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Conversations on Care Podcast

Dysphagia and How It Affects the Elderly

Conversations on Care: Dysphagia & How It Affects the Elderly

In a recent Conversations on Care episode, Open Arms Solutions founder Julie Kollada spoke with Carly Pine, a Registered Dietitian Nutritionist who is pursuing her Master’s degree at Rush University. Carly shared some incredibly important information about what dysphagia is, signs and symptoms to look out for, and how to help your loved one with dysphagia eat and drink and safely.

What is Dysphagia?

Dysphagia is the inability to chew or swallow normally. It interferes with the transfer of food or liquid from the mouth to the stomach. Swallowing is a complex process that involves over 30 muscles and nerves. With degenerative diseases, the strength of those muscles and nerves can decline over time, which makes it hard to swallow properly. Dysphagia can affect anyone who has had a stroke, trauma, dementia, cerebral palsy, multiple sclerosis, muscular dystrophy, or Parkinson’s disease, although patients can also develop it simply from aging, as coordination declines.

Signs & Symptoms of Dysphagia

Some telltale signs of dysphagia can include:

  • Pain while swallowing
  • The sensation of food getting stuck in the throat
  • Drooling
  • Hoarseness
  • Heartburn
  • Sensing a dry lump in the throat while swallowing
  • Regurgitation
  • Unexpected weight loss
  • Malnutrition

What Happens in Dysphagia?

There are two pathways at the back of the throat: the trachea leads to the lungs and the esophagus goes to the stomach. The epiglottis is a structure in the throat that blocks the passageway to the trachea when you are swallowing, acting a shield so you don’t aspirate food or liquid into your lungs. In dysphagia, the epiglottis stops working as fast and efficiently as it should, so it can’t completely block the trachea and some food or liquid can get in. In a healthy person, if this happens, we begin to cough and it usually resolves. But, for people with dysphagia, they often can’t effectively cough out the food and it can reach the lungs and cause an infection like pneumonia. This can be very serious for elderly people.

How Do You Identify Dysphagia vs. Normal Accidental Swallowing ‘Down the Wrong Pipe’?

Everyone occasionally swallows the wrong way or even can choke on their saliva. Again, for healthy individuals, coughing and having a sip of water can quickly resolve these issues in most cases. Since it happens to everyone, it can be hard to know if an elderly person is actually developing dysphagia. Carly recommends that with the onset of a neurodegenerative disease, it’s best to have your loved one visit a speech language pathologist (SLP).

An SLP can evaluate the efficacy of your loved one’s swallow with a videofluoroscopic swallow study (VFSS). Food and drinks of varying textures are mixed with barium, which appears white on an X-ray. As the person swallows, the X-ray reveals if the food is going safely down their esophagus or if some is getting into their trachea. The SLP can then work with a dietitian and your loved one’s physician to determine if dysphagia is truly occurring and if so, what to do about it.

Your Loved One Has Been Diagnosed With Dysphagia – Now What?

Upon diagnosis, a dietitian can help by recommending types of foods and drinks that will be most easily consumed by your loved one and that minimize the risk of aspiration. Typically, dysphagia makes it more difficult for people to swallow thin liquids safely. Thicker foods have a longer transit time from the mouth down the throat, which gives the epiglottis more time to close completely and protect the airway. So, as dysphagia progresses, your loved one may need to move to thicker liquids and foods.

There are many different classes of food and beverages that may be recommended depending on the severity of the dysphagia. Beverages range from thin liquids (like water, milk, tea, coffee, and juice) to extremely thick liquids on a scale of zero to four, where class four liquids actually need to be eaten with a spoon. There is a similar range for foods, from liquidized foods like broths and soups to foods that require all your chewing muscles to work such as bread or crackers.

Thickeners can be added to thin liquids to make them into more of a gelatinous texture. It can be difficult to adjust to these texture changes, but it allows those with dysphagia to continue enjoying their favorite flavors in a more appropriate texture. Carly’s grandfather suffered from dysphagia in his later years and he found it hard to adjust from liquid water to water that is almost in a gel form, but it increased his longevity and his quality of life by helping him to eat and drink properly. He also really enjoyed black coffee, but as a thin liquid, it wasn’t safe for him to drink. However, with the addition of a thickener, he could still consume his coffee.

Thickeners can also double as caloric supplements. For example, you might use protein powder, heavy cream, butter, or avocado to thicken a food or beverage and to help your loved one get the nutrients they need or gain weight that they’ve lost due to dysphagia or another condition.

What is Pocketing?

Patients with dementia may start to chew their food, but can forget to actually swallow it or they may want to avoid swallowing if it’s become difficult or painful. The food accumulates in their cheeks, which is known as pocketing. Carly recommends using packaged nutritional beverages like Ensure or Kate Farms to help avoid pocketing or minimize the amount of times that someone has to swallow, while still ensuring that they receive adequate protein and other nutrients. Thickeners can be added to these types of beverages to make them a safe texture. These can also be great solutions for elderly people who have a waning appetite and may no longer want to eat as much as they need.

Consequences of Untreated Dysphagia

Without proper diagnosis and treatment of dysphagia, an elderly person may not be able to clear their airway. If they aren’t drinking or eating safe textures, they can easily choke or aspirate, which can quickly turn into aspiration pneumonia. This can be a very serious illness and may be fatal.

Tips From a Dietitian

Carly saw many elderly patients in the hospital eating while reclined in bed. However, it’s extremely important to eat while sitting up at a 90-degree angle to elongate the esophagus, and to remain in the upright position for 15-20 minutes after eating. This helps ensure that everything passes through completely to the stomach. Minimize distractions while eating to help your loved one focus on chewing and swallowing. Discourage them from talking while eating.

Ensure that your loved one sees a dietitian, who can evaluate their muscle stores and assess for malnutrition. A dietitian will conduct a nutrition-focused physical assessment (NFPA) to assess a patient’s orbital fat pads, triceps, legs, ribcage, and so forth to check for edema and to see how the body is holding on to muscle or fat.

Learn More

If your loved one is dealing with dysphagia, contact Open Arms Solutions to learn more about our in-home care options. Our caregivers are trained in safe eating techniques as well as in adding thickeners to foods and beverages to make them safe.


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