Guidelines for a Palliative Approach in Residential Aged Care

such as poor gastric emptying, then a prokinetic agent (e.g. metoclopramide, cisapride or
domperidone) should be used. Should constipation be the cause, then promethazine should
be effective. Hyperacidity can produce considerable nausea, heartburn, acidity or a bitter
taste and has been associated with vomiting. Treatment of hyperacidity can be accomplished
by nonabsorbable antacids (magnesium plus aluminium hydroxide preparations), antacid
plus alginate preparations, histamine H2-receptor antagonist (e.g. ranitidine) or a proton
pump inhibitor (e.g. omeprazole). The Therapeutic Guidelines: Palliative Care [109] provide
recommended dosages for these medications.
A recent systematic review of the advanced cancer literature on nausea concluded that there
were few well-designed studies which could be used to develop guidelines for the management
of nausea [215] (Level II). For the gerontological literature, the same finding would also apply.
Consequently, the management of nausea and vomiting will continue to be based on expert
opinion until such studies are conducted.
6.8 DYSPHAGIA
Dysphagia, or difficulty in swallowing, can lead to significant weight loss for residents in
RACFs. Dysphagia is associated with a large number of neurological conditions, such as
cerebral vascular accidents, Parkinson’s disease, dementia, multiple sclerosis and motor neurone
disease [104] (Level III-1). The risk factors identified include neurological conditions, an altered
state of consciousness, decreased cognitive ability, decreased alertness and attention span,
increased impulsiveness or agitation, some medications, and advanced age [104] (Level III-1).
The signs of dysphagia may include: [216]
• difficulty swallowing;
• facial droop;
• choking when eating or drinking;
• coughing before, during or after swallowing food or liquids;
• refusal to open the mouth and/or accept a large bite of food; and
• retention of food in the mouth or pharynx.
6.8.1 Assessment
A resident at risk of swallowing problems requires early assessment and referral to a speech
pathologist or GP [104] (Level III-1). In rural and remote areas where access to speech
pathologists may not be readily available, qualified nurses can be educated to perform screening
assessments of the resident’s ability to swallow in order to identify early signs of dysphagia. [105]
Assessment should involve asking the resident, and/or their family, if there is any difficulty
swallowing food or liquids. Questions that could be used during this assessment might include:
• Do you choke when eating or drinking?
• Do you experience coughing associated with eating or drinking?
• Does food ever stick in your throat?
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