Swallowing is an involuntary natural reflex. In fact, we swallow as soon as we’re born, and for most of us, swallowing continues to be a simple process we don’t think much about. However, for older adults with dysphagia, swallowing becomes a challenging and sometimes scary process, caused by motor disorders such as Parkinson’s disease, the process of aging, or sometimes by gastroesophageal reflux disease (GERD). Dysphagia can also result from a stroke or throat or other oral cancers.
How to tell if your senior has dysphagia
Symptoms of dysphagia can be challenging to discern from the occasional “going down the wrong pipe” that happens to all of us from time to time when we eat. If any of these symptoms becomes a persistent problem, take your senior to the doctor to have them examined for other signs of dysphagia, which can, at its worst, cause severe weight loss or aspiration pneumonia:
- Pain when swallowing
- Inability to swallow
- A feeling like there’s food getting stuck in the throat or chest
- Drooling while eating
- Food coming back up (regurgitation)
- Persistent heartburn
- Acid reflux
- Weight loss
- Coughing or gagging when swallowing
- A wet quality to the voice
- Eating very slowly
- Coughing when lying down
The doctor will recommend a fluoroscopy or endoscopy (and possibly also an X-ray) to see if your senior has dysphagia, and will also examine the tongue, head, neck and throat.
“Many people occasionally experience difficult or impaired swallowing, but they often adapt their eating patterns to their symptoms and do not seek medical attention,” write researchers from the Mayo Clinic College of Medicine and Science in AFP Journal. “Among those seeking care, the most common causes are generally benign and self-limited, and serious or life-threatening conditions are rare. However, many older adults with progressive neurologic disease have significant but unrecognized dysphagia, which increases their risk of aspiration pneumonia and malnourishment. In these patients, the diagnosis of dysphagia should prompt a discussion about goals of care.”
Tips for making swallowing easier
Eating and drinking are difficult with dysphagia. Once your older adult is diagnosed, they’ll be referred to a speech pathologist for evaluation to determine the specific type of dysphagia they have because many types exist.
Maintain good oral hygiene
- According to researchers, good oral hygiene reduces the chance of getting pneumonia. However, gargling might pose a risk of liquids entering the airway for those with dysphagia. Instead of gargling, use a damp cloth to clean inside the mouth.
Sit up when eating
- Sit upright when eating, and never lie in bed during meals. If your older adult must stay in bed, prop them up with pillows to reduce the risk of choking.
- Never let seniors eat when they’re tired or distracted.
Safe eating behavior
- Discourage your older adult from talking while eating, chewing and swallowing.
- Swallow all food and liquid entirely before taking the next bite.
Pills are hard to swallow
Without sufficient water, many people may have trouble swallowing pills. Unfortunately, dysphagia can make drinking water or other liquids difficult, so it may be necessary to find other options for taking medications. If your senior has difficulty swallowing pills because of dysphagia, try one of these alternatives to make it easier to take their medicine.
- Crush the pills: Check with your pharmacist to see if the medication can be crushed and mixed into soft foods like applesauce or pudding. This is important because some time-released pills should not be crushed.
- Get the prescription modified by a compounding pharmacy: If you’d prefer not to crush the pills yourself – or your older adult finds the taste too bitter – a compounding pharmacy can create a liquid form of the medication.
- Use a non-prescription flavored spray: You can spray inside the mouth with a substance that makes it easier to swallow medications.
Other tips for making swallowing easier you can try:
- Always use cool liquids to take pills. Hot beverages could result in medications dissolving in the throat, leading to a gag reflex.
- If your senior takes their pills while standing, it will help them move the pill more quickly through the throat to the stomach. They shouldn’t lie down for half an hour after taking any medications.
- Use a carbonated drink instead of flat tap water. The bubbles will help move the pill quickly down the throat.
- Put the pill or capsule as far back on the tongue as possible. Use a straw for drinking liquid and moving the tablet.
- Have your senior chew a small piece of a cookie or cracker after they’ve wet their mouth. They should then add the pill to their mouth. Then they can then swallow everything at the same time.
Managing dysphagia requires a team effort among the older adult, caregiver, physician and speech therapist. Patience is needed while determining the best method for eating, taking medication and swallowing safely and correctly.