Aspiration

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Dysphagia can lead to aspiration, a condition in which food, fluids, or saliva enter the lungs rather than the stomach.  In severe cases aspiration can lead to pneumonia. Here are some interventions to prevent aspiration:

1.   Ask the resident to sit up whenever consuming food or fluids.

When a resident reclines, the risk of choking is increased. Some find even leaning forward slightly facilitates better swallowing.

2.   Verify allowable foods for newly admitted resident.

Staff can help ensure safety when only foods the resident can consume easily are served. Check the physicians orders regarding dietary restrictions and modified diets.

3.   Cut, chop, grind or puree foods as ordered. Serving the food at the table already cut into appropriately sized pieces or texture is important.  Residents with cognitive impairment may not remember to cut foods as necessary.

4.   Allow additional time for meals. Residents with swallowing difficulties may need extra time at meals.  Don’t rush them.

5.   Serve meals in supervised areas. Residents with swallowing problems or who are at risk for aspiration should never eat without staff supervision. If eating alone, they may not be able to summon emergency help.  Staff should be trained to perform the Heimlich maneuver.

6.   Encourage the resident to put only a small amount of food in the mouth and place it in the mouth on the unaffected side.  This will make it easier to control the food in the mouth, decreasing the possibility of choking.

7.  Remind the resident to clear his mouth before taking another bite of food. Food may have a tendency to become lodged in the affected side of the mouth.

8.   Provide the resident with adaptive devices for eating. It can be embarrassing for the resident when food is spilled or there are problems reaching for things on the table or using utensils, yet these are frequent problems for the resident who is post stroke.  Providing adaptive devices such as rubber suction cups for dishes, rocker knifes, etc., can be very helpful.

9.   Monitor the resident for any signs of aspiration or respiratory infection.

Immediately report any signs of respiratory complications to the physician. Sounds of congestion, coughing, shortness of breath, malaise, fever should all be reported. Keep in mind that the elderly do not always spike a high fever or demonstrate dramatic signs of infection, even though illness could be present.