Quality of life is as or more important than quantity of life for many people [ , — ]. The fact that modified diets often worsen quality of life suggests that non-compliance is an understandable and rational choice for many people [ 58 , 65 ]. This would still be the case even if there were evidence that non-compliance result in adverse effects.
One benefit of reviewing patients who have had a trial of therapy with modified diets is that they can balance any possible benefits such as absence of chest infections , possible risks such as need for treatment with parenteral fluids and their lived experience with modified diets and make a fresh, and more-informed, decision whether to continue with a modified diet.
Modified diets are a more intrusive intervention than any medication and are widely used in the absence of a high-quality evidence base. Individual patient trials may be the best that can be achieved at present but are no substitute for having RCT evidence to guide practice.
Such trials are even more important if widespread screening of those who do not present with worrying symptoms directly suggestive of aspiration problems is to be recommended [ ]. There is also much to learn about how best to monitor those receiving modified diets, in particular for hydration status. Biochemical testing, perhaps weekly initially and then less frequently, would seem the most obvious candidate but this requires further evaluation.
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Gorham-Rowan M, Coston J. For example, food may be placed on the right side of the mouth if left facial weakness is present.
Determine the food viscosity that is best tolerated by the individual. Ideally a trained dysphagia clinician such as a speech therapist is available to assist with this assessment. Be aware that thickened liquids are commonly used to promote safer bolus transit and better airway protection Joyce et al.
However, they may not be appropriate for all patients. Some patients may find thickened liquids unpalatable and thus drink insufficient fluids Murray et al.
Encourage fluid intake by offering fluids between meals as well as during meals. Minimize the use of sedatives and hypnotics since these agents may impair the cough reflex and swallowing.
When the tube-fed person is able to communicate, ask if any of the following signs of gastrointestinal intolerance are present: nausea, feeling of fullness, abdominal pain or cramping. These signs are indicative of slowed gastric emptying that may, in turn, increase the probability for regurgitation and aspiration of gastric contents. Monitor tube location every 4 hours or per institutional policy Boullata et al. A feeding tube inadvertently displaced into the esophagus greatly increases risk for aspiration.
Observe for signs of intolerance to feedings, such as abdominal distention and large gastric residual volumes Boullata et al. These observations are especially important for patients unable to communicate their discomfort.
Percutaneous gastrostomy offers no significant protection against aspiration pneuomonia; in fact, it is the commonest cause of death in PEG fed patients Onur et al. Also, nutritional intake is likely to be higher in patients with PEG tubes than in those with NG tubes, since the latter type of tubes have more mechanical problems.
Good dental hygiene is important to minimize risk for aspiration pneumonia for several reasons: Missing teeth and poorly fitted dentures predispose to aspiration by interfering with chewing and swallowing.
Infected teeth and poor oral hygiene predispose to pneumonia following the aspiration of contaminated oral secretions. Suggestions for mouth care are as follow Sarin et al. Try This PDF. How To Try This Video:. How To Try This Article:. Protocols Advance Directives. Age Related Changes. Assessing Cognition.
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Optimize Mealtimes in Dementia. Oral Healthcare. Pain Management. Palliative Care. Physical Restraints. Your esophagus is the tube that carries food and liquid from your mouth to your stomach. You may be at risk of aspiration if you have trouble swallowing. This is because food or liquid can get stuck in the back of your throat and go into your airway. Aspiration can lead to pneumonia, respiratory infections infections in your nose, throat, or lungs , and other health problems.
You and your caregiver should watch for these signs before, during, and after you eat, drink, or tube feed. If you have any of these signs, stop eating, drinking, or tube feeding. Call your healthcare provider right away. Your feedback will help us improve the information we provide to patients and caregivers. We read every comment, but we're not able to respond. If you have questions about your care, contact your healthcare provider.
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