Stuck in the Middle: Multidisciplinary Approaches to Managing Dysphagia in Older Patients with Severe and Persistent Mental Illness in Long Term Care Settings

Abstract

The process of swallowing is a complex and intricate action that involves the coordinated movement of activation of 56 pairs of muscles and is performed unconsciously approximately 2000 times per day, all while protecting the airway [1]. Swallowing disorders are a frequently encountered yet inadequately understood aspect of Schizophrenia. This condition causes significant morbidity and mortality within the affected population, often due to acute respiratory distress resulting from airway obstruction or more gradual complications such as aspiration and pneumonia. [2].Elderly patients with a prior history of severe persistent mental illness encounter added elements that can exacerbate their condition. Such obstacles may encompass extensive utilization of psychotropic medications, behavioral changes, presbyphagia, central nervous system disorders, suboptimal oral hygiene, and living at long-term care facilities or institutional settings. Studies suggest a high prevalence of dysphagia in patients with Schizophrenia [3], with rates as high as 53% in those residing in care facilities [1].This symposium will focus on changes in eating and swallowing patterns among elderly patients with Schizophrenia. During the first presentation, we aim to provide a comprehensive overview of the prevalence of dysphagia, types of swallowing difficulties, pathophysiology, and complications associated with dysphagia. Specifically, we will explore changes that can be attributed to the disease itself, as well as those that may arise as a result of the use of psychotropic medications, particularly antipsychotic medications. A clinical case study presentation of a patient with Schizophrenia who developed oropharyngeal dysphagia and associated complications will be discussed in the second presentation. The case discussion will offer an opportunity to review early signs, behavioral and iatrogenic contributing factors and the importance of a multi-disciplinary team approach. During a presentation by a qualified speech pathologist, an in-depth discussion on the early indicators of dysphagia, screening techniques, as well as bedside and radiographic tests will be highlighted. Additionally, therapeutic considerations will be explored, providing valuable insights and recommendations. The final session will explore various management options, including both pharmacological and non-pharmacological approaches to treatment.The central aim of this presentation is to attain an in-depth understanding of the complexities inherent in these multifarious matters, with the ultimate goal of elevating patient care, enhancing quality of life, and attaining favorable outcomes that endure over the long term.