Dysphagia (swallowing difficulty associated with foods, fluids and saliva) is common after acute stroke with an incidence between 40 and 78%. There is an association between dysphagia and poor outcomes including a higher risk of longer hospital stay, chest infection, disability and death (Martino et al, 2005). Evidence from national audit shows that delays in the screening and assessment of dysphagia are associated with an increased risk of stroke-associated pneumonia (Bray et al, 2017). Prompt detection of dysphagia in patients with acute stroke is therefore essential. In patients with dysphagia on initial screening, a specialist swallowing assessment is indicated that includes consideration of function and cognition and a broader range of food and fluids of varying texture. [2016]
The majority of people with dysphagia after stroke will recover, in part due to bilateral cortical representation of neurological pathways (Hamdy et al, 1998). A proportion will have persistent abnormal swallow and continued aspiration at 6 months (Mann et al, 1999) and a small proportion, particularly those with brainstem lesions, will have chronic and severe swallowing difficulty. People with persistent swallowing problems may avoid eating in social settings and thus lose the physical and social pleasures connected with food and drink. [2016]
This section should be read in conjunction with the sections on hydration and nutrition (Section 4.9 Hydration and nutrition), mental capacity (Section 4.35 Mental capacity) and end-of-life (palliative) care (Section 2.15 End-of-life (palliative) care). In particular, these recommendations are not intended as burdensome restrictions on oral food and fluid intake for people with stroke receiving holistic palliative care. The decision-making process to support people to eat and drink with acknowledged risks should be person-centred and involve the person and/or family/carers, and other members of the multidisciplinary team, and include a swallowing assessment and steps to minimise risk (Royal College of Physicians, 2021). [2023]