Social and phycologic impact of dysphagia

Complications of oropharyngeal dysphagia include aspiration pneumonia, malnutrition, dehydration and impact on psychosocial well-being. However, patients, caregivers and clinicians perceive the importance of these complications differently, with patients addressing psychosocial sequelae as predominant. The chapter provides an overview of the psychological and social impact of dysphagia on patients and their caregivers. Embarassment due to inability to eat and drink in a social acceptable way leads to social isolation. Diminished self-esteem, fear, anxiety, frustration and depression may be experienced. Eating habits may be overturned, especially in case of more restricted diets and introduction of enteral feeding. Over time, patients find a range of coping strategies, which may be beneficial for some, while negative for others. Caregivers have to cope with changes of their role and responsibilities; in reaction to these, affective symptoms may arise. Implications for clinical practice are discussed, including a multidisciplinary and holistic assessment of the patient and the caregiver to be performed periodically, personalization of the counseling, skill building programs and interactions with other patients.