Barbro Gustafsson

Dysphagia and its consequences in the elderly

This investigation was designed to study to what extent dysphagia in the elderly is accompanied by other chest symptoms and if it leads to a reduction in body weight and quality of life. To this end 796 persons, randomly taken from a population register, replied to a questionnaire concerning swallowing difficulties and other chest symptoms. Chest pain, heartburn, and regurgitation occurred significantly more frequently in subjects who admitted feelings of obstruction in the throat or chest during the ingestion of food (p<0.001) than in the rest, as did so-called heart problems (p<0.05). People with dysphagia had more often gained weight over the last 5 years than people without dysphagia (p<0.05). Psychosocial problems in those with dysphagia were given as anxiety at mealtimes and the wish to eat alone. Of those with dysphagia, 40% had consulted a physician, but despite this these patients had as many problems as those who had not seen a doctor. It is apparent that difficulty in swallowing in the elderly leads to physical and psychosocial problems that may reduce their quality of life.

A motivational approach to confirmation: An interpretation of dysphagic patients' experiences

In this paper we articulate confirmation and disconfirmation as components in human motivation. We develop a theory of motivation on the basis of a model of human action and we explore aspects of confirmation and disconfirmation in the context of the meeting of dysphagic patients with their physicians. We distinguish four central elements in confirmation and disconfirmation and use these and the relations between them for the purpose of constructing a typology. Finally, on the basis of the results obtained we interpret a small volume of remarks reflecting the meaning field of some dysphagic patients in relation to their physicians. The underlying motive is to develop tools for understanding health care processes. The “SAUC-Confirmation-Model” and the theoretical framework in which it is embedded should be seen from that point of view.