Although little known, dysphagia often has devastating consequences: each year, according to the Agency for Health Care Policy and Research (AHCPR), over 60,000 Americans die from complications associated with swallowing difficulties, most commonly aspiration pneumonia – caused by food or saliva going down the windpipe and into the lungs.(AHRQ 1999) A large proportion of these cases are due to dysphagia arising from a variety of causes including stroke, degenerative neurological diseases, and head and neck cancer.
Based on CDC mortality data, this is more than the total number of people dying from all forms of liver disease, kidney disease, and HIV-AIDS, combined – and nearly as many as died from diabetes, the #6 killer of Americans.(CDC 2008)
Aspiration pneumonia is one of the leading causes of death among the elderly and has been reported as a growing cause of hospital admissions in that population segment. Pneumonia – a large percentage of which arises from dysphagia – is the fifth leading cause of death of Americans over the age of 65, and the third leading cause of death in those over 85.(LaCroix et al. 1989)
In addition to aspiration pneumonia, dysphagia also predisposes patients to complications such as choking, bronchospasm, increased infection rate, chronic malnutrition, severe life-threatening dehydration, significant weight loss, muscle wasting, physical debilitation, and death from asphyxia.(Lieu et al. 2001; Marik and Kaplan 2003) In head and neck cancer patients, dysphagia can also lead to poor wound healing and reduced tolerance to medical treatments.
Complications due to dysphagia also increase healthcare costs by resultant hospital readmissions, emergency room visits, extended hospital stays, the necessity for long-term institutional care, and the need for expensive respiratory and nutritional support. For the most severe cases, a tracheostomy for breathing and percutaneous endoscopic gastrostomy (PEG) tube for nutritional supplements are typical
The cost of managing a patient with a feeding tube (PEG) is reported to average over $31,000 per patient per year.(Callahan et al. 2001) The presence of a PEG tube contributes to significantly more complications, longer length of stay and more expenses.(Roth et al. 2002) Over 75% of stroke patients who require a PEG require it long-term.(Ha and Hauge 2003)
Dysphagia profoundly affects quality of life: people with dysphagia experience personal discomfort and a drastic reduction in the quality of their lifestyles due to the inconvenience and pain of feeding tubes, which for many has been the primary treatment option for this condition. The loss of swallowing can also lead to severe depression due to the interruption of patients’ normal ways of life.(Ekberg et al. 2002)
Read a recent article from the LA Times on dysphagia's affect on the elderly.
- AHRQ. Diagnosis and traetment of swallowing disorders (dysphagia) in acute care stroke patients. Summary. Agency for Healthcare Research and Quality, 1999.
- ASHA. Prevalence of speech, voice and language disorders in the United States. American Speech-Language-Hearing Association, 1994.
- Callahan CM, Buchanan NN, and Stump TE. Healthcare costs associated with percutaneous endoscopic gastrostomy among older adults in a defined community. J Am Geriatr Soc 49: 1525-1529, 2001.
- CDC. Mortality data from the national vital statistics system. CDC. http://www.cdc.gov/nchs/deaths.htm. [Sept. 17, 2008].
- Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, and Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17: 139-146, 2002.
- Ha L, and Hauge T. Percutaneous endoscopic gastrostomy (PEG) for enteral nutrition in patients with stroke. Scand J Gastroenterol 38: 962-966, 2003.
- LaCroix AZ, Lipson S, Miles TP, and White L. Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors, and nutritional status. Public Health Rep 104: 350-360, 1989.
- Lieu PK, Chong MS, and Seshadri R. The impact of swallowing disorders in the elderly. Ann Acad Med Singapore 30: 148-154, 2001.
- Marik PE, and Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest 124: 328-336, 2003.
- Roth EJ, Lovell L, Harvey RL, Bode RK, and Heinemann AW. Stroke rehabilitation: indwelling urinary catheters, enteral feeding tubes, and tracheostomies are associated with resource use and functional outcomes. Stroke 33: 1845-1850, 2002.