MODULE 1: METHODOLOGY AND TOOLS DEVELOPMENT FOR ADULT EDUCATORS

Dysphagia is a swallowing disorder that causes difficulty or sensation of having difficulty swallowing certain foods, liquids, medicines or saliva.

It may involve the oral cavity, pharynx, esophagus or gastroesophageal junction and it can range from difficulty with deglutition (the coordinated, active process of passing food and liquids from the oral cavity into the oropharynx and below) to the passive passage of contents from the oropharynx through the esophagus and into the stomach.

Another's swallowing complications.

• Odynophagia, which is often confused with dysphagia, is defined as pain during swallowing. Both of these symptoms indicate an abnormality—either benign or malignant—that should be further worked up and evaluated.

• Presbyphagia is the medical term for the characteristic changes in the swallowing mechanism of otherwise healthy older adults. Although age-related changes place older adults at risk of swallowing problems, an older adult’s swallow is not necessarily an impaired swallow, but there are definite changes that can make swallowing more challenging.

Some changes that impact swallowing with ageing may be obvious; for example, missing teeth or dentures may make it more difficult to chew. Other changes are not as easy to see such as changes in the muscles and tissues. In fact, the muscle fibers decrease in size and strength, referred to as sarcopenia, leading to the slowing of pressure generated during swallowing. The elderly often learn to successfully adapt to these physiological changes in early stages. However, with progressing age, swallowing function may deteriorate beyond the patients’ compensatory capacity, eventually presenting as dysphagia.

Dysphagia classification:

• Oropharyngeal dysphagia. Difficulty or discomfort arising during the swallowing process, from the time the food or drink reaches the mouth and the food bolus is formed, until the upper esophageal sphincter of the esophagus opens. It includes disorders of oral, pharyngeal, laryngeal and upper esophageal sphincter origin and accounts for almost 80% of diagnosed dysphagia. Symptoms usually appear in the first moments after initiating swallowing, although they can also occur during, after or a few minutes after swallowing. Sometimes they can go unnoticed, giving rise to silent aspirations.

• Esophageal dysphagia. Difficulty or discomfort arising during the swallowing process, from the time the food or drink bolus passes through the upper esophageal sphincter until it reaches the stomach. The main esophageal alterations arise from mechanical obstructive lesions, motor disorders of the upper esophagus, the esophageal body, the lower sphincter or the cardia. Symptoms usually appear several seconds after swallowing and are characteristically referred to the retrosternal and even cervical region. It accounts for 20% of diagnosed dysphagia.

Other classifications can also be made according to:

• Cause: organic or functional.

• Establishment: acute or progressive.

• Duration: transient or permanent.

• Texture affected: dysphagia to solids, dysphagia to liquids or dysphagia to mixed textures.

Videos:

Normal swallowing and dysphagia:

Explanation of dysphagia:

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