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Dysphagia is an insidious condition. 

Multiple causes eventually lead to the weakness and failure of the muscles involved in swallowing. The sad reality is that clinicians, carers and patients all tend to look at the underlying condition and overlook the subtle onset of Dysphagia with distressing consequences. 

So, 80% of Dysphagia goes unnoticed.

If untreated, the grave danger is that the vortex of the Spiral will get a hold and pull the victim down to death in front of our very eyes, with all of us oblivious to the process. 

And the size of the problem has taken on pandemic proportions—more than a million suffering from the condition in Australia and 590 million worldwide. 

So, what is the Death Spiral of Dysphagia?

The primary condition that grabs our attention might be a significant neurological condition like Motor Neuron Disease, a head injury, Cerebral Palsy or Parkinson's Disease. Still, it could also be more subtle, like Dementia or Depression. The primary conditions all have one thing in common: they cause inactivity. The lack of muscle function leads to a lack of appetite, lethargy and muscle wasting. Muscle wasting affects all muscle groups in the body, including the muscles involved in swallowing. So, suppose the primary condition did not directly lead to Dysphagia and poor intake. In that case, Dysphagia now follows the 2nd wave of muscle wasting in the wake of inactivity.

And so the slip down the Spiral is initiated. Dysphagia and poor intake lead to the subtle onset of Malnutrition and Dehydration - both usually undiagnosed. Consequently, weight loss follows, and the immune system is compromised. This leads to infections (often lung and bladder), further bedrest and even hospitalisation. Emotional decline sets in. The patient becomes discouraged and depressed and experiences a cognitive slump. Inactivity and muscle wasting become more prevalent, balance is compromised, and falls and aspirations become a high risk. These are the most common causes of unnatural deaths in nursing homes. The decline down the Spiral now accelerates, and the windings of the vortex repeat itself and become tighter. Exercise programs become very hard to keep up, bedsores and contractures develop, infection rates increase, and the patient and family lose hope. The grip of the Death Spiral gets even tighter, and we brace ourselves for the inevitable. 

But is there something we can do to stop the demise, or can we at least slow the process down and increase the quality of life?

Sure we can!

We need to diagnose Dysphagia early.

We need to intervene by optimising intake and prevent dehydration and malnutrition from taking effect. We must achieve a minimum intake of 1500ml (target 2500ml) and 1600 calories (target 2500 cal) daily. 

‍Let us not despair.

‍If we can identify the problem early, fuel the engine and make it work, disease will fall by the wayside, and quality of life will prevail.‍