Dysphagia (Difficulty Swallowing): Tips for Seniors and Their Caregivers

	Dysphagia: when you have difficulty swallowing Frequent coughing when eating or drinking is not normal, and could indicate dysphagia, a medical term for swallowing difficulties. Such difficulty swallowing may lead to chest infection, dehydration or malnutrition, which are potentially fatal conditions. What is swallowing? Swallowing is the process of moving food or liquid from one’s mouth to the stomach. It is something we do almost automatically, but is in fact a complicated process involving many muscles and nerves.  Swallowing is done in three phases: oral phase (within the mouth), pharyngeal phase (through the throat) and oesophageal phase (through the food pipe before reaching the stomach). Swallowing difficulties may be encountered along any of these phases, and could occur with liquids and/or solids.  How can dysphagia lead to chest infection? As our airway and food pipe are just next to each other, dysphagia can result in food and liquids entering the wrong way, into the airway, and into the lungs. This can potentially contribute to aspiration pneumonia – a chest infection due to the entry of foreign material into the lungs. Why do some people have difficulty swallowing? Swallowing difficulty is not a primary condition. It is usually a consequence or side effect of a medical condition or treatment. Swallowing requires intact sensation and adequate muscle strength. People who suffer from medical conditions or who have undergone treatment affecting the nerves and/or muscles involved in the swallowing process may experience swallowing difficulties. An obstruction along the swallowing tract, such as a tumour, could also result in difficulty swallowing. Here are some risk factors for swallowing difficulties: History of stroke or brain injury History of radiotherapy to the head and neck region History of surgery to the head and neck region Existing medical conditions like Parkinson disease, myasthenia gravis, dementia Who can diagnose dysphagia? A speech therapist diagnoses swallowing difficulties related to the oral and pharyngeal phases, whereas swallowing difficulties related to the oesophageal phase are diagnosed by a doctor. Here are some signs of swallowing difficulties: Frequent coughing or throat clearing when you eat/drink Taking too long for each meal (e.g. more than an hour) Difficulty swallowing your own saliva Drooling at rest or during mealtimes Avoidance of some food or liquids Holding of food or liquids in the mouth for a prolonged duration Feeling tired and/or breathless during or after meals Unexplained weight loss Can dysphagia be cured? Depending on the cause of the dysphagia, rehabilitation exercises may help improve the swallowing function.  Compensatory strategies can also improve the safety and ease of swallowing. A speech therapist will be able to prescribe exercises or strategies that are suitable for you or your loved one. Here are some useful tips to cope with swallowing difficulties: Maintain good oral hygieneo  Research has shown that good oral hygiene reduces the chance of acquiring pneumonia.     Caution: For some people with difficulty swallowing, gargling might pose a risk of liquids entering the     airway. An alternative to gargling would be using a damp towel or gauze to clean the interior of the     mouth. Adjust mealtimes environment/settingo  Sit upright during mealtimes. If possible, sit on a chair instead of staying in bed during mealtimes. o  Feed only when alert. o  Reduce distractions during mealtimes. Adopt safe eating habitso  Do not talk with food/liquids in mouth. o  Clear food/liquids in mouth before taking the next mouthful. To remind the person with difficulty     swallowing to clear any residue, caregivers may prompt verbally or put an empty spoon into the     person’s mouth. Modify the dieto  Drink from a spoon of appropriate size instead of drinking from the cup. Put the whole spoon into the     mouth instead of slurping from the spoon. o  Straw-drinking is not recommended for people with dysphagia as it requires more coordination than     cup-drinking. o  Add thickener to liquids.  Thickened liquids flow slower, allowing more time for the control of the     liquid. Caution: Thicker liquids are not always better. A speech therapist will be able to advise you     on the appropriate consistency. o  Eat food of softer texture or cut in smaller pieces. Blend if necessary. o  Avoid taking solid and liquid in one single spoonful (e.g. noodle soup). This requires more     coordination since solid and liquid travel at different speeds, and may not be suitable for people with     difficulty swallowing. o  If finishing a meal is tiring, try small, frequent meals. If in doubt, speak to your doctor for a referral to a speech therapist to determine if you or your loved one suffers from dysphagia, and if there are any suitable exercises or strategies. Article contributed by the Dept of Speech Therapy at: