Cuidados Paliativos: Disfagia, perspectivas clínicas y psicosociales

Abstract

Comprehensive nursing care in situations of health vulnerability implies a complete analysis from clinical and psychosocial references. Dysphagia, difficulty in swallowing, is an important risk, caused by organic lesions or neuromuscular dysfunctions. Normal swallowing is divided into four phases, any of which can be affected and lead to dysphagia. Dysphagia is associated with diseases such as Parkinson's disease, esophageal cancer, and pulmonary disorders. Its prevalence is high in older patients, with 30% in those over 65 years of age and up to 86% in older adults hospitalized with pneumonia. Its early detection is crucial, as it can lead to comorbidities such as dehydration, malnutrition and aspiration pneumonia. Tolerance tests with foods of different textures and liquids of various viscosities are used to assess dysphagia. Results may indicate impaired chewing, oral storage of food, reduced laryngeal elevation, and more. In addition, instrumental tests such as videofluoroscopy and endoscopic examination are used to detect aspiration and other abnormalities. The goal of comprehensive diagnosis is to find solutions and early oral rehabilitation, adopt appropriate therapeutic measures, improve posture and ergonomics, strengthen the oropharyngeal musculature and prevent associated risks. Quality of life in people with chronic dysphagia is addressed in the context of advanced chronic diseases or palliative care.