Question

1. List five (5) ways the Personal Support Worker can assist a person who is having swallowing difficulties.  

2. List observations and associated problems the Personal Support Worker can make to observe for common swallowing problems.

3. List management approaches that can be done to help prevent choking or problems swallowing.

4. List factors that could create problems with feeding such as vision loss and weakness and explore how the Personal Support Worker can help.

Answer 1

1. The five (5) ways the Personal Support Worker can assist a person who is having swallowing difficulties are:

a) Stop the patient eating and drinking if there is ongoing coughing, choking, a wet sounding voice, or they are unable to clear food from their mouth.

b) Encourage patient to undertake therapy as prescribed by the dietitian or speech pathologist. This starts with ensuring the right meal is delivered to the patient and ensuring the person is:

• eating or drinking when they are alert
• taking small mouthfuls of food
• taking sips of fluid between mouthfuls
• sitting upright during the meal and staying upright for 30 minutes after they have finished
• focused on the task and environmental distractions are minimised.

c) Encourage patients who have lost interest in food to eat small meals regularly and motivate them to keep well.

d) Ask the patient if they enjoy how their food tastes, as taste has a very important input into the swallowing reflex and is needed to enjoy our food and safely swallow. A loss of taste should not prevent a patient from eating.

e) Encourage patient to keep good dental hygiene and if necessary, help the patient brush his teeth after meals, also encourage patient to rinse with water if he is not able to brush his teeth following a meal and offer water, if safe to so do, during and after meal times.

2. Observations and associated problems the Personal Support Worker can make to observe for common swallowing problems are:

• difficulty swallowing or lack of swallowing
• coughing before swallowing, during meal times, or after eating
• heartburn
• drooling
• taking a long time to eat and drink, wasting food
• altered level of alertness or reduced response
• speech or voice changes as they may indicate silent aspiration. Look for slurred speech, a weak, hoarse, crackly, gurgling or wet-sounding voice. If in doubt, ask family members if they have noticed any recent vocal changes
• a history of recurrent chest infections or suspected aspiration
• tongue, facial or lip weakness or altered appearance
• pocketing food or tablets in the cheeks
• the patient describing food as sticking to the roof of their mouth or throat, or the sensation of a ‘lump’ or discomfort in the throat or chest, or frequent throat clearing during meal times.
• unexplained weight loss
• reluctance to swallow food, water or medication.

And some of the associated problems that can result due to swallowing problems are:

• Malnutrition, weight loss and dehydration
• Aspiration pneumonia
• Choking.

3. Management to prevent choking or problems swallowing are:

• A person’s adaptive eating aids (such as sippy cups, rim plates or built-up cutlery) are used for each meal or snack
• Oral hygiene is done adequtely
• Dentures if any are checked and fixed in place before meals
• All meals are supervised. Eating alone can increase the risk of choking or aspiration
• There should be no distractions such as loud talking or TV during meals
• Person should be awake and alert during meals
• Person must be sitting appropriately while eating
• The person is reminded or prompted to swallow, slow down or to continue eating or drinking
• Do not rush or force feed

4. The factors that could create problems with feeding are:

• nervous system disorders, like cerebral palsy or meningitis
• reflux or other stomach problems
• heart disease
• cleft lip or palate
• breathing problems, like asthma or other diseases
• autism
• head and neck problems
• muscle weakness in the face and neck
• medicines that make her sleepy or not hungry
• sensory issues
• behavior problems

A Personal Support Worker can help overcome such problems are by suggesting:

• medical treatment, like medicines for reflux
• feeding therapy
• trying different foods or adding calories to food
• ways to get the person to try new foods or textures
• changing how hot or cold food is or how crunchy or soft it is
• changing the person's position while eating
• new ways to handle his behavior
• seeing another professional, like a psychologist or dentist

The Personal Support Worker may work on:

• making the muscles of the person's mouth stronger
• helping him move his tongue more
• helping him chew foods
• getting him to try new foods and drinks
• helping with sensory issues. Personal Support Worker can help him get used to how food feels.