Social and Psychological Burden of Dysphagia: Its Impact on Diagnosis and Treatment Olle Ekberg, 1 Shaheen Hamdy, 2 Virginie Woisard, 3 Anita Wuttge±Hannig, 4 and Primitivo Ortega 5 1 Department of Diagnostic Radiology, MalmoÈ University Hospital, MalmoÈ, Sweden; 2 Hope Hospital, Salford, Great Britain; 3 Centre Hospitalo-Universitaire de Rangueil, Toulouse, France; 4 Radiologie Strahlentherapie und Nuklearmedizin, Munich, Germany; and 5 Hospital de MoÂstoles, Madrid, Spain Submitted July 23, 2000; accepted September 27, 2001 with revision Abstract. The social and psychological impact of dysphagia has not been routinely reported in large studies. We sought to determine the eects of dys- phagia on broad measures of the quality of life of patients and to explore the relationship between the psychological handicaps of the condition and the frequency of diagnosis and treatment. A total of 360 patients selected on the basis of known subjective dysphagia complaints, regardless of origin, in nursing homes and clinics in Germany, France, Spain, and the United Kingdom were interviewed using an es- tablished questionnaire. Qualitative interviews with a total of 28 health professionals were conducted to improve understanding of the patient data in the context of each country. Over 50% of patients claimed that they were ``eating less'' with 44% re- porting weight loss during the preceding 12 months. Thirty-six percent of patients acknowledged receiving a con®rmed diagnosis of dysphagia; only 32% ac- knowledged receiving professional treatment for it. Most people with dysphagia believe their condition to be untreatable; only 39% of the suerers believed that their swallowing diculties could be treated. Eighty- four percent of patients felt that eating should be an enjoyable experience but only 45% actually found it so. Moreover, 41% of patients stated that they ex- perienced anxiety or panic during mealtimes. Over one-third 36%) of patients reported that they avoided eating with others because of their dyspha- gia. In a largely elderly population that might accept dysphagia as an untreatable part of the aging process, clinicians need to be aware of the adverse eects of dysphagia on self-esteem, socialization, and enjoy- ment of life. Careful questioning should assess the impact of the condition on each patient's life, and patients should be educated on their choices for treatment in the context of any coexisting illness. Awareness of the condition, diagnostic procedures, and treatment options must be increased in society and among the medical profession. Key words: Dysphagia Ð Swallowing Ð Quality of life Ð Nutrition Ð Eating habits Ð Psychosocial eects Ð Deglutition Ð Deglutition disorders. Epidemiological data estimates the prevalence of dys- phagia among individuals older than 50 years to be as high as 22% [1,2]. Studies have found that 13% of patients in short-term-care hospitals and up to 60% of nursing home occupants have feeding diculties [3,4]. Dysphagia, which occurs mainly in elderly people, has a series of physical consequences but is less well understood in terms of its social and psy- chological consequences [5]. Patients with dysphagia are often at increased risk of developing other med- ical conditions. Unmanaged, dysphagia can lead to dehydration, malnutrition, respiratory infections, and death. The dehydration causes sputum to thicken and patients may be aected by breathing diculties [6,7]. The associated malnutrition from dysphagia leads to lethargy and decreased ability to perform This project was supported by an unconditioned educational grant from Novartis Consumer Health SA Correspondence to: Olle Ekberg, M.D., Department of Diagnostic Radiology,MalmoÈ UniversityHospital,SE-20502MalmoÈ ,Sweden. Telephone : +46-40331541, Fax: +46-40-969977 E-mail: olle.ek- berg@rontgen.mas.lu.se Dysphagia 17:139±146 2002) DOI: 10.1007/s00455-001-0113-5