Dysphagia presents with various signs and symptoms. It varies from mild masticatory dysfunction such as difficulty in chewing solid food to severe cases such as poor bolus formation caused by a weakened tongue or muscles of mastication, or impaired sensation. In addition, choking while swallowing or poor initiation of swallowing is also observed in swallowing impairments, and cognitive impairment may cause another concern.
Thus, it is extremely difficult to develop appropriate methods of feeding for these disorders in nursing practice.
To understand the actual conditions under which nursing care food is cooked and prepared in nursing homes, we collected basic data to clarify the classification and terminology of dysphagia in accordance with actual feeding methods. Responses were collected from 41 institutions . The disorders ranging from mild masticatory dysfunction to poorinitiation of swallowing were managed by changing the consistency of the food, however, we found that thickening agent was overused as a preventive measure with little consideration given to the severity of the disorder .Therefore, we suggest that there needs to be a clearly-defined standard for evaluating masticatory dysfunction and swallowing disorders. There are many patients with cognitive impairment at all types of special nursing homes, including special nursing homes for the elderly (Kaigo rojin fukushi shisetsu), geriatric health care facilities for the elderly (Kaigo rojin hoken shisetu) and geriatric medical care facilities for the elderly (Kaigo ryoyo gata iryo shisetsu). Thus, we decided, to examine dysphagia and cognitive impairment as separate categories. On open format questions, we found that there was confusion in the nursing care field due to lack of guidelines about which feeding methods correspond to specific disorders, andthe absence of clear terminology for forms of food. We suggest that a “matching” manual, which correlates degree of dysphagia withdifferent forms of nursing care food, is needed for specialist nursing care insurance homes, and also for home care. Thus, our aim is to produce a manual that can easily be understood in the nursing care environment.