People may experience age-related changes, such as difficulty swallowing food as they age.
This condition is called dysphagia.
What is dysphagia? Can this affect the quality of life for elderlies? Is there a cure for this?
Today, we will be explaining what this condition is all about and what are the best ways to combat this condition.
What Is Elderly Dysphagia?
Dysphagia is a condition wherein older adults experience swallowing difficulties. This condition can happen in any of these phases of swallowing:
- Oral Dysphagia
- Esophageal Dysphagia
- Pharyngeal Dysphagia
Suppose a person is putting in the effort to swallow solid foods or is taking a considerable amount of time pushing thin liquids into their stomach. In that case, then it is highly likely that they have dysphagia.
While it can happen at any age, swallowing disorders like dysphagia is more common in older adults.
It has been estimated that around 20% to 25% of people aged 50 and beyond experience dysphagia.
Dysphagia management differs from one person to the other. Treatments and medication also differ on the cause.
Why You Should Be Concerned About Swallowing Difficulties
You should be concerned about swallowing difficulties as they can cause serious health problems for seniors.
When a person has dysphagia, they may experience some of these problems, including:
- Impaired swallowing
- Dry mouth
- Poor nutrition
- Weight loss
- Aspiration pneumonia – a common lung infection for elderly and nursing home residents with swallowing difficulties.
- It is one of the leading causes of death and hospitalization for people with dysphagia.
Elderly Difficulty Swallowing
Dysphagia affects almost 10% to 33% of older adults. They are more common in elderlies who have experienced neurodegenerative disorders such as Alzheimer’s and Parkinson’s.
Patients diagnosed with dysphagia can experience several health conditions, such as aspiration pneumonia, malnutrition, dehydration, and weight loss.
In addition, patients with dysphagia can experience long-term admission and an increased risk of mortality.
Physicians and providers can often detect which type of dysphagia a patient has by asking these questions.
- Do you have difficulties swallowing solids, liquids, and both?
- Do you have problems chewing?
- Describe the onset, frequency, and duration of symptoms
- What happens when you try to swallow?
- What are the associated symptoms?
Once these questions are answered, the doctor can request a fiberoptic endoscopic evaluation and a videofluoroscopic swallow study to assess the oropharyngeal dysphagia of the patient further.
However, if doctors and providers assess a patient with esophageal dysphagia, they would have to request esophagogastroduodenoscopy and barium esophagography for further assessment.
Treatments for oropharyngeal dysphagia often include behavioral changes, dietary modification, and oral care.
Rehabilitative interventions are also highly possible such as therapeutic oral trials and exercise.
Esophageal dysphagia is managed by addressing the underlying etiology. Further studies and assessments are needed to diagnose the condition and treat the specific disorder appropriately.
What Causes Dysphagia?
Several conditions can lead to swallowing disorders, especially as people grow older.
There are many possible causes for dysphagia, which is why it is important to have a doctor check up on you if you experience difficulty swallowing.
Common causes of dysphagia include:
- GERD (Gastroesophageal reflux disease)
- Cognitive disorders such as Multiple Sclerosis, Dementia, Alzheimer’s, and Parkinson’s disease can weaken the muscles involved in swallowing.
- Dry mouth
- Cancer of the esophagus, throat, or mouth
- Specific medications
- Poorly fitting dentures or bad teeth condition
In other cases, a neurologic examination is needed to evaluate what causes dysphagia.
What Are Other Swallowing Disorders to Consider?
Dysphagia is just one of the few swallowing disorders people might experience in their lives.
Here are some swallowing disorders to consider:
1. Esophageal Dysphagia (Esophagus Dysphagia)
Esophageal dysphagia is when a patient feels the food is getting stuck in the base of the throat. This happens after you’ve started to swallow.
There are also some causes of esophageal dysphagia, including:
- GERD. Gastroesophageal reflux disease is when your esophageal tissues are damaged due to stomach acid reflux, it can lead to scarring, spasming, and narrowing of the lower region of the esophagus.
- Achalasia. This condition causes the food to return to the throat when the lower esophageal sphincter doesn’t relax to let the food enter the stomach.
- Radiation therapy. This type of cancer treatment can lead to scarring and inflammation of the esophagus, which may lead to difficulties in the swallowing process.
2. Oropharyngeal Dysphagia (Mouth and Throat Dysphagia)
The swallowing and eating process is a complex process. Specific conditions make it difficult to transport food to the stomach through the esophagus and throat.
People with oropharyngeal dysphagia often tend to choke, gag, or cough when they try to swallow their food. Causes of oropharyngeal dysphagia include:
- Pharyngoesophageal Diverticulum. A small pouch above the esophagus collects food and particles in the throat. It can lead to repeated gagging, difficulty swallowing, bad breath, and coughing or clearing.
- Cancer. Specific cancers can lead to difficulty swallowing. Cancer treatments such as radiation therapy can also lead to dysphagia.
- Neurological Damage. Certain neurological damage, such as spinal or brain injury, or stroke, can affect a person’s ability to swallow.
- Neurological Disorders. Certain health conditions, such as multiple sclerosis, Parkinson’s disease, and muscular dystrophy, can cause dysphagia.
Elderly Swallowing Issues
Older adults tend to experience difficulty swallowing due to several factors, such as wear and tear on the esophagus, normal aging, and when a person experiences problems with their central nervous system.
In the mouth, elderlies can experience age-related changes such as an impaired sense of taste and smell.
In addition, there is also a weakness in the contraction due to reduced muscle mass that leads to poor tongue functions and strength, as well as the jaw, velum, and lips.
All these changes can affect how elderlies swallow. It can affect how fluids and food particles are transported from the mouth into the stomach via the esophagus and pharynx.
What Are the Signs and Symptoms of Dysphagia?
Dysphagia is the medical term for older adults and patients who experience swallowing difficulty.
Some people might experience difficulty swallowing food, whereas others can’t swallow. But dysphagia is more common in older adults, especially those with acid reflux.
Here are some of the signs and symptoms of dysphagia:
- Swallowing difficulty when eating or drinking
- persistent drooling of saliva
- trouble chewing food
- A feeling that food is stuck in your chest or throat
- the wet-sounding voice when drinking or eating
Over time, if dysphagia isn’t addressed, it can cause symptoms of weight loss, recurring chest infections, and many more.
Risks When Someone Has a Swallowing Difficulty
Older adults are at higher risk when dysphagia isn’t properly treated or detected at an early stage. Sometimes, it can lead to further problems.
Aspiration pneumonia is one of the more common risks if a person has difficulty swallowing.
It can occur when someone accidentally inhales something, such as small food particles.
Signs of aspiration pneumonia:
- Hard time breathing
- a gurgly voice when drinking or eating
- coughing while drinking or eating
If you know someone with dysphagia and are currently experiencing these symptoms, it may be best to seek immediate help.
Elderly Can’t Swallow
Even healthy older adults can experience difficulty swallowing or can’t swallow at all.
They experience changes in the swallowing mechanism’s structure, innervation, and physiology.
How Can You Do Proper Dysphagia Management?
If a person has difficulty swallowing, ask for immediate help from a professional.
Also, there are some things you can properly do to manage dysphagia, including:
- Limiting alcohol and caffeine intake. Drinking caffeine and alcohol can dry your mouth and throat, making it difficult to swallow.
- Try foods with different textures to see if they cause more problems. Avoid foods that can cause you problems with swallowing. Juice and coffee are a problem for patients with dysphagia.
- Change in diet. You can try eating smaller portions of meals but in a systematic manner. Cut your food into smaller chunks or pieces, and try eating slowly. This method can help you swallow safely and effectively.
How Can You Treat and Prevent Dysphagia?
Certain swallowing problems can be managed; however, treatment varies on what type of dysphagia you have.
Treatment is based on the underlying pathology you have. If you have oropharyngeal dysphagia, you have problems within your throat and mouth, whereas esophageal dysphagia is in the esophagus.
In addition, the cause of dysphagia is considered when deciding about dysphagia care treatment.
In some cases, treating the underlying cause can help with dysphagia, such as mouth cancer and oesophageal cancer, which can help a person relieve swallowing problems.
Treatment of both dysphagias can be managed by a group of specialized doctors that may include speech-language pathologists, a surgeon, and a dietitian.
Oropharyngeal Dysphagia Treatments
Treating this type of swallowing disorder can be difficult if it affects the nervous system, as these health conditions can’t be corrected via neck surgery or medication.
There are three ways you can treat oropharyngeal dysphagia. This include:
- Swallowing therapy
- Feeding tubes
- Dietary changes
1. Swallowing Therapy
Speech-language pathologists do this therapy for the aging population and nursing home residents with swallowing complaints and difficulties.
They are professionals who use a wide range of techniques for people who have trouble chewing, swallowing, and eating. SLPs can also teach patients swallowing exercises to improve swallow function.
2. Dietary Changes
Patients are often referred to a dietitian to give them a healthy and balanced diet.
They can prescribe softer foods and fluids that are easier to swallow. They also ensure you get the proper amount of vitamins and nutrients in your meals.
3. Feeding Tubes
If you’ve undergone neck surgery and have difficulty swallowing, a doctor may advise you to be fed on a feeding tube while you recover.
In addition, people with severe dysphagia are also placed on feeding tubes to reduce the risk of dehydration and malnutrition.
A feeding tube can also make life easier for patients swallowing their medication.
Oesophageal Dysphagia Treatments
This dysphagia relates to difficulties in swallowing because of problems with the esophagus.
It may be possible to treat this type of dysphagia with various medications. One medication that is proven to be effective is using proton-pump inhibitors.
This type of medication is used to treat indigestion. It can dramatically improve symptoms caused by scarring or narrowing of the esophagus, known as a peptic stricture.
Botox is one of the more effective treatments for Achalasia. It can help paralyze the tightened muscles that prevent food particles from entering the stomach.
While this treatment is proven effective, its effects can only last up to six months. However, it is beneficial if you have severe Achalasia and are having difficulties swallowing.
If all medication fails, surgery is the last resort to treat all types of swallowing disorders.
Endoscopic dilatation is one of the common surgeries done for patients with dysphagia. It can help stretch out the esophagus that has scar tissue.
Endoscopy is done when a balloon or a bougie is inserted into the narrowed portion of the esophagus.
This balloon or bougie is then inflated to widen the narrowed part of the esophagus before being deflated.
But, this procedure has risks to it. It can either cause perforations in your esophagus or cause a tear in its surrounding parts. This procedure can help ease up the swallowing process for patients.
4. Stent Insertion
When you have esophageal cancer, and the tumor can’t be removed, inserting a stent is another treatment for dysphagia.
The stent is like a metal mesh tube inserted in the esophagus during X-ray guidance or endoscopy.
This stent serves as a pathway for food particles to enter the stomach. However, you must follow a particular diet to keep this pathway unblocked.
Risk Factors of Dysphagia in Patients
The common risk factors associated with dysphagia include:
Dysphagia risk factors:
- Alcohol and caffeine intake
- Hiatal hernia
- Normal aging
- Weight loss
Activities That Can Relieve Pain From Dysphagia
Here are some activities you can do if you have a difficult time swallowing:
Swallow Test for the Elderly
A swallow test for the elderly is an examination to check whether you have dysphagia or not. When dysphagia isn’t detected at an early stage, it may lead to more serious conditions.
One of the most common swallow tests to check if a patient has dysphagia is a videofluoroscopic swallowing study, more commonly known as the modified barium swallow.
This test remains best as it can guide the patient’s management if diagnosed with dysphagia.
In addition, this swallow assessment tests whether a patient has oropharyngeal dysphagia as it provides information on the four categories of swallowing dysfunction.
The four critical categories for assessing whether a patient has dysphagia via this test are as follows:
- aspiration or ingestate
- nasopharyngeal regurgitation
- excessive delay or inability to initiate pharyngeal swallowing
- the residue of the ingestate around the pharyngeal cavity upon swallowing
In simpler terms, this test tests your ability to swallow effectively and safely. It also tells whether you have normal swallowing physiology or not.
On the other hand, a barium swallow test is different as it checks on the propulsion of liquids from the esophagus and into the stomach.
This non-invasive treatment also lets you know what type of food and fluids you can safely eat without experiencing difficulty swallowing.
Shaker Exercise for Dysphagia
Commonly known as the head lift technique, the shaker exercise is a method for people with dysphagia showing a reduced anterior and superior movement of the hyolaryngeal complex, the larynx, and the hyoid.
When the larynx and hyoid are not lifting and moving forward into the upper esophageal sphincter opening, it can result in the pyriform sinus, which patients are at risk if they are to aspirate this material.
Shaker exercise works by lying in a prone position on the bed or mat. You slowly lift your head, looking at your toes.
The goal is to maintain this position for a minute or two and in two more repetitions.
The second part of this exercise is a repetitive movement in which the patient is doing the same position. This time, they are looking at their chin instead of their toes.
They then lower their head onto the bed or mat and repeat the process 30 times. The goal of this exercise is to repeat it 30 times for 3 sets.
In addition, therapists can also recommend swallowing maneuvers such as the effortful swallow technique and Mendelson maneuvers for patients with dysphagia.
Frequently Asked Questions (FAQs)
If you have further questions about swallowing problems and difficulty, you might find them below.
What Foods Should You Avoid With Dysphagia?
After your doctor has assessed your swallowing mechanism, they may recommend specific types of food to help you with your swallowing difficulty and trouble chewing.
Foods to avoid:
- Non-pureed vegetables
- Chewy candies, nuts, and seeds
- Non-pureed potatoes, rice, or pasta
- Cookies, pastries, or cakes
- Any cereal with lumps
- Non-pureed bread
- A whole fruit of any kind
- Non-pureed soup
- Fried, boiled, scrambled egg
Always follow your doctor’s recommendation for the food you are allowed to eat.
Will Dysphagia Go Away?
While treatments can help improve dysphagia, a cure isn’t always possible.
Some types of dysphagia can be temporary and treated with certain medications, whereas some might be chronic or lifelong.
It is one of the reasons why you should consult a doctor if you’re experiencing difficulty swallowing.
When dysphagia is detected early, treatments and medications are more likely to be more effective and won’t further complicate health.
How Should Dysphagia Guidance in Older Adults Differ?
They should differ by establishing optimal practice patterns. It is best to differentiate what dysphagia the patient has to achieve the best clinical practice.
Almost 50% of older patients who don’t report swallowing impediments have swallowing impairment. As a result, they are at risk of silent aspiration.
Older adults have various age-related changes that are irreversible, which means a different approach might be necessary to guide older adults with dysphagia.
What Is the Physiology of Swallowing Normally?
The normal physiology of swallowing is also referred to as deglutition. It involves substances such as food particles and fluids passing through the mouth (oral cavity) into the stomach via the esophagus and pharynx.
After the initiation of swallowing, the food (bolus) should take around one second to reach the stomach. It takes another 10 to 15 seconds for the swallow to be completed.
There are three phases to conventional swallowing, oral, pharyngeal, and esophageal.
- The oral phase prepares food to be transported from the mouth into the pharynx.
- The pharyngeal phase involves sealing the airway as the bolus passes through the pharynx and into the esophagus.
- The last stage is the esophageal phase, wherein the bolus is transported from the pharynx that is propelled to the stomach in coordination with the relaxation of the lower esophageal sphincter and esophageal peristalsis.
When to Seek Medical Attention for Dysphagia?
The first moment you experience difficulties in swallowing or feel like a portion of food is stuck in your throat, and this should be a telltale sign that you should seek medical attention.
It is highly recommended that the doctor determine the cause of your swallowing problems.
In addition, if you are experiencing sudden muscle weakness and can’t swallow, you should visit your nearest hospital to address the situation.
Regardless of what dysphagia an elderly has, it has to be properly diagnosed to make the treatment more effective.
As we’ve already laid out for you, there are different swallowing disorders, each of which can pose serious risks to elderlies.
It is important to detect this condition as early as possible to avoid complications and certain conditions that may already aggravate a serious situation.