This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.

/pdf/european-society-for-swallowing-disorders-european-union-4jitjw33jq.pdf

European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome.

PALLIATIVE CARE’S SACRAMENTAL AND LITURGICAL FOUNDATIONS: HEALTHCARE FORMED BY FAITH, HOPE, AND LOVE Darren M. Henson, B.B.A, M.Div., S.T.B., S.T.L. Marquette University, 2014 Medical history identifies Dame Cicely Saunders as the founder of modern hospice and palliative care for the unique care she gave to the incurably and terminally ill. Less known is how her Christian faith, combined with her knowledge of medicine, influenced her vision. This work retrieves the Christian roots of palliative care and asserts that the practice of faith preserves the practice of medicine from succumbing to medicalized dying—a phenomenon that excessively relies on technology with the implied hope that it will ultimately conquer illnesses and even death. Efficiency and effectiveness ground modern medicine’s epistemology. These concepts follow the philosophical ideals of the essence of technology asserting that it can and ought to use and control nature to ameliorate problems, including the progression of human illness, frailty, and death. Scholars observe how this forms a medical environment that almost exclusively views death as failure. Christianity, however, forms believers in the paschal mystery of Christ Jesus whose resurrection redeems death. I argue that the sacramental-liturgical practices of the Christian faith enable healthcare practitioners and patients to renegotiate an understanding of health, death, and life. The celebrations of baptism and Eucharist give the gifts of faith, hope, and love. These rituals form the believer in the pattern of the paschal mystery—the life, death, and resurrection of Christ, and the believer is sent forth to live this in the world. This means that Christians ought to engage medicine differently, in ways that stymie medicalized dying. The practice of faith remains evermore important especially for Catholic healthcare as it increasingly relies less on the women religious who founded these ministries and more on lay professionals whose commitments to living the paschal mystery are less certain. By encountering God’s gratuitous love in the sacraments, one learns to lovingly bear the burdens of illness and also how to create healthcare systems that benefit the common good. The result of this vision of care necessitates the cooperation of both local parishes and large healthcare systems to fully enact the gospel call to lovingly care for the vulnerably ill and dying.

Palliative care's sacramental and liturgical foundations: Healthcare formed by faith, hope, and love

Food is significant from an anthropological and sociological perspective. The emotional and symbolic meanings of food, however, are rarely examined in the health care literature, nor are such meanings specifically linked to end-of-life treatments. The aim of this study was to explore the meaning, value, beliefs, and emotions connected with food and how a cultural model for older adults shapes this meaning related to end-of-life treatments. This article describes a qualitative study of older male veterans with terminal or advanced progressive illness perceptions and beliefs about food. Analysis of the data revealed a cultural model of community identity and social memory as described through food. The meaning of food was highly symbolic and temporal in nature. Given the historical struggle concerning the use of artificial nutrition at end of life, results of this study might provide a foundation upon which clinicians can explore the meaning of food in those with terminal or advanced progressive illnesses and incorporate this into end-of-life decision making. Further clinicians may address the need for nurturance and caring without the use of end-of-life treatments by focusing on physical comfort measures and the use of other nurturing activities to replace the “food connection” between the older adult and family.

/pdf/food-identity-and-memory-among-aging-veterans-at-end-of-life-4kyp1ut0s6.pdf

Food, Identity, and Memory Among Aging Veterans at End of Life

People with many different medical problems will develop swallowing problems or dysphagia. The management of dysphagia cannot be done in isolation, particularly as the end of life approaches. Interventions to assist in the provision of nutrition are in most countries a medical treatment. Decisions will need to be made that will be influenced as much by social, cultural and religious expectations and norms as by clinical status and medical information. The best interests of the patient will always be the overriding aim, but negotiation between the patient, family and medical team may be required.

Ethical Issues and Dysphagia

May Alzheimer's Patients Refuse Tube Feeding? Yet More Questions on the Papal Allocution—And Perhaps an Answer

The Catholic Health Association supports the use of the Ethical and Religious Directives for Catholic Health Care Services when making decisions about artificial nutrition and hydration. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

/pdf/the-catholic-health-association-s-response-to-the-papal-33vy636q4e.pdf

The Catholic Health Association's Response to the Papal Allocution on Artificial Nutrition and Hydration

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The Catholic Health Association's Response to the Papal Allocution on Artificial Nutrition and Hydration