid-3618"><a href="/blog" title="">Blog</a></li> <li class="expanded menu-mlid-6766"><a href="/events">Events</a><ul class="menu"><li class="first leaf menu-mlid-6835"><a href="/events" title="">Upcoming events</a></li> <li class="leaf menu-mlid-8769"><a href="/abstracts">Abstract submission</a></li> <li class="leaf menu-mlid-9165"><a href="/funded">Funded places</a></li> <li class="leaf menu-mlid-9098"><a href="/events/hybrid-event-faqs">Hybrid Event FAQs</a></li> <li class="leaf menu-mlid-6827"><a href="/events/past-events" title="">On Demand and Past events</a></li> <li class="leaf menu-mlid-8771"><a href="/events/sponsorship" title="Sponsorship Opportunities">Sponsorship</a></li> <li class="expanded menu-mlid-6830"><a href="/events/external-events">External events</a><ul class="menu"><li class="first last leaf menu-mlid-9195"><a href="/events/external-events/add-an-external-event">Add an external event</a></li> </ul></li> <li class="last expanded menu-mlid-6829"><a href="/events/external-courses" title="">External courses and examinations</a><ul class="menu"><li class="first leaf menu-mlid-6844"><a href="/events/external-courses/add-an-external-course">Add an external course</a></li> <li class="last leaf menu-mlid-9140"><a href="/DGM">Diploma in Geriatric Medicine (DGM)</a></li> </ul></li> </ul></li> <li class="expanded menu-mlid-3631"><a href="/policy-and-media" title="">News & Policy</a><ul class="menu"><li class="first leaf menu-mlid-9112"><a href="/policy-and-media/news-policy">Latest news and policy</a></li> <li class="leaf menu-mlid-9215"><a href="/choose">#ChooseGeriatrics</a></li> <li class="last leaf menu-mlid-9147"><a href="https://www.bgs.org.uk/campaigns" title="">Campaigns</a></li> </ul></li> <li class="expanded active-trail menu-mlid-3334"><a href="/resources" class="active-trail">Resources</a><ul class="menu"><li class="first expanded menu-mlid-9186"><a href="/resources/bgs-hubs">BGS Hubs</a><ul class="menu"><li class="first leaf menu-mlid-9187"><a href="/node/5805/" title="">Frailty Hub</a></li> <li class="leaf menu-mlid-9188"><a href="/deliriumhub" title="">Delirium Hub</a></li> <li class="leaf menu-mlid-9189"><a href="/QIHub" title="">QI Hub</a></li> <li class="last leaf menu-mlid-9190"><a href="/research" title="">Research Hub</a></li> </ul></li> <li class="leaf menu-mlid-3704"><a href="/resources/resource-series">Resources by series</a></li> <li class="expanded menu-mlid-3706"><a href="/resources/topics">Resources by topic</a><ul class="menu"><li class="first expanded menu-mlid-8776"><a href="http://www.bgs.org.uk/covid-19" title="">COVID</a><ul class="menu"><li class="first leaf menu-mlid-8777"><a href="https://www.bgs.org.uk/resources/resource-series/coronavirus-and-older-people" title="">For healthcare professionals</a></li> <li class="leaf menu-mlid-8778"><a href="https://www.bgs.org.uk/coronavirus-advice-to-older-people" title="">For the public</a></li> <li class="leaf menu-mlid-8779"><a href="https://www.bgs.org.uk/media-enquiries" title="">Media enquiries</a></li> <li class="last leaf menu-mlid-9101"><a href="/http%3A/www.bgs.org.uk/covid-19/covid-19-research">Research and trials</a></li> </ul></li> <li class="expanded menu-mlid-5651"><a href="/topics/acute-care" title="Acute Care">Acute Care</a><ul class="menu"><li class="first leaf menu-mlid-5653"><a href="/topics/deconditioning-rehabilitation" title="Deconditioning">Deconditioning</a></li> <li class="leaf menu-mlid-5656"><a href="/topics/emergency-care" title="Emergency care">Emergency care</a></li> <li class="leaf menu-mlid-5657"><a href="/topics/end-of-life-care" title="End of life care">End of life care</a></li> <li class="leaf menu-mlid-5658"><a href="/topics/patient-safety" title="Patient safety">Patient safety</a></li> <li class="leaf menu-mlid-5659"><a href="/topics/patientfamily-involvement" title="Patient/Family Involvement">Patient/Family Involvement</a></li> <li class="leaf menu-mlid-5655"><a href="/topics/peri-operative-care-for-surgical-patients" title="Peri-operative care for surgical patients">Peri-operative care for surgical patients</a></li> <li class="last leaf menu-mlid-5652"><a href="/topics/cga-in-acute-settings" title="Comprehensive Geriatric Assessment (CGA) in acute settings">Comprehensive Geriatric Assessment (CGA) in acute settings</a></li> </ul></li> <li class="expanded menu-mlid-5660"><a href="/topics/primary-and-community-care" title="Primary and Community Care">Primary and Community Care</a><ul class="menu"><li class="first leaf menu-mlid-9109"><a href="/topics/care-homes" title="Care Homes">Care Homes</a></li> <li class="leaf menu-mlid-5662"><a href="/topics/commissioning" title="Commissioning">Commissioning</a></li> <li class="leaf menu-mlid-5664"><a href="/topics/healthy-ageing" title="Healthy Ageing">Healthy Ageing</a></li> <li class="leaf menu-mlid-6968"><a href="/topics/transfer-of-care" title="Transfer of Care">Transfer of Care</a></li> <li class="leaf menu-mlid-5661"><a href="/topics/cga-in-community-settings" title="Comprehensive Geriatric Assessment (CGA) in community settings">Comprehensive Geriatric Assessment (CGA) in community settings</a></li> <li class="leaf menu-mlid-5667"><a href="/topics/digital-health-ampamp-technology" title="Digital Health and Technology">Digital Health and Technology</a></li> <li class="last leaf menu-mlid-5707"><a href="/topics/eyes-and-ears" title="Eyes, Ears and Teeth">Eyes, Ears and Teeth</a></li> </ul></li> <li class="expanded menu-mlid-7717"><a href="/topics/cross-cutting-primaryacute" title="Cross-cutting Primary/Acute">Cross-cutting Primary/Acute</a><ul class="menu"><li class="first leaf menu-mlid-5654"><a href="/topics/dignity" title="Dignity">Dignity</a></li> <li class="leaf menu-mlid-5663"><a href="/topics/frailty-indexes" title="Frailty indexes">Frailty indexes</a></li> <li class="leaf menu-mlid-5665"><a href="/topics/integrated-care" title="Integrated care">Integrated care</a></li> <li class="leaf menu-mlid-9110"><a href="/topics/rehabilitation" title="Rehabilitation">Rehabilitation</a></li> <li class="last leaf menu-mlid-5666"><a href="/topics/prescribing%20and%20medication%20management" title="Prescribing and medication management">Prescribing and medication management</a></li> </ul></li> <li class="expanded menu-mlid-9172"><a href="/topics/clinical-quality" title="Clinical Quality">Clinical Quality</a><ul class="menu"><li class="first leaf menu-mlid-9173"><a href="/topics/quality-improvement" title="Quality Improvement">Quality Improvement</a></li> <li class="last leaf menu-mlid-9185"><a href="/QIHub" title="">QI Hub</a></li> </ul></li> <li class="expanded menu-mlid-5695"><a href="/topics/research" title="Research">Research</a><ul class="menu"><li class="first leaf menu-mlid-6861"><a href="/topics/grants-fellowships-and-research-proposals" title="Grants, Fellowships and Research Proposals">Grants, Fellowships and Research Proposals</a></li> <li class="last leaf menu-mlid-9184"><a href="/research" title="">Research Hub</a></li> </ul></li> <li class="expanded menu-mlid-5685"><a href="/topics/general" title="General">General</a><ul class="menu"><li class="first leaf menu-mlid-5687"><a href="/topics/allied-healthcare-professionals" title="Allied Healthcare Professionals">Allied Health Professionals</a></li> <li class="leaf menu-mlid-5688"><a href="/topics/demographics" title="demographics">Demographics</a></li> <li class="leaf menu-mlid-5689"><a href="/topics/education-training-and-careers" title="Education, Training and Careers">Education, Training and Careers</a></li> <li class="leaf menu-mlid-5690"><a href="/topics/ethics-and-law" title="Ethics and Law">Ethics and Law</a></li> <li class="leaf menu-mlid-5691"><a href="/topics/health-and-social-care-policy" title="Health and social care policy">Health and social care policy</a></li> <li class="leaf menu-mlid-5692"><a href="/topics/history-of-geriatric-medicine" title="History of Geriatric medicine">History of Geriatric medicine</a></li> <li class="leaf menu-mlid-5693"><a href="/topics/nice-guidelines" title="NICE guidelines">NICE guidelines</a></li> <li class="leaf menu-mlid-5694"><a href="/topics/nursing" title="Nursing">Nursing</a></li> <li class="leaf menu-mlid-5696"><a href="/topics/workforce" title="Workforce">Workforce</a></li> <li class="last leaf menu-mlid-9116"><a href="/topics/wellbeing" title="Wellbeing">Wellbeing</a></li> </ul></li> <li class="expanded menu-mlid-5668"><a href="/topics/specific-conditions" title="Specific conditions">Specific conditions</a><ul class="menu"><li class="first leaf menu-mlid-5669"><a href="/topics/balance-disorders" title="Balance disorders">Balance disorders</a></li> <li class="leaf menu-mlid-5672"><a href="/topics/continence" title="Continence">Continence</a></li> <li class="leaf menu-mlid-9111"><a href="/topics/covid-19" title="COVID-19">COVID-19</a></li> <li class="leaf menu-mlid-5673"><a href="/topics/delirium" title="Delirium">Delirium</a></li> <li class="leaf menu-mlid-5674"><a href="/topics/dementia" title="Dementia">Dementia</a></li> <li class="leaf menu-mlid-5677"><a href="/topics/frailty" title="Frailty">Frailty</a></li> <li class="leaf menu-mlid-5678"><a href="/topics/mental-health" title="Mental Health">Mental Health</a></li> <li class="leaf menu-mlid-5679"><a href="/topics/movement-disorders" title="Movement Disorders including Parkinsons">Movement Disorders including Parkinsons</a></li> <li class="leaf menu-mlid-5680"><a href="/topics/multimorbidity" title="Multimorbidity">Multimorbidity</a></li> <li class="leaf menu-mlid-5681"><a href="/topics/nutrition" title="Nutrition">Nutrition</a></li> <li class="leaf menu-mlid-5682"><a href="/topics/pain" title="Pain">Pain</a></li> <li class="leaf menu-mlid-5683"><a href="/topics/stroke" title="Stroke">Stroke</a></li> <li class="leaf menu-mlid-5684"><a href="/topics/tissue-viability" title="Tissue Viability">Tissue Viability</a></li> <li class="leaf menu-mlid-5671"><a href="/topics/cardiovascular-health" title="Cardiovascular Health">Cardiovascular Health</a></li> <li class="leaf menu-mlid-5675"><a href="/topics/diabetes" title="Endocrinology">Endocrinology</a></li> <li class="leaf menu-mlid-5676"><a href="/topics/falls-joints-bone-health" title="Falls and Balance">Falls and Balance</a></li> <li class="last leaf menu-mlid-5670"><a href="/topics/oncogeriatrics" title="Oncogeriatrics">Oncogeriatrics</a></li> </ul></li> <li class="leaf menu-mlid-9214"><a href="/topics/choosegeriatrics" title="#ChooseGeriatrics">#ChooseGeriatrics</a></li> <li class="leaf menu-mlid-9203"><a href="/topics/admission" title="Admission">Admission</a></li> <li class="leaf menu-mlid-9204"><a href="/topics/advance-care-planning" title="Advance Care Planning">Advance Care Planning</a></li> <li class="leaf menu-mlid-9205"><a href="/topics/alternative-therapy" title="Alternative therapy">Alternative therapy</a></li> <li class="leaf menu-mlid-9206"><a href="/topics/biology-of-ageing" title="Biology of Ageing">Biology of Ageing</a></li> <li class="leaf menu-mlid-9208"><a href="/topics/community-care" title="Community Care">Community Care</a></li> <li class="leaf menu-mlid-9209"><a href="/topics/continuing-professional-development-cpd" title="Continuing Professional Development (CPD)">Continuing Professional Development (CPD)</a></li> <li class="leaf menu-mlid-9210"><a href="/topics/disability" title="Disability">Disability</a></li> <li class="leaf menu-mlid-9211"><a href="/topics/discharge-planning" title="Discharge planning">Discharge planning</a></li> <li class="leaf menu-mlid-9212"><a href="/topics/dysphagiaswallowing" title="Dysphagia/Swallowing">Dysphagia/Swallowing</a></li> <li class="leaf menu-mlid-9213"><a href="/topics/exercise" title="Exercise">Exercise</a></li> <li class="last leaf menu-mlid-9202"><a href="/topics/hospital-at-home" title="Hospital at Home">Hospital at Home</a></li> </ul></li> <li class="leaf menu-mlid-7705"><a href="https://www.bgs.org.uk/resources" title="">Resources by date</a></li> <li class="leaf menu-mlid-9107"><a href="https://www.bgs.org.uk/resources?keywords=&group=All&type=All&field_resource_series_target_id_selective=All&tag=All&authors=All&from_date%5Bvalue%5D%5Bdate%5D=&to_date%5Bvalue%5D%5Bdate%5D=&sort_by=score" title="">Search resources</a></li> <li class="last leaf menu-mlid-3797"><a href="/AAAjournal">Age and Ageing journal</a></li> </ul></li> <li class="expanded menu-mlid-3577"><a href="/bgs-groups">BGS groups</a><ul class="menu"><li class="first leaf menu-mlid-3575"><a href="/about/national-regional-groups" title="">Nations & Regions</a></li> <li class="last leaf menu-mlid-8435"><a href="/bgs-groups/bgs-special-interest-groups">Professions & Special Interest</a></li> </ul></li> <li class="last expanded menu-mlid-3256"><a href="/about">About</a><ul class="menu"><li class="first leaf menu-mlid-5591"><a href="/about/become-a-member-of-the-bgs">Become a member</a></li> <li class="expanded menu-mlid-3796"><a href="/about/our-purpose">Who we are</a><ul class="menu"><li class="first expanded menu-mlid-3710"><a href="/about/our-purpose/bgs-trustees-and-officers">Our Board of Trustees</a><ul class="menu"><li class="first leaf menu-mlid-7680"><a href="/about/our-purpose/bgs-trustees-and-officers/bgs-elections">BGS Elections</a></li> <li class="leaf menu-mlid-8767"><a href="/agm" title="">AGM</a></li> <li class="last leaf menu-mlid-9160"><a href="/about/our-purpose/bgs-trustees-and-officers/past-presidents">Past Presidents</a></li> </ul></li> <li class="leaf menu-mlid-7754"><a href="/about/our-purpose/bgs-staff">Our Staff Team</a></li> <li class="leaf menu-mlid-8768"><a href="/strategy">Our Strategy</a></li> <li class="last leaf menu-mlid-6700"><a href="/about/our-purpose/library-and-archives">Our History</a></li> </ul></li> <li class="expanded menu-mlid-9104"><a href="https://www.bgs.org.uk/get-involved" title="">Get involved</a><ul class="menu"><li class="first leaf menu-mlid-9108"><a href="/https%3A/www.bgs.org.uk/get-involved/get-involved">How to get involved</a></li> <li class="last leaf menu-mlid-6967"><a href="/https%3A/www.bgs.org.uk/get-involved/our-partner-organisations">Our partner organisations</a></li> </ul></li> <li class="expanded menu-mlid-6698"><a href="/bgsvacancies">Vacancies</a><ul class="menu"><li class="first collapsed menu-mlid-8438"><a href="/bgsvacancies" title="">BGS vacancies</a></li> <li class="leaf menu-mlid-7718"><a href="/about/external-vacancies" title="">External vacancies</a></li> <li class="last leaf menu-mlid-8437"><a href="https://www.bgs.org.uk/submit-job-advert" title="">Submit a job vacancy</a></li> </ul></li> <li class="leaf menu-mlid-9096"><a href="/about/make-a-donation">Donate</a></li> <li class="last leaf menu-mlid-3711"><a href="/about/contact">Contact us</a></li> </ul></li> </ul></div> </section> <section class="block block-block search-toggle-wrapper"> <div class="search-toggle">Search</div> </section> <section class="block block-search"> <form action="/resources/dysphagia-management-for-older-people" method="post" id="search-block-form" accept-charset="UTF-8"><div><div class="container-inline"> <h2>Search</h2> <div class="form-wrapper"> <div class="form-item form-type-textfield form-item-search-block-form"> <label class="element-invisible" for="edit-search-block-form--2">Search </label> <input title="Enter the terms you wish to search for." type="text" id="edit-search-block-form--2" name="search_block_form" value="" size="15" maxlength="128" class="form-text" /> </div> <div class="form-actions form-wrapper" id="edit-actions"><input type="submit" id="edit-submit" name="op" value="Search" class="form-submit" /></div><input type="hidden" name="form_build_id" value="form-3d6u3sd84eymJ41hEkWUVK4QdFZG2ROR8lP23oeD4xE" /> <input type="hidden" name="form_id" value="search_block_form" /> </div> </div> </div></form> </section> </nav> </div> </div> </header> <section id="breadcrumb"> <div class="outer-wrapper"> <div class="breadcrumb"><span class="first"><a href="/">Home</a></span><span class="crumb-1"><a href="/resources">Resources</a></span><span class="last">Resources</span></div> </div> </section> <div class="tabs outer-wrapper"> </div> <main role="main"> <div class="outer-wrapper"> <aside id="sidebar-first" role="complementary" class="sidebar"> <div id="block-block-1" class="block block-block soc-accelerators"> <div class="soc-accelerators-inner"><div class="block-content-wrapper clearfix"> <h2>Share</h2> <div class="content"> <div class="card-links"> <ul> <li class="facebook"><a title="Share on Facebook." href="http://www.facebook.com/sharer.php?u=https://www.bgs.org.uk/resources/dysphagia-management-for-older-people&t=Dysphagia+Management+for+Older+People" rel="nofollow" target="_blank">Share on Facebook</a></li> <li class="twitter"><a target="_blank" rel="nofollow" title="Share this on Twitter" href="http://twitter.com/share?url=https://www.bgs.org.uk/resources/dysphagia-management-for-older-people&text=Dysphagia+Management+for+Older+People">Tweet</a></li> <li class="linkedin"><a title="Share on LinkedIn" href="http://www.linkedin.com/shareArticle?mini=true&url=https://www.bgs.org.uk/resources/dysphagia-management-for-older-people&title=Dysphagia+Management+for+Older+People]&source=ALNAP" rel="nofollow" target="_blank">Share on LinkedIn</a></li> <li class="email"><a title="Share by Email" href="mailto:?subject=I wanted you to see this site&body=Check out this site https://www.bgs.org.uk/resources/dysphagia-management-for-older-people" rel="nofollow">Share by Email</a></li> <li class="calendar"> </li> </ul> </div> </div> </div></div> </div> </aside> <section id="content"> <div class="content-main"> <article id="node-418" class="node node-resource node-content" about="/resources/dysphagia-management-for-older-people" typeof="sioc:Item foaf:Document"> <div class="resource-header node-header"> <h1><div class="card-full-title"> Dysphagia Management for Older People towards the end of life </div> </h1> <span property="dc:title" content="Dysphagia Management for Older People" class="rdf-meta element-hidden"></span><span property="sioc:num_replies" content="0" datatype="xsd:integer" class="rdf-meta element-hidden"></span> <div class="resource-header-details"> <div class="card-resource-type-i"> <div class="card-resource-type"> Good practice guide </div> <div class="resource-type-i-icon">i</div> <div class="resource-type-info-arrow"></div> </div> <div class="resource-type-info"><div class="resource-type-info-text">Good practices guides focus on providing information on a clinical topic.</div></div> </div> <div class="node-header-details"> <div class="card-authors-wrapper"><div class="label">Authors:</div><div class="author-details">British Geriatrics Society</div></div> <div class="card-topics-wrapper"><div class="label">Topics:</div><a href="/taxonomy/term/13">End of life care</a>, <a href="/taxonomy/term/2959">Oncogeriatrics</a>, <a href="/taxonomy/term/2710">Delirium</a>, <a href="/taxonomy/term/2956">Dementia</a>, <a href="/taxonomy/term/2955">Frailty</a></div> <div class="node-header-dates"> <div class="card-date-wrapper"><div class="label">Date Published:</div><div class="card-date"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2012-11-22T00:00:00+00:00">22 November 2012</span> </div> </div> <div class="card-date-updated"> <div class="label">Last updated: </div> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2018-04-03T11:05:00+01:00">03 April 2018</span> </div> </div> </div> <div class="card-resource-summary"> <p>Older patients in acute hospitals frequently have dysphagia, resulting from acute or chronic illnesses such as stroke, dementia, and respiratory diseases.  Dysphagia management requires a collaborative, multidisciplinary team (MDT) approach. Dysphagia assessment and management for older people is best provided by the MDT because of the complexities and inter-related nature of their needs; swallowing cannot be assessed in isolation. Geriatricians therefore have an important role to play in overseeing the management of dysphagia.</p> <p>The decision-making process regarding whether to provide an older person with artificial nutrition and hydration or continue to allow food and drink by mouth once their swallowing becomes unsafe provokes difficult ethical decisions for professionals and patients. There are currently wide variations in the management decisions made, and inconsistencies occur in MDTs working across acute settings in the UK (Groher 1994, Logemann et al 2008).  As a result patients’ are often unable to access the specialist services required to effectively manage their eating and drinking difficulties towards the end of life; potentially causing more distress in the longer-term.</p> <p>Professionals within the MDT need to work together to ensure a comprehensive geriatric approach is applied in relation to dysphagia management, considering the risks and benefits of eating and drinking for each individual to enable optimal quality of life. A co-ordinated approach, particularly towards the end of life is essential for patients with dementia and other chronic, progressive conditions, to ensure consistent transfer of care between acute and community settings.</p> </div> </div> <div class="view view-sections view-id-sections view-display-id-main view-dom-id-d546dba0826bfb5f0998d9201695ad54"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first views-row-last section-row palette-default "> <div class="section-inner"> <div class="card-body"> <h2 class="sidebar-nav">Introduction</h2> <p>Ageing does not necessarily cause dysphagia, but the potential for developing dysphagia becomes increasingly common with advancing age (Leder and Suiter 2009). Age-related changes affect head and neck anatomy and physiology, increasing the risk of dysphagia. These include: tongue pressure changes, slower swallowing, increased airway penetration, sensory changes, and oesophageal motility changes (Ney et al 2009). These changes contribute to older people being more vulnerable to dysphagia, as a result of a decreased functional reserve (Robbins et al 2002).</p> <p>The rising incidence of dysphagia for older people in hospitals, particularly those over 80 years of age (Leder and Suiter 2009) has many health implications including: malnutrition, dehydration, poor oral hygiene, choking, aspiration pneumonia, and increased need for institutionalised care (Marik and Kaplan 2003, Ney et al 2009). Complex feeding decisions regarding the continuation of oral intake or commencement of artificial nutrition for patients with severe dysphagia are becoming more frequent for Geriatricians, and they in turn seek advice from their MDT colleagues, such as speech and language therapists and dieticians.</p> <p>The management of swallowing difficulties for older people towards the end of life remains an under researched area (Bath et al 2000, Wright et al 2008). Research and guidance has focused on decision-making for initiating artificial nutrition and hydration for older patients (Enrione and Chutkan 2007, Volkert et al 2006), but alternative dysphagia management options such as risk management have yet to be fully evaluated (Dibartolo 2006, Palecek et al 2010). Research is needed to develop the required specialist approach to dysphagia management for older people (Leder and Suiter 2009, McCullough et al 2007), especially those living with progressive chronic conditions who are nearing the end of their life. Best-practice guidance is available in relation to managing dysphagia for specific conditions affecting older people; commonly stroke and dementia. (These are referenced and available below; see section 4.) Specific information regarding feeding and hydration management towards the end of life is also available in the BGS best practice guide ‘Nutritional advice in common clinical situations’.</p> <p>The Royal College of Physicians has provided recent structured advice for oral feeding difficulties and dilemmas particularly towards the end of life, which are an excellent referent for MDTs working in this area. It covers in detail: 1) Background: oral feeding; 2) Techniques of artificial nutrition; 3) Ethics; 4) Law; 5) Practice, and gives just consideration to risk management and social oral feeding techniques:</p> <p>“Patients with oral feeding difficulties deserve special care but may not receive it. Their care should be tailored to their requirements, not to the needs of others. It should, as far as possible, preserve their oral intake. If this is impossible, tube feeding may be necessary, short or long term. Very rarely, intravenous nutrition may be appropriate” (RCP, 2010).</p> <h2 class="sidebar-nav">Definitions and terminology</h2> <p><strong>Artificial nutrition and hydration</strong> – refers to tube feeding by either; Naso-gastric tube (NGT) or Percutaneous Endoscopic Gastrostomy (PEG).</p> <p><strong>Aspiration</strong> –refers to pulmonary aspiration, the entry of secretions or foreign material into the trachea and lungs which can lead to aspiration pneumonitis (Logemann 1998).</p> <p><strong>Dysphagia</strong> – refers to oro-pharyngeal dysphagia defined as “difficulty in swallowing or impairment in the movement of swallowed material from the pharynx to the stomach” (Logemann 1998). This definition is most commonly used in the literature referring to this type of dysphagia.</p> <p><strong>Oral intake</strong> – refers to when the main route of feeding and hydration is through the mouth, via the oesophagus, into the stomach (Logemann et al 2008).</p> <p><strong>Risk management</strong> – describes an approach to dysphagia management where patients continue to eat and drink, with the support of the multidisciplinary team, despite an ‘unsafe swallow’ and ongoing risk of aspiration, (RCP 2010). This approach is also referred to clinically as ‘at risk feeding’ or ‘comfort feeding’.</p> <p><strong>Swallowing</strong> – refers to the entire act of deglutition, the process whereby something is passed from the mouth to the pharynx, into the oesophagus, and to the stomach, whilst the epiglottis is shut to prevent material from falling into the airway and causing aspiration (Logemann 1998).</p> <h2 class="sidebar-nav">Health Policy and Guidance</h2> <p>There are several related policy documents and guidelines which relate to dysphagia management, particularly towards the end of life:</p> <ul> <li>Dementia: supporting people with dementia and their carers in health and social care. (2006) National Institute for Health and Clinical Excellence; DOH: <a href="http://publications.nice.org.uk/dementia-cg42">http://publications.nice.org.uk/dementia-cg42</a></li> <li>Living well with dementia National Dementia Strategy (2009) DOH: Crown Copyright. <a href="http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094058">http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...</a></li> <li>Management of patients with dementia. A national clinical guideline, (2006) Scottish Intercollegiate Guidelines Network, Edinburgh: <a href="http://www.sign.ac.uk/pdf/sign86.pdf">http://www.sign.ac.uk/pdf/sign86.pdf</a></li> <li>Management of patients with stroke or TIA: Assessment, investigation, immediate management and secondary prevention (2008) Scottish Intercollegiate Guideline Network. Edinburgh:<a href="http://www.sign.ac.uk/guidelines/fulltext/108/index.html">http://www.sign.ac.uk/guidelines/fulltext/108/index.html</a></li> <li>Management of patients with stroke: identification and management of dysphagia (2010) Scottish Intercollegiate Guideline Network: <a href="http://www.sign.ac.uk/guidelines/fulltext/119/index.html">http://www.sign.ac.uk/guidelines/fulltext/119/index.html</a></li> <li>· Mental Capacity Act (2005), London: HMSO <a href="http://www.legislation.gov.uk/ukpga/2005/9/contents">http://www.legislation.gov.uk/ukpga/2005/9/contents</a></li> <li>Nutrition advice in common clinical situations (2009) Good Practice Guides, RJA, British Geriatrics Society: <a href="http://www.bgs.org.uk/index.php?option=com_content&view=article&id=41:gpgnutrition&catid=12:goodpractice&Itemid=106">http://www.bgs.org.uk/index.php?option=com_content&view=article&id=41:gp...</a></li> <li>Nutrition Support in Adults: oral nutrition support, enteral tube feeding and parenteral nutrition (2006) National Institute for Health and Clinical Excellence; DOH: <a href="http://publications.nice.org.uk/nutrition-support-in-adults-cg32">http://publications.nice.org.uk/nutrition-support-in-adults-cg32</a></li> <li>Quality Standard for end of life care for adults (2011) National Institute for Health and Clinical Excellence; DOH. <a href="http://publications.nice.org.uk/quality-standard-for-end-of-life-care-for-adults-qs13">http://publications.nice.org.uk/quality-standard-for-end-of-life-care-fo...</a></li> <li>Royal College of Speech and Language Therapists “Speech and language therapy provision for people with dementia” (2005) RCSLT Position Paper, RCSLT: London. <a href="http://www.rcslt.org/docs/free-pub/dementia_paper.pdf">http://www.rcslt.org/docs/free-pub/dementia_paper.pdf</a></li> <li>Royal College of Physicians (2010) Oral Feeding Difficulties and Dilemmas: particularly towards the end of life. Royal College of Physicians & British Society of Gastroenterology, London. <a href="http://bookshop.rcplondon.ac.uk/contents/pub295-ca2ff0c8-85f7-48ee-b857-8fed6ccb2ad7.pdf">http://bookshop.rcplondon.ac.uk/contents/pub295-ca2ff0c8-85f7-48ee-b857-...</a></li> <li>Stroke: diagnosis and initial management of acute stroke and transient ischaemic attack (TIA) (2008) National Institute for Health and Clinical Excellence; DOH. <a href="http://publications.nice.org.uk/stroke-cg68">http://publications.nice.org.uk/stroke-cg68</a></li> <li>The National Stroke Strategy (2007) DOH: Crown Copyright. <a href="http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081062">http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...</a></li> </ul> <h2 class="sidebar-nav">Models of Service Provision</h2> <p>The RCP outlines the following approaches for the MDT to consider in managing dysphagia towards the end of life:</p> <ol> <li>Full oral feeding using a range of compensatory strategies</li> <li>A combination of oral and non-oral feeding</li> <li>Palliative feeding using small amounts of food, mainly for enjoyment</li> <li>Artificial nutrition using non-oral methods</li> </ol> <p>“Speech and language therapists can advise on strategies to minimise aspiration risk, facilitate eating and drinking, and improve nutritional status. These are modifications of food and fluids including changes to texture, consistency and quantity swallowing strategies including manoeuvres and sensory techniques; positioning and postural techniques; external strategies such as carer support, environment and administering food and drink; and behavioural and cognitive techniques” (RCP, 2010).</p> <h6>Patient capacity and wishes</h6> <p>Patients’ wishes are of primary importance. A competent patient is able to make an informed decision about whether they wish to continue to eat and drink despite an unsafe swallow. For those patients who lack capacity the Mental Capacity Act which came into force in 2007 is followed and the MDT and patient advocate acts in the best interest of each individual patient (DOH, 2005).</p> <h6>MDT working</h6> <p>Dysphagia management should be patient centred and a team decision made, drawing on all levels of expertise. A MDT approach to dysphagia management is well established, and recognised as best practice to optimise nutrition and hydration for patients (Garo et al 2004, Logemann 1998, Marks and Rainbow 2001). Although the Geriatrician holds the final responsibility for the decisions regarding a patient’s swallowing and nutritional management, they should work closely with speech and language therapists and dietitians to optimally manage dysphagia. Speech and language therapists are able to provide detailed information about the severity of the dysphagia and recommend how safe a person’s swallow is to manage food and drink orally, assessing the aspiration risk. Dietitians can recommend how patients can best meet their nutrition and hydration requirements. Nurses provide daily hands-on assistance for those patients who have swallowing difficulties and need to be supported and engaged in the process as part of the MDT. Occupational therapists and physiotherapists can also help to manage dysphagia, with regards to respiratory management, positioning, and optimal feeding strategies.</p> <h6>Patient characteristics</h6> <p>The following are an important consideration when deciding on the dysphagia management approach taken:</p> <p>Distress – the level of patient distress is an important factor in continuing oral intake. This can be distress related to:</p> <ul> <li>eating and drinking,</li> <li>artificial nutrition and hydration</li> <li>feelings of hunger/thirst</li> <li>repeated hospital admissions/ changes of environment.</li> </ul> <p>Respiratory status – this refers to any underlying respiratory disease which may impact on:</p> <ul> <li>safe co-ordination of swallowing</li> <li>nutrition and hydration requirements</li> <li>airway protection</li> <li>swallow comfort</li> </ul> <p>Mobility – this refers to how mobile a patient is which may impact on:</p> <ul> <li>positioning</li> <li>chest status</li> <li>feeding dependence</li> <li>airway protection</li> <li>swallow comfort</li> </ul> <p>Risks – this refers to the different risks to the patient of:</p> <ul> <li>aspiration (of oral intake and/ tube feeding)</li> <li>being Nil-By-Mouth</li> <li>oral hygiene</li> <li>reduced social well being</li> <li>dehydration and under-nutrition</li> </ul> <h6>Medical management</h6> <p>In making dysphagia management decisions towards the end of life it is essential to consider the following:</p> <ul> <li>Acute/ chronic dysphagia</li> <li>The underlying medical condition/s (see related Healthcare guidelines for specific conditions)</li> <li>Nutritional status</li> <li>The stage of their condition</li> <li>The prognosis</li> </ul> <h6>Professional training</h6> <p>Specialist training in the needs of older people is essential in order to take a holistic management approach to dysphagia. Swallowing difficulties cannot be managed in isolation to other difficulties this patient group may face. Coordinated MDT training in this area for geriatricians, speech and language therapists, nurses and dietitians is essential to enable all factors to be taken into account when decisions are made regarding a dysphagia care-plan. Principles from formal training in palliative medicine concerning end of life care and treatment decisions may also be applicable.</p> <h2 class="sidebar-nav">Recommendations</h2> <ul> <li>A holistic patient-centred MDT approach to dysphagia management is essential.</li> <li>Expertise of speech and language therapists and dietitians should be sought and a team decision made which is in the best interest for each individual patient.</li> <li>Specialist experience and training in the needs of older people is essential.</li> <li>Geriatricians need to work with speech and language therapists and dietitians to encourage engagement throughout the care of the patient, ensuring continued access to specialist services to help make swallowing as comfortable and safe as possible towards the end of life.</li> <li>Dysphagia management needs to move away from a discipline specific framework in order to take more risks for the benefit of the whole patient.</li> <li>There is a need to develop alternative dysphagia management strategies such as social and hand feeding techniques with a focus on comfort rather than risk, and outcomes pertaining to quality of life.</li> <li>Older patients with dysphagia need to have an individual dysphagia care plan outlining the agreed management approach.</li> </ul> <p>“At the end of life, even if deemed to have an ‘unsafe swallow’ a risk management approach may offer the patient the best quality of life. If in doubt a trial of nasogastric feeding with clear agreed objectives may be appropriate. Tube feeding should then be withdrawn if failing to achieve the objectives. ‘Nil by mouth’ should be a last resort, not the initial default option” (RCP 2010).</p> <h2 class="sidebar-nav">References</h2> <p>BATH, P., BATH, F., & SMITHARD, D. (2000) Interventions for dysphagia in acute stroke. Cochrane Database Systematic Review.</p> <p>DIBARTOLO, C, M. (2006) Careful Hand Feeding: a reasonable alternative to PEG tube placement in individuals with Dementia. Journal of Gerontological Nursing, 26-32.</p> <p>ENRIONE, E. & CHUTKAN, S. (2007) Preferences of Registered Dieticians and Nurses Recommending Artificial Nutrition and Hydration for Elderly Patients. Journal of the American Dietetic Association, 107, 416-421.</p> <p>GARO, S., MONTORFANI, C., & PICHARD, C. (2004) Dysphagia and nutritional treatment: decision tree. Rev Med Suisse Romande, 124, 625-628.</p> <p>GROHER, M. E. (1994) Determination of the risks and benefits of oral feeding. Dysphagia, 9, 233-235.</p> <p>LEDER, S. B. & SUITER, D. M. (2009) An Epidemiologic Study on Aging and Dysphagia in the Acute Care Hospitalized Population: 2000-2007. Gerontology, 55, 714-718.</p> <p>LOGEMANN, J. (1998) Evaluation and Treatment of Swallowing Disorders (rev-ed), Austin, Texas, Pro-Ed</p> <p>LOGEMANN, J., RADEMAKER, A., PAULOSKI, B., ANTINOJA, J., ET AL. (2008) What Information Do Clinicians Use in Recommending Oral versus Nonoral Feeding in Oropharyngeal Dysphagic Patients? Dysphagia, 23, 378-384.</p> <p>MARIK, P. E. & KAPLAN, D. (2003) Aspiration Pneumonia and Dysphagia in the Elderly. Chest, 124, 328-336.</p> <p>MARKS, L., & RAINBOW, D (2001) Working with Dysphagia, Oxon, UK, Speechmark Publishing Ltd.</p> <p>MCCULLOUGH, G. H., ROSENBEK, J. C., WERTZ, R. T., SUITER, D., & MCCOY, S. C. (2007) Defining Swallowing Function by Age: Promises and Pitfalls of Pigeonholing. Topics in Geriatric Rehabilitation, 23, 290-307.</p> <p>NATIONAL INSTITUTE OF CLINICAL EXCELENCE (NICE) (2011) Dementia: supporting people with dementia and their carers in health and social care. NICE, London.</p> <p>NEY, D. M., WEISS, J. M., KIND, A. J. H. & ROBBINS, J. (2009) Senescent Swallowing: Impact, Strategies, and Interventions. Nutr Clin Pract, 24, 395-413.</p> <p>PALECEK, E. J., TENO, J. M., CASARETT, D. J., HANSON, L. C., ET AL. (2010) Comfort Feeding Only: A Proposal to Bring Clarity to Decision-Making Regarding Difficulty with Eating for Persons with Advanced Dementia. Journal of the American Geriatrics Society, 58, 580-584.</p> <p>ROBBINS, J., LANGMORE, S., HIND, J. & ERLICHMAN, M. (2002) Dysphagia Research in the 21st Century and Beyond: Proceedings from Dysphagia Experts Meeting, August 21st, 2001. Journal of Rehabilitation Research and Development, 39, 543-548.</p> <p>ROYAL COLLEGE OF PHYSICIANS (2010) Oral Feeding Difficulties and Dilemmas: particularly towards the end of life. Royal College of Physicians & British Society of Gastroenterology, London.</p> <p>VOLKERT, D., BERNER, Y., BERRY, E., CEDERHOLM, T., ET AL. (2006) ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clinical Nutrition, 25, 330-360.</p> <p>WRIGHT, L., COTTER, D., & HICKSON, M. (2008) The effectiveness of targeted feeding assistance to improve the nutritional intake of elderly dysphagic patients in hospital. Journal of Human Nutrition and Dietetics, 21, 555-562</p> </div> <div class="card-view-4"> <div class="view view-attachment view-id-attachment view-display-id-main view-dom-id-9c652b107670f76e4fb6c979ad4e2a53"> </div> </div> </div> </div> </div> </div> </article> <div id="block-webform-client-block-250" class="block block-webform"> <h2>Please help us evaluate this resource</h2> <p class="form-help">If you are happy to be contacted for feedback on this resource, probably in 6-12 months' time, please submit your name and email address</p> <div id="webform-ajax-wrapper-250"><form class="webform-client-form webform-client-form-250" action="/resources/dysphagia-management-for-older-people" method="post" id="webform-client-form-250" accept-charset="UTF-8"><div><div class="form-item webform-component webform-component-textfield webform-component--name"> <label for="edit-submitted-name">Name </label> <input type="text" id="edit-submitted-name" name="submitted[name]" value="" size="60" maxlength="128" class="form-text" /> </div> <div class="form-item webform-component webform-component-email webform-component--email"> <label for="edit-submitted-email">Email </label> <input class="email form-text form-email" type="email" id="edit-submitted-email" name="submitted[email]" size="60" /> </div> <input type="hidden" name="details[sid]" /> <input type="hidden" name="details[page_num]" value="1" /> <input type="hidden" name="details[page_count]" value="1" /> <input type="hidden" name="details[finished]" value="0" /> <input type="hidden" name="form_build_id" value="form-tLRDWvuZTVyBseETzFklcnbMH4__8DWO74R-MlAn7ok" /> <input type="hidden" name="form_id" value="webform_client_form_250" /> <input type="hidden" name="webform_ajax_wrapper_id" value="webform-ajax-wrapper-250" /> <div class="form-actions"><input class="webform-submit button-primary form-submit" id="edit-webform-ajax-submit-250" type="submit" name="op" value="Submit" /></div></div></form></div></div> </div> <div class="content-additional"> <div id="block-webform-client-block-227" class="block block-webform"> <h2 class="resource-feedback-toggle">Feedback on this resource?</h2> <div class="content"> <div id="webform-ajax-wrapper-227"><form class="webform-client-form webform-client-form-227" action="/resources/dysphagia-management-for-older-people" method="post" id="webform-client-form-227" accept-charset="UTF-8"><div><div class="webform-email form-item webform-component webform-component-email webform-component--email webform-container-inline"> <label for="edit-submitted-email--2">Email </label> <input class="email form-text form-email" type="email" id="edit-submitted-email--2" name="submitted[email]" size="60" /> <div class="description">If you鈥檇 like us to contact you, please leave your email</div> </div> <div class="webform-feedback form-item webform-component webform-component-textarea webform-component--comment webform-container-inline"> <label for="edit-submitted-comment">Your feedback <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper"><textarea required="required" placeholder="(max 300 words)" id="edit-submitted-comment" name="submitted[comment]" cols="60" rows="3" class="form-textarea required"></textarea></div> </div> <input type="hidden" name="details[sid]" /> <input type="hidden" name="details[page_num]" value="1" /> <input type="hidden" name="details[page_count]" value="1" /> <input type="hidden" name="details[finished]" value="0" /> <input type="hidden" name="form_build_id" value="form-7oJ8z2j1GhKumiT3P1HoM1uDbgWHCOEbO4uXQavGs-I" /> <input type="hidden" name="form_id" value="webform_client_form_227" /> <input type="hidden" name="webform_ajax_wrapper_id" value="webform-ajax-wrapper-227" /> <fieldset class="captcha form-wrapper"><legend><span class="fieldset-legend">CAPTCHA</span></legend><div class="fieldset-wrapper"><div class="fieldset-description">This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.</div><input type="hidden" name="captcha_sid" value="8311263" /> <input type="hidden" name="captcha_token" value="a475fa3c09872c2a35f00f03e79e8a44" /> <input type="hidden" name="captcha_response" value="Google no captcha" /> <div class="g-recaptcha" data-sitekey="6LdxcUsUAAAAABXmfqM-hujH0UGJIQjSzRbBKU2w" data-theme="light" data-type="image"></div></div></fieldset> <div class="form-actions"><input class="webform-submit button-primary form-submit" id="edit-webform-ajax-submit-227" type="submit" name="op" value="Send" /></div></div></form></div> </div> </div> </div> </section> <aside id="sidebar-second" role="complementary" class="sidebar"> <div class="sidebar-second-wrapper"> <section class="block block-views side-row resource-dl-block"> <h2 class="block-title">Download</h2> <div class="view view-resource-download view-id-resource_download view-display-id-download view-dom-id-4f093a965aa9ba55d4269db4deac5b0c"> <div class="view-content view-content-main"> <div> </div> </div> </div> </section> </div> </aside> </div> </main> <section class="postscript-first"> <div class="postscript_first"> <section class="block block-views postscript-section-row-block"> <h2 class="block-title">You may also be interested in</h2> <div class="view view-resource-series view-id-resource_series view-display-id-related_auto_manual view-dom-id-a7c21a510a5446697dd3562b6d1c4117"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first views-row-last"> <div class="card-views-conditional"> <div class="view view-resource-series view-id-resource_series view-display-id-related section-row row-max-4 view-card-default-palette view-dom-id-529d36c13d8b18e453fe0b4d8191e1dc"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first views-row-last"> <a class="card resource-card" href="/policy-and-media/the-dying-well-charter-principles-of-care-and-support"><div class="card-text"><div class="card-content"> <div class="card-title"> <h3>The Dying Well charter - principles of care and support</h3> </div> <div class="card-date-display-override"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2014-07-21T00:00:00+01:00">21 Jul 2014</span> </div> </div><div class="card-footer"> </div></div></a> </div> </div> </div> </div> </div> </div> </div> </section> </div> </section> <footer id="site-footer" role="contentinfo"> <section class="footer-first"> <div class="outer-wrapper"> <section class="block block-views"> <div class="view view-footer-sections view-id-footer_sections view-display-id-orgs view-display-grid view-dom-id-458849d4ca812ca40ed8c61f6fe1d6f1"> <div class="view-header"> <script> if(jQuery('#Main.CRM_Contribute_Form_Contribution_Main').length > 0){ jQuery('#Main.CRM_Contribute_Form_Contribution_Main').on('submit',function(e){ setTimeout(function(){ e.preventDefault(); let firstInvalidElement = jQuery('label.crm-inline-error:visible:first'); if(firstInvalidElement){ let fid=firstInvalidElement.attr('for'); let originalDisplay = jQuery('#'+fid).css('display'); jQuery('#'+fid).css('display', 'block'); jQuery('#'+fid).focus(); jQuery('#'+fid).css('display', originalDisplay); } },100) }); } </script> </div> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first section-row palette-default "> <div class="card-title"> <h2 class="field-content">Contact us</h2> </div> <div class="card-body"> <h6>British Geriatrics Society</h6> <p>Marjory Warren House<br /> 31 St John’s Square<br /> London EC1M 4DN</p> <p><a class="arrow" href="/about/contact">Visit us</a></p> <p><strong>Tel:</strong> +44 (0)20 7608 1369</p> <p><a href="/about/contact">Email us</a></p> <p class="smaller-text">Charity No 268762<br /> Company No 1189776 (England and Wales)</p> </div> </div> <div class="views-row views-row-2 views-row-even section-row palette-default "> <div class="card-title"> <h2 class="field-content">Quick links</h2> </div> <div class="card-body"> <p><a href="/media-enquiries">Media enquiries</a></p> <p><a href="/AGENDA">AGENDA</a></p> <p><a href="/about/what-we-do/age-and-ageing"><em>Age and Ageing</em> Journal</a></p> <p><a href="/about/make-a-donation">Donate</a></p> <p><a href="/blog">Our blog</a></p> <p><a href="/about/what-we-do/research-opportunities-and-cpd">BGS Grants</a></p> <p><a href="/about/bgs-vacancies">Jobs/Vacancies</a></p> </div> </div> <div class="views-row views-row-3 views-row-odd section-row "> <div class="card-title"> <h2 class="field-content">Follow us</h2> </div> <div class="card-follow-us-on"> <div class="item-list"><ul><li class="first"><div class='card-links'><a href="https://facebook.com/BGS1947" rel="nofollow" target="_blank">Facebook</a> </div></li> <li><div class='card-links'><a href="https://twitter.com/GeriSoc" rel="nofollow" target="_blank">Twitter</a> </div></li> <li class="last"><div class='card-links'><a href="http://linkedin.com/company/british-geriatrics-society" rel="nofollow" target="_blank">LinkedIn</a> </div></li> </ul></div> </div> </div> <div class="views-row views-row-4 views-row-even views-row-last section-row palette-default "> <div class="card-title"> <h2 class="field-content">Sign up for our e-bulletin</h2> </div> <div class="card-body"> <a href="/user/register" class="button">Sign up</a> <style> .webform-container-inline.webform-datepicker div, .webform-container-inline.webform-datepicker input { display: inline-block !important; margin-top: 1em; } select { padding-right: 39px; background-size: 29px; } #multiple_block > input { display: inline-block; } </style> </div> </div> </div> </div> </section> </div> </section> <section class="footer-third"> <div class="outer-wrapper"> <section class="block block-menu"> <ul class="menu"><li class="first leaf"><a href="/terms-of-use">Website Terms of use</a></li> <li class="leaf"><a href="/privacy-statement">Privacy Statement</a></li> <li class="leaf"><a href="/membership-terms-and-conditions" title="ToC governing membership of the BGS">Membership Terms and Conditions</a></li> <li class="last leaf"><a href="/event-booking-terms-and-conditions" title="">Event Booking Terms and Conditions</a></li> </ul> </section> <div id="manta-ray-media">Built by <a href="http://www.mantaraymedia.co.uk/" target="_blank">Manta Ray Media</a></div> </div> </section> </footer> </div>  <div class="pswp" tabindex="-1" role="dialog" aria-hidden="true">  <div class="pswp__bg"></div>  <div class="pswp__scroll-wrap">  <div class="pswp__container"> <div class="pswp__item"></div> <div class="pswp__item"></div> <div class="pswp__item"></div> </div>  <div class="pswp__ui pswp__ui--hidden"> <div class="pswp__top-bar">  <div class="pswp__counter"></div> <button class="pswp__button pswp__button--close" title="Close (Esc)"></button> <button class="pswp__button pswp__button--share" title="Share"></button> <button class="pswp__button pswp__button--fs" title="Toggle fullscreen"></button> <button class="pswp__button pswp__button--zoom" title="Zoom in/out"></button>   <div class="pswp__preloader"> <div class="pswp__preloader__icn"> <div class="pswp__preloader__cut"> <div class="pswp__preloader__donut"></div> </div> </div> </div> </div> <div class="pswp__share-modal pswp__share-modal--hidden pswp__single-tap"> <div class="pswp__share-tooltip"></div> </div> <button class="pswp__button pswp__button--arrow--left" title="Previous (arrow left)"> </button> <button class="pswp__button pswp__button--arrow--right" title="Next (arrow right)"> </button> <div class="pswp__caption"> <div class="pswp__caption__center"></div> </div> </div> </div> </div> <script type="text/javascript" async="async" src="/sites/all/modules/picture/picturefill2/picturefill.min.js?v=2.3.1"></script> <script type="text/javascript" async="async" src="/sites/all/modules/picture/picture.min.js?v=7.74"></script> <script type="text/javascript" src="/sites/all/modules/photoswipe/js/photoswipe.jquery.js?sn052y"></script> <script type="text/javascript" src="/sites/all/modules/mautic-drupal/js/mauticform-prefill.js?sn052y"></script> </body> </html>