Dysphagia: the management and detection of a disabling problem.

Dysphagia represents a varying group of swallowing difficulties commonly encountered in patients in both acute and community settings. It accompanies a variety of disease states, can be neuromuscular or mechanical/obstructive in origin and encompasses varied prognoses and outcomes. Its consequences include dehydration, malnutrition, bronchospasm, airways obstruction, aspiration pneumonia and chronic chest infection, social isolation, depression and detrimental psychosocial effects. Current "best evidence" in screening, assessment and management is of variable quality but demonstrates that nurses have an important role to play in interventions entailing multiprofessional collaboration within individually tailored programmes. Clear benefits for patients have been indicated. There are gaps in the knowledge base, especially in relation to psychosocial effects and treatment strategies and the nursing contribution in this area.