It's not only swallowing: a clinician primer to adult food refusal beyond dysphagia

Abstract

Purpose of reviewMedical teams are frequently faced with challenging clinical scenarios when their patients exhibit reduced intake of food and drink. Speech-language pathologists, who serve as oropharyngeal swallowing specialists in medical settings, are frequently the first to be summoned with the referral, ‘Poor PO intake. Please evaluate and treat.’ As our practices have illuminated, many differentials other than oropharyngeal dysphagia are often at play.Recent findingsChanges to taste, salivary supply/dry mouth, hunger drive, and psychosocial circumstances will significantly impact intake per os – each scenario to be explored further in this paper. Consequences to diminished nutrition and hydration include medical complications, lengthier hospital stays, and diminished quality of life.SummaryIn this review, two medical speech-language pathologists detail more common alternative diagnoses that explain reduced intake by mouth amongst adults with acute and chronic diseases. Ultimately, a multidisciplinary approach should be considered when evaluating such patients to ensure a comprehensive and effective care plan.