Dysphagia refers to difficulty in swallowing food and liquids. It occurs when there is a problem with the neural control of the swallowing process or an obstruction in the throat or esophagus. Dysphagia can occur in all age groups, but is more common in older adults. It is estimated that about 10 million Americans experience dysphagia each year.
There are different levels of dysphagia ranging from mild to severe. Mild dysphagia may cause difficulty or discomfort while swallowing certain foods or liquids. More severe dysphagia can prevent swallowing anything safely by mouth. Based on the severity, dysphagia is classified into different grades or levels.
One common classification system is:
Levels of Dysphagia
| Level | Description |
|---|---|
| Level 1 | No obvious difficulty swallowing. Able to swallow all food consistencies. |
| Level 2 | Mild dysphagia. Difficulty swallowing specific food consistencies. May need modified diet. |
| Level 3 | Moderate dysphagia. Can swallow moist and soft foods only. Needs modified diet and close supervision during meals. |
| Level 4 | Moderately severe dysphagia. Can only tolerate pureed solids and thick liquids. Needs modified diet and supervision. |
| Level 5 | Severe dysphagia. Unable to swallow anything safely by mouth. Needs non-oral feeding like tube feeding. |
Dysphagia Advanced refers to severe or moderately severe dysphagia which limits oral intake significantly. This corresponds to level 4 or 5 in the classification above.
Food Level for Dysphagia Advanced
People with dysphagia advanced (level 4-5) have significant difficulty and risks associated with oral swallowing. They are often unable to swallow safely by mouth and need an alternate means of nutrition like tube feeding. However, some people with advanced dysphagia can manage small amounts of very soft or liquid foods with proper precautions and supervision.
The National Dysphagia Diet (NDD) provides guidelines on appropriate food textures and liquid consistencies for people with dysphagia. According to NDD, the recommended diet for dysphagia advanced is:
NDD Level 4 – Dysphagia Advanced
Solids: Smooth pureed foods with a pudding-like consistency. Homogeneous, no lumps.
Liquids: Spoon-thick liquids only
Here are some key tips for NDD Level 4:
– All foods are smooth and pureed, with no lumps. Can be piped, layered or molded.
– Maximum liquid or moisture content to enable molding, layering etc.
– Spoon-thick liquids only (flows like pudding)
– May need further thickening of liquids to ensure safety
– Needs supervision and control of food and liquid intake
– Meals likely given in small frequent portions
– Alternate means of nutrition may be needed, like tube feeding
Examples of Foods for Dysphagia Advanced
| Food Group | Food Textures | Examples |
|---|---|---|
| Beverages | Spoon-thick only | Thickened juice, thickened milk, thickened coffee |
| Main Dishes | Smooth purees | Pureed meats, casseroles, mashed potatoes |
| Fruits | Smooth purees | Applesauce, pureed fruits |
| Vegetables | Smooth purees | Pureed vegetables |
| Snacks | Smooth purees | Pureed desserts, pudding, yogurt |
As seen above, the recommended diet focuses on very smooth, homogenous foods and liquids. Foods may need to be blended or processed to obtain the right consistency. Thickening agents are often used to achieve spoon-thick liquids.
This highly modified diet reduces risks of choking and aspiration. However, nutrition adequacy, food intake and quality of life are important considerations. A multidisciplinary team including speech therapist, dietitian, nurse and caregivers is ideal to manage dysphagia advanced.
Precautions with Dysphagia Advanced
There are significant risks associated with swallowing difficulties in dysphagia advanced. Some key precautions include:
– Supervision is required during meals and swallowing. Signs of aspiration or choking should be monitored.
– Small, frequent meals spaced out over the day may prevent fatigue.
– Alternate nutrition route like feeding tube may be necessary to maintain nutrition and hydration.
– Positioning techniques like chin tuck may facilitate safe swallowing.
– Therapeutic techniques can help strengthen swallowing muscles.
– Oral care is critical to prevent aspiration pneumonia.
– Avoid mixed food textures and thin liquids which increase risks.
– Medications may need to be adjusted to liquid or crushable forms.
With proper management, risks can be reduced and quality of life improved for those with severe dysphagia. Speech therapy and adequate nutrition support are key.
Conclusion
Dysphagia advanced refers to severe difficulty swallowing, classified as level 4-5 on the dysphagia scale. Individuals with this level of dysphagia have substantial risks associated with oral intake and often cannot swallow safely by mouth.
The recommended diet is smooth pureed solids and spoon-thick liquids only. Foods require blending and processing to make them smooth and homogeneous without lumps. Liquids need thickening to a pudding consistency. Even with these modifications, close supervision is required during swallowing.
While it poses challenges, dysphagia advanced can be managed with a coordinated effort between various specialists. Goals include reducing complications like aspiration and malnutrition while maintaining nutrition and hydration. With proper precautions and therapy, the condition can be handled effectively.