Dysphagia is any kind of difficulty associated with swallowing including chewing food and sipping drinks. It is often acquired as a result of another health condition such as stroke, Parkinson’s Disease, head and neck cancer and MND just to name a few. In fact, 1.25 million Australians or approximately 5%, live with dysphagia and up to 22% of people over the age of 50 have some kind of swallowing difficulty. However, it is also a condition that some can be born with. For so many people, eating and drinking is a source of pleasure, comfort, celebration, commiseration and so much more, not just merely a routine or a means to survive. Because of this, it’s known to inextricably contribute to one’s quality of life.
Dysphagia can be both short term or long term and can vary in severity. This might be something as mild as difficulty chewing meats and crusty bread, or needing to flush your food down with a sip of drink. Other times, it can be as severe as being unsafe to eat and drink at all and requiring nutritional support by other means.
In some cases, there is potential for therapy or rehab in order to eat and drink normal foods but for others, the likely and the safest option is to adhere to food and drink modifications for a period of time or indefinitely. These modifications can look like; softer foods, cut up foods, minced foods or pureed foods. For others it can look like different viscosities of drinks- or both.
Often, health and medical decisions regarding swallowing are prioritised for the purpose of safety and for good reason because this is usually to preserve health and life. Some of the most severe risks of not adhering to food and drink recommendations is choking, and aspiration pneumonia which can both be fatal. However, there is often a decrease in pleasure and motivation to eat despite the increase in safety and ease of eating.
In the long term, there is also the added difficulty of choosing foods that are considered “safe” and an even harder time at finding foods within this category that one enjoys. A modified diet can sometimes impact nutritional status, therefore, having a reduced interest in food and drink due to discontent with food modifications can have further impacts on health.
Research shows that a person’s quality of life decreases as symptoms of dysphagia increase and typically, that means that food and drink modifications increase too. This is something that is seen in progressive conditions, such as Parkinson’s Disease. Unfortunately, this is also associated with detrimental impacts to socialisation with up to 25% of people with Parkinson’s Disease reporting so. This can lead to concern about coughing or choking in front of others, taking longer to eat than everyone else, a sense of embarrassment and ultimately avoiding mealtime with others. Some evidence even indicates that this impacts interactions with family members too.
Mealtimes are such a central part of culture and socialisation, so it stands to reason that this can cause isolation in people living with dysphagia. Further to this, dysphagia is known to impact mood and mental health with rates of anxiety and depression increasing at the onset of symptoms. Reports indicate a sense of anger, frustration, lack of confidence and poor self esteem when it comes to difficulties with eating and drinking, especially in instances where insight and cognition are fully intact, such as head and neck cancer. If you consider the range of contexts in which we eat and drink, dysphagia has also been known to impact participation in sport, exercise and other leisure activities.
Fortunately, over the years, there has been a shift or trend within speech pathology and other clinical fields in making decisions for quality of life and a focus on improving this quality within the guidelines and restrictions of food and drink modifications.
In this vain, The Fourth Place aims to maximise the quality of modified foods, and experiences with food for those who are impacted by dysphagia and limited to certain foods and drinks. Just as importantly, it aims to get the wider community involved to bring skills, ideas and creativity to the forefront of this space and bring a sense of awareness, inclusion and sharing to the humble and centric mealtime.
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