All you need to know about swallowing issues as you age, is how to catch signs early, and most importantly, what you can do about it.
Difficulty swallowing, otherwise known as dysphagia, is a disorder that affects 10-33% of the elderly population.
It stems from the Greek word dys (difficulty) and phagia (to eat).
Swallowing is not as straightforward as it seems!
Swallowing mee goreng involves up to 30 (yes, 30!) nerves and muscles. They work together to allow easy passage of food from our mouth to our stomach.
It takes less than a second for food to pass from our mouth to the esophagus (the tube that connects our mouth to the stomach).
Did you know? A healthy adult swallows up to 600 times a day- most of which is done subconsciously.
How Does Swallowing Actually Work?
Swallowing centers located in the brain will send signals to these nerves and muscles. When someone suffers from a stroke or has a disease of the brain, the pathway becomes disrupted, causing dysphagia.
This is why people with strokes, neurodegenerative diseases like Parkinson’s Disease, dementia and Alzheimer’s Disease are at increased risk of swallowing disorders.
How does Swallowing Change as I Age?
As we age, the structure, mechanism and nerve pathways change. Another term for this is called presbyphagia.
Changes to the Structure
As we age, our sense of smell or taste may change. Oral hygiene, the flow of saliva and dentition may change.
Our lip, tongue and jaw muscles are not as strong as before, due to a reduction in muscle mass and muscle contraction.
Some older adults may notice their tongue size getting bigger (tongue hypertrophy), as a result of fatty deposits and reduced muscle mass.
All of these can reduce our range of motion and the rate of swallowing.
Delayed Swallow Reflex
As a person ages, it might take a longer time to initiate the swallow reflex. The tissues around the neck lose their elasticity and flexibility. Smooth muscles that aid with peristalsis do not contract as strongly as before.
Chewing may take more effort too.
There is delayed emptying of food content from the esophagus into the stomach.
This can increase the risk of choking and accidental aspiration of food or drinks.
What are the Signs or Symptoms of Difficulty Swallowing?
Warning Signs
- Choking on solids, liquids and/ or medication
- Drooling
- Requiring more effort to swallow
- Swallowing with a gurgling noise while eating or drinking
- Delirium
- Voice hoarseness
- Regurgitating food after meals
Here are some questions to ask yourself :
- Do you choke and cough while eating and drinking?
- Do you feel food stuck in your throat during or after mealtimes?
- Do you experience chest pain or heartburn after swallowing?
- Do you find yourself taking a longer time to finish your meal?
- Have you lost weight recently?
- Do you need to swallow multiple times to get food down?
- Do you struggle to breathe properly during your mealtimes?
- Do you have frequent lung infections?
These signs and symptoms might indicate a swallowing disorder.
Who Is At Risk?
If you have
- A history of stroke
- Parkinson’s disease
- Dementia
- Ill-fitting dentures
- A thyroid disorder
- Gastroesophageal reflux disease (GERD)
- Esophageal cancer
- Systemic illnesses like rheumatoid arthritis, systemic lupus erythematosus (SLE) and CREST syndrome,
You may have a higher risk of developing a swallowing disorder.
Should I Be Concerned?
Swallowing disorders can affect us in multiple ways:
- Malnutrition
As we age, our muscle mass reduces with age. A swallowing disease can further hinder a person from getting enough nutrients- protein especially. This can lead to muscle wasting.
- Weight Loss
This is a result of malnutrition. It also comes with a wide set of issues like increased susceptibility to infections, osteoporosis, longer recovery time, reduced mobility, lethargy, anxiety and depression.
- Dehydration
Difficulty in swallowing liquids can cause an elderly adult to have reduced fluid intake. This may lead to electrolyte imbalance and confusion.
- Aspiration Pneumonia
This may occur when a person accidentally inhales food into the lungs instead of the stomach while swallowing. Bits and pieces of food accumulate, which can lead to bacterial infection of the lungs. This is the main cause of hospital admissions and mortality in nursing home residents.
- Non-compliance to medication
It can be a daily dread to swallow food, even more so – small, round pills. A swallowing disease can further deter an elderly person from taking their medications on time. Non-compliance can further worsen a person’s comorbidities.
What Can I Do?
Fret not. Here are some tips for you or your loved one that may help make mealtimes more enjoyable.
- Always sit up to eat. Lying down can increase your risk of developing aspiration pneumonia.
- Take small mouthfuls. Watch out for any warning signs in between meals.
- Eat slowly. Rushing can further increase the risk of choking.
- Eat soft, moist foods. We can incorporate porridge, oats, smoothies, soft fruits like bananas and steamed cooked vegetables into our diet.
- Have small sips of fluids in between mouthfuls. This can help break down foods for them to be easier to swallow.
- Reduce distractions while eating. Turn off the television and avoid reading and eating at the same time.
- Get well-fitting dentures – most people struggle to chew due to ill-fitting dentures.
Dementia and Swallowing
A study found that 85.9% of elderly adults with Alzheimer’s disease and dementia struggle to swallow and chew properly.
Dementia is a neurodegenerative disease that causes a deterioration in cognitive function. It affects an individual’s thinking, orientation, memory, judgment, perception and ability to learn. It can reduce the quality of life and level of independence of a person.
A person with dementia may spit out food, play with food or simply refuse to eat. It can be distressing and frustrating for the family member or caretaker to witness.
What Can Be Done?
A simple method would be to make sure the food served is soft and consistent. Remove hard lumps like fruit skin, raw carrots or hard biscuits.
A person with dementia may also forget to swallow. Patiently encourage them verbally. We can try changing the temperature and taste of food in meals, for example, alternating between sweet and savory foods. Gently placing an empty spoon throughout mealtimes can even encourage them to swallow.
Sometimes, a person with dementia may store food in their mouth after mealtimes.
There is a risk of mouth infections and bad breath. We can check their mouth after each meal and encourage them to regularly brush their teeth. If they are unable to do it, we can make sure their dentures are cleaned after each meal.
We can also keep them upright for a short time after meals.
If the food is still in the mouth, try to safely remove it. Always be patient and kind throughout.
Where can I seek help?
Treatment is dependent on whether you have a swallowing disorder of the mouth or throat (oropharyngeal dysphagia) or in your esophagus (esophageal dysphagia).
Oropharyngeal dysphagia
Your speech-language therapist will manage you through these:
- Swallowing therapy
You will be taught swallowing techniques, including how to position your mouth and body while swallowing. You will also learn exercises to strengthen your swallowing muscles and restimulate swallowing reflex nerves.
If you have a neurodegenerative disease like Alzheimer’s disease or Parkinson’s disease, your speech-language therapist might also introduce these exercises to help.
- Dietary changes
They are fully equipped to advise you on tweaks to your diet. A soft, moist diet while making sure you get all your nutrients in!
Feeding tubes can be used to provide nutrition while you’re recovering your ability to swallow. If your swallowing disorder is more severe, a feeding tube can better help prevent you from malnutrition and dehydration. It is also easier to take your medications.
There are two types:
- A nasogastric tube is passed down to your stomach from your nose. It is mostly for short-term use.
- A percutaneous endoscopic gastrostomy (PEG) tube is directly placed in your stomach. It is a better option for long-term use.
Esophageal dysphagia
- Medications
Corticosteroids can be used to treat eosinophilic esophagitis. Proton Pump Inhibitors (PPI) can relieve symptoms caused by GERD.
- Surgery
Surgery can relieve your symptoms caused by throat blockage or narrowing, GERD or esophageal cancer. A speech-language therapist will aid you in rehabilitation after surgery.
- Diet
Diet modifications will be made according to the degree and cause of your swallowing disorder.
- Botox
Achalasia is a disorder due to nerve damage, where the esophagus becomes tight and paralyzed, making it hard for food and liquids to be pushed into the stomach. Botox relaxes the tightened muscles. However, it only lasts for 6 months.
Aging is something to look forward to! It is the right of every Malaysian to have easy access to the best quality of healthcare. Do not wait until it is too late. Make an appointment here.
