Swallowing Issues and Malnutrition

The Nursing Home Reform Act of 1987 is a federal law that requires nursing home staff to assess an incoming resident’s nutritional status at the time of admission to the home, and then repeated every three months for the duration of the resident’s stay at the facility. However, despite the law, it is estimated that some 40 percent of residents are still malnourished. Sometimes malnourishment can be attributable to a resident having difficulties swallowing, which goes unnoticed by nursing home staff. Nursing home staff should be trained to identify the signs of malnutrition in residents. They should also be trained to recognize residents who have difficulty swallowing and should take corrective action immediately upon notice.

Difficulties Swallowing

When elderly people have difficulty swallowing it is referred to as dysphagia. Some residents with dysphagia may experience pain when they try to swallow food or water, known as odynophagia, which discourages them from ingesting more than they have to. This can lead to an undernourished state. Dysphagia can result from esophagus dysfunction or can be the result of a neurological condition or nervous system disorders. If the dysphagia is persistent and occurs frequently, the resident may need to see a doctor.

It is also possible for dysphagia to cause an obstruction in the esophagus, which can also have serious health implications for respiratory function or could result in choking. Nursing home staff should be trained to recognize the signs of choking and should be trained to provide the appropriate immediate care, such as the Heimlich maneuver, if necessary. Instances of choking in a nursing home are investigated as cases of potential nursing home neglect.

Nursing staff should be able to identify residents who are having difficulty with swallowing. Staff should recognize signs, such as if the resident is not eating enough, loses weight, leaves much of his or her meals uneaten, or visibly seems to have difficulty swallowing. If difficulty swallowing is suspected in a resident, the resident should see a doctor so that tests can be conducted. The type of doctor depends on what the suspected cause of the swallowing problem is. A neurologist should be consulted if the suspected cause is neurological in nature; a doctor specializing in digestive disorders might be appropriate based on the resident’s symptoms; or an ear, nose, and throat doctor may be consulted as well.

The doctor may require certain tests be conducted to assess the swallowing problem. These tests can include x-rays, visual examination with an endoscope (lighted camera inserted into the patient’s throat), an esophageal muscle test (a pressure sensor is swallowed by the patient and the pressure sensor tests how tightly the esophagus muscles squeeze), or a dynamic swallowing study (a patient swallows a variety of foods coated with barium and having different consistencies, which are then tracked by as the foods make their way through the body).

Residents who have problems swallowing require special care and treatment from nursing home staff. If your loved one has difficulty swallowing and is not receiving the care he or she needs to manage the condition, please contact our Illinois personal injury firm online or call us at (847) 869-9100.

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Illinois Citizens for Better Care, Nutrition and Hydration Consumer Fact Sheet, 2009,