In Jan 2017 the UK Patient’s Association launched a charter to improve the care of residents in care homes who have swallowing difficulties. In response to a survey results which identified sub-optimal practices with respect to covert administration and medicines administration for care home residents with dysphagia, the Patient’s Association convened an advisory group to address the problem. Consisting of representatives from care homes, primary care organisations, the nursing, medical and pharmacy professions and leading academics in the field, nine point charters for both patients and healthcare professionals were developed. With recommendations that medicines and formulation choice be regularly reviewed, that residents are placed at the centre of any decision making and assessment for dysphagia is regularly undertaken it is hoped that residents in care homes will receive better quality care. Detailed guidance on the charter and how to implement it into care homes is due in August.
Recent research published in the international journal Dysphagia has shown that if Mitiglinide tablets, a treatment for type 2 diabetes are mixed with a thickener before being administered to healthy volunteers, Mitinglinide’s ability to reduce blood sugar levels was seriously affected. In practice this would mean that if the drug was routinely administered with a thickening agent then the patient’s diabetes control would be poor. The trial was in five patients who received the tablets on their own and then in a thickening agent and therefore acting as their own controls. The results showed that the thickener not only delayed absorption of the drug but also resulted in reduced effectiveness. 30 minutes after ingestion the blood glucose level in patients when they had used the thickener was 160mg/dl on average compared to 110mg/dl when it was not used and this difference was shown to be statistically significant. The authors recommend that if medicines are to be mixed with thickeners then it would be wise to carefully assess and monitor the patient. The paper’s full title: Tomita T, Goto H, Sumiya K, Yoshida T, Tanaka K,, Kudo K, Kohda Y.Effect of Food Thickener on the Inhibitory Effect of Mitiglinide Tablets on Post-prandial Elevation of Blood Glucose Levels. Dysphagia. 2017 Jun; 32(3): 449-503. doi: 10.1007/s00455-017-9787-1.
A recent study has demonstrated that acupuncture combined with neuromuscular electrical stimulation and rehabilitation exercises is an effective treatment for restoration of the swallowing function when dysphagia (defined as a disorder involving difficulty or discomfort when swallowing) has occurred following craniocerebral injuries; injuries involving both the brain and the cranium. The acupuncture practice is based on traditional Chinese medicine.
This shows a similar outcome to a study in 2010 where neuromuscular electrical stimulation was found to help stroke victims swallow. This second news article states that 75% of stroke sufferers are left drooling or choking on foods and drinks because they have lost their swallowing function. It is well known that improving the swallowing function in stroke patients can significantly improve their quality of life. This same improvement will apply to the aforementioned craniocerebral injury patients.
Both acupuncture and neuromuscular electrical stimulation are thought to be easy and quick to deliver to patients, and they also require very little patient adherence. This suggests that they may be used concomitantly in the future to help patients with swallowing difficulties.