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Swallowing disorders and aspiration in palliative care: Definition, consequences, pathophysiology, and etiology

Tessa Goldsmith, MA, CCC-SLP
Audrey Kurash Cohen, MS, CCC-SLP
Section Editors
Eduardo Bruera, MD
Kenneth E Schmader, MD
Daniel G Deschler, MD, FACS
Deputy Editor
Diane MF Savarese, MD


Difficulty swallowing is a disturbing symptom that occurs frequently in terminal illness, especially with malignancies of the upper aerodigestive tract; progressive neurologic disorders such as amyotrophic lateral sclerosis (ALS), Parkinson disease, and multiple sclerosis; dementia; and the general debility that develops in patients near the end of life. In the final weeks to months of life functional decline can impair the desire or ability to eat or drink; furthermore, dysphagia to solids and liquids is one of the most frequent symptoms that tends to worsen during the last days of life [1]. Swallowing dysfunction can impact the essence of pleasurable activities, compromise quality of life (eg, social interaction, communication), and impair nutrition and hydration. Swallowing disorders are also a major predisposing condition for aspiration, and can lead to several pulmonary syndromes, including pneumonia, and, in some cases, even asphyxiation or death.

Given the place of food and nutrition as a central focus of social interaction and the common concerns about adequate nutrition for well-being, swallowing disorders can also cause frustration and distress for families and caregivers. In addition, for many patients with a terminal illness, the inability to swallow and/or disinterest in food may represent a pivotal symptom that prompts the decision to consider end-of-life or hospice care. Management of patients with an advanced, life-threatening illness who are experiencing swallowing difficulty should focus on the following palliative care principles: (1), the primary goals are prevention and relief of suffering with an emphasis on ensuring comfort, rather than optimal nutrition and hydration; (2) the care plan should reflect the underlying life-threatening disease and be consistent with the overall goals of treatment; (3) care is optimized by involving an interdisciplinary team whereby each specialist contributes his/her expert knowledge; and (4) the patient and family are the unit of care and their wishes and preferences should guide collaborative decision making.  

This topic review will cover the definitions, consequences, and etiology of swallowing disorders in patients receiving palliative care. Assessment and management of swallowing disorders in this patient population; overview of the causes and treatment of aspiration pneumonia in adults; issues related to swallowing problems in patients with head and neck cancer; assessment and management of oropharyngeal and esophageal dysphagia in adults; and aspiration due to swallowing dysfunction in children are presented elsewhere.

(See "Swallowing disorders and aspiration in palliative care: Assessment and strategies for management".)

(See "Aspiration pneumonia in adults".)


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Literature review current through: Sep 2016. | This topic last updated: Jun 14, 2016.
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