Many people have swallowing problems after having a stroke, trauma, or brain injury or when diagnosed with a debilitating disease, such as Parkinson’s disease or advanced dementia. Suspected aspiration (food/drinks entering the airway) and feared consequences of swallowing difficulty often lead to a recommendation for tube feeding by health care providers. Tube feeding is not always a good choice, as it also carries risks. Past research has revealed harm (pneumonia, depression, and death) from tube feeding in persons with dementia, chronic obstructive pulmonary disease, and stroke. Past studies offer evidence that oral feeding may be possible even when swallowing problems exist, and it may carry less risk than tube feeding for certain patient populations.
To reduce risk of harm from aspiration (with oral or tube feeding), it is best for the mouth to be cleaned at least four times per day. Cleaning the mouth after meals rids the mouth of harmful bacteria and prevents pulmonary ingestion of oral pathogens (bacteria that can cause lung infections). It is the bacteria drawn to the lungs by food of drink entering the airway that causes infectious sequelae. Ridding the mouth of this harmful bacteria can help preserve lung health in persons who have chosen to eat by mouth knowing that a swallowing problem is present. Lastly, past studies report diluted hydrogen peroxide or chlorhexidine to be the best choices for mouth cleaning.
It is best for persons with swallowing problems who have chosen oral feeding to eat and drink while sitting up in bed or in a chair. Eating or drinking in a partially-reclined position is permitted, if necessary. However, smaller bites and sips are recommended if a person cannot sit up to eat or drink. Using a bit of effort when swallowing is a maneuver that is commonly recommended to help speed thicker viscosities through the throat, and over time, consistent use of this technique as a swallowing strategy may increase the strength of the swallow. There are other therapeutic and swallow evaluation best practices that can be covered in future articles. For now, it is essential that you understand that tube feeding is not the only option, and may indeed not be the best option, for persons diagnosed with life-limiting illness and dysphagia (difficulty swallowing).
Cintra, M. T., de Rezende, N. A., de Moraes, E. N., Cunha, L. C., & da Gama Torres, H. O. (2014). A comparison of survival, pneumonia, and hospitalization in patients with advanced dementia and dysphagia receiving either oral or enteral nutrition. The Journal of Nutrition, Health, and Aging, 18(10), 894-899. doi:10.1007/s12603-014-0487-3
Gillick, M. R. (2000). Rethinking the role of tube feeding in patients with advanced dementia. New England Journal of Medicine, 342(3), 206-210. doi:10.1056/NEJM200001203420312
Hanners Gutierrez, J. (2019). Artificial Enteral Nutrition versus Oral Nutrition as Related to Outcomes in Palliative Care Patients with Dysphagia (Doctoral dissertation).
