Decreased Swallowing Reflex in Hospice Patients

As hospice nurses, caregivers, aides, and managers, one of the challenges encountered when caring for patients nearing the end of life is a decreased or lost swallowing reflex. This condition results in difficulties swallowing medications, fluids, and even food. Understanding this issue’s causes and management strategies is crucial in providing compassionate and effective care. 

In this article, we will explore the reasons behind the end-of-life inability to swallow, how to help patients experiencing this issue, and the importance of mouth care and comfort measures.

Causes of Decreased Swallowing Reflex in Hospice Patients

Several factors contribute to a hospice patient’s inability to swallow, including:

1. Muscle weakness: As patients become weaker at the end of life, the muscles involved in swallowing can lose strength, making it difficult to control the swallowing process.
2. Reduced consciousness: Changes in a patient’s level of consciousness can impact their ability to coordinate swallowing effectively.
3. Neurological disorders: Conditions such as dementia, stroke, and Parkinson’s disease can affect the swallowing reflex and the patient’s swallowing ability.
4. Medications: Certain medications used in end-of-life care can cause dry mouth or other side effects that impact swallowing.

Recognizing Signs of Swallowing Difficulties

It is essential to identify the signs that a hospice patient is having difficulty swallowing. These may include:

• Coughing, gagging, or choking while eating or drinking
• Drooling or having difficulty controlling saliva
• Changes in voice or speech
• Unintentional weight loss

How to Treat Decreased Swallowing Reflex

Modify Food and Fluid Consistency

When a patient begins to have difficulty swallowing, try offering small amounts of their favorite foods with modified textures. For example, pureed or softened foods may be easier to swallow. Take note of which foods are more accessible for the patient to swallow and which aren’t.

Adjust Medications

Talk to the healthcare team about adjusting medications. Medications are often available in alternative forms that don’t require swallowing, such as patches, injections, or suppositories. This may also be a time to prioritize comfort-related medications over those less essential to the patient’s well-being.

Use Swallowing Techniques

For some patients, specific swallowing techniques can help. These may include:

• Tucking the chin down while swallowing
• Turning the head to one side when swallowing
• Taking small sips or bites

Mouth Care and Comfort Measures for Decreased Swallowing Reflex

When hospice patients can’t swallow, it is essential to prioritize their comfort. Here are some ways to achieve this:

Provide Regular Mouth Care

To help prevent dryness and discomfort, provide mouth care every two hours. This may include:

• Gently brushing the patient’s teeth or dentures
• Using a soft, moist cloth to clean the patient’s mouth, tongue, and gums
• Applying a water-based lip balm or moisturizer to the patient’s lips

Offer Hydration Alternatives

Offer ice chips or cold clothes dampened in water to relieve dry mouth symptoms. Swabbing the inside of the patient’s mouth with a moist sponge or oral swab can also help.

Create a Comfortable Environment

Ensure the patient’s environment is comfortable, with adequate humidity and temperature control to help prevent dry mouth symptoms.

In conclusion, understanding and managing the decreased swallowing reflex in hospice patients are crucial to providing compassionate, effective care. By recognizing the signs of swallowing difficulties, adjusting medications, and prioritizing mouth care and comfort measures, hospice professionals can help patients maintain dignity and comfort during their final days.

FAQ

Is difficulty swallowing an end-of-life symptom?

Difficulty swallowing, or dysphagia, can be an end-of-life symptom in neurological disorders, cancer, or dementia. However, it can also occur due to various other causes unrelated to the end of life. It is essential to consult hospice care professionals for an opinion.

Why is swallowing difficult at the end of life?

Swallowing is difficult at the end of life due to the weakening of muscles and nerves. Progressive neurological conditions, age-related decline, or general frailty can cause this. Additionally, a decreased level of consciousness or poor oral health can contribute to swallowing difficulties, potentially leading to aspiration, choking, or malnutrition.

How can you feed a patient who Cannot swallow at the end of life?

At the end of life, a patient who cannot swallow may be fed through alternative methods, such as a nasogastric tube or a percutaneous endoscopic gastrostomy (PEG) tube. These methods bypass the mouth and throat, delivering nutrition directly to the stomach. 

How do you get a hospice patient to swallow?

To help a hospice patient swallow, first ensure they are in an upright position. Then, offer small bites or sips, and encourage them to take their time. You can also try moistening their mouth with a swab, using a medication dropper, or employing the “chin tuck” technique. Continuously monitor for signs of choking and seek professional assistance if the patient struggles to swallow.

What is the last stage of swallowing?

The last stage of swallowing is the esophageal phase. During this stage, the bolus of food or liquid moves from the pharynx into the esophagus through peristaltic contractions. Then, the lower esophageal sphincter opens to allow the bolus to enter the stomach and closes afterward to prevent reflux.