Management Strategies for Dysphagia in End-of-Life Palliative Care

Assessment and Collaborative Approach

The American Geriatrics Society recommends regular assessment for dysphagia in patients with serious illness at the end of life, as it significantly impacts quality of life and comfort 2
Early involvement of a Speech-Language Pathologist (SLP) is critical for thorough assessment and appropriate management recommendations, according to the American Geriatrics Society 3, 4
An interprofessional team approach including palliative care specialists, geriatricians, SLPs, and nursing staff improves outcomes and patient satisfaction, as suggested by the American College of Physicians 4, 5

The American Geriatrics Society recommends modifying food and fluid consistencies based on individual swallowing capabilities to reduce aspiration risk while maximizing oral intake pleasure 1, 3
Opioids should be considered for symptom management in patients with severe dysphagia at end of life, as they can help manage associated discomfort, according to the American College of Physicians 6
For patients experiencing significant distress from dysphagia, palliative sedation may be considered after discussing aims, benefits, and risks with the patient and family, as recommended by the European Society for Medical Oncology 7

The American Geriatrics Society recommends careful hand feeding as the preferred approach over feeding tubes for patients with dysphagia at end of life 1
Evidence suggests that feeding tubes do not improve outcomes in end-stage illness and may increase discomfort, according to the American Geriatrics Society 4
Involve geriatricians in discussions about feeding tubes, as this has been shown to reduce unnecessary tube placements by 50%, as recommended by the American Geriatrics Society 4

Regularly screen caregivers for practical and emotional needs while caring for patients with dysphagia, as suggested by the American College of Physicians 5
Implement individualized multicomponent interventions for caregivers, as these are more beneficial than limited interventions, according to the American College of Physicians 5