In Reply I appreciated the thoughtful insights of Dr Finucane, regarding my article “Response to a Patient’s Failed Swallowing Study: Decisions Regarding Feeding Tubes and Dysphagia,”1 and am glad to have the opportunity for further dialogue.
Dr Finucane noted that there was no clear etiology described in the vignette regarding the cause of this patient’s dysphagia. In this case, and in many others, there was no single clear, reversible etiology for the problem—medications were minimized, volunteers were present to assist with eating, and days had passed since intubation and anesthesia exposure. It is my clinical experience that in these cases, unrelated to end-stage dementia, we are likely unmasking a low-level chronic dysphagia that was present prior to hospitalization. Data suggest that there is a large population of community and nursing home residents with a certain level of dysphagia at baseline.2 This chronic problem is only worsened by illness, debility, and the potentially reversible etiologies noted above.
Albert RH. Questioning Feeding Tubes to Treat Dysphagia—Reply. JAMA Intern Med. 2017;177(3):443-444. doi:10.1001/jamainternmed.2016.9003