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Dysphagia: where nutritional care meets speech therapy

Although it is not exclusive to the elderly, it is during the ageing process that it becomes common for people to have difficulty swallowing liquid or solid food, leading to frequent choking, coughing, chewing problems and slow mealtimes.

These complications, known clinically as dysphagia, can develop slowly over the years and can be caused by a number of conditions, such as muscular dystrophies, loss of teeth, ill-fitting dentures, cancer, neurological diseases such as strokes and degenerative diseases such as Alzheimer's and Parkinson's disease.

As a consequence, they increase the risk of these individuals facing malnutrition and undernutrition, which is even more dangerous for those who already have chronic diseases.

The solution to dysphagia is often to prescribe diets with a change in consistency. This is to prevent bronchoaspiration and ensure safety and ease of consumption. However, changing the texture, presentation and taste of meals also impairs proper nutrition, leading to a decreased appetite and a lack of interest in food.

It was with this problem in mind that a speech therapist and a nutritionist teamed up to create FONUTRY, which promotes safe, nutritious, tasty and appetizing food solutions and practices for patients with swallowing disorders. Check out the interview with the professionals.

1) Can you introduce yourselves, telling us a little about your education and professional experience?

Karin Nascimento: I've been a speech therapist for fifteen years and specialize in Hospital Speech Therapy and Gerontology. I have experience in clinical care, at home and in long-term care institutions for the elderly. I am also a volunteer speaker for ABRAZ-PE and one of the founders of FONUTRY.

Márcia Rodrigues: I have been a nutritionist for five years and specialize in Clinical Nutrition and Gerontology. I have experience as a preceptor of curricular internships in nutrition, clinical care, home care and in Long Stay Institutions for the Elderly. Together with Karin, I am the founder of FONUTRY.

2) How did the idea of combining nutrition with speech therapy come about? Where do these two areas meet?

They support the aging process, which is multifactorial and can cause changes in the sense organs, orofacial and laryngeal muscles, causing functional and physical limitations, interfering with eating and social interaction.

Speech therapy and nutritional monitoring are therefore essential to prevent and control geriatric syndromes, symptoms or pathologies common in the elderly, as well as rehabilitate when necessary.

The duties of nutritionists and speech therapists include:

Nutritionist:

  • Observe the presence of choking and coughing during feeding and inform the speech therapist.
  • Promoting safe, tasty and well-presented food

Speech therapist:

  • Preventing, diagnosing and treating changes in chewing and swallowing, providing safe food and preventing bronchoaspiration.

3) What is the aim of FONUTRY? Tell us a bit about the project.

FONUTRY was born to offer options for better presentation of dishes for the elderly and patients with specific dietary needs, promoting acceptability, prioritizing taste, safety and nutritional value.

The project was conceived with the intention of promoting a better presentation of dishes for the elderly in ILPI and home care patients, favoring acceptability, prioritizing taste, safety and nutritional value. Initially, the concern was to provide the correct consistency of the creamy pasty diet, as this is always the subject of training for the institution's kitchen staff and caregivers.

A diet of inadequate consistency can compromise the patient's swallowing, increasing the chances of choking, coughing and bronchoaspiration. It can occur silently and gradually lead to aspiration pneumonia and, in more serious cases, death. For this reason, in addition to teaching kitchen staff and formal and informal caregivers how to prepare food/consistency, our focus is also on a more beautiful and varied presentation, contributing to the patient's well-being and quality of life.

We took inspiration from techniques used abroad to make the adapted dishes and used icing nozzles for the preparations. At first, we had some difficulties when it came to preparation, but little by little we perfected the technique and adapted it to the correct consistency for each individual case.

4) What are food thickeners used for? How do I incorporate it into preparations?

It is of the utmost importance that after the speech and hearing assessment, the speech and hearing therapist indicates the appropriate consistency of food to maintain a safe diet for the patient. In cases of dysphagia (difficulty swallowing), it is necessary to adapt the diet and indicate the use of food thickener to avoid respiratory complications and maintain a safe oral diet.

Thickeners are used to thicken thin liquids, as dysphagic patients have difficulty swallowing liquids. The speech therapist then prescribes the amount to be used for each patient. For this reason, we use Instant Clear thickener when finalizing preparations to achieve the correct and safe consistency for each specific condition.

5) How important is the presentation of dishes for the elderly or people who need a specific diet?

Better food acceptance, adequate calorie intake, prevention of bronchoaspiration and promoting well-being and quality of life

6) If you had to give a tip on how to feed the elderly, what would it be and why?

Promote beautiful, colorful, tasty food, with the right texture and food separated by color, served on a white plate for better visibility of the preparation.

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