Eating is a human basic need. It also makes us satisfied and contented. However, some elderly persons may have swallowing difficulty. In such cases, the food cannot be safely delivered from the mouth to the gastrointestinal system which affects the absorption of nutrition and fluid. Swallowing difficulty must be managed as it can lead to choking or aspiration pneumonia in severe cases.

Symptoms and Consequences of Swallowing Difficulty

• Coughing or choking while/ after eating or drinking
• The need to repeat “swallowing” several times
• Nocturnal awakening due to coughing
• Backflow of food into nose
• Food remaining in mouth after eating, causing bad breath
• Drooling due to decreased control of oral muscles
• Ways to assist feeding: the elderly persons change their eating habits due to difficulty swallowing. For example, they are more likely to eat porridge or softer food, or add soup or water to the rice.
• Food impacted at the throat
• Reflux of food

If severe, it can lead to:

• Aspiration pneumonia
• Tracheal obstruction and suffocation
• Malnutrition and dehydration (weight loss, dry skin)

Signs of Suffocation

• Hands held around the neck, unable to speak or with obvious breathing difficulty
• Engorged face and neck veins, lips turning blue, loss of consciousness in severe cases

Risk Factors for Swallowing Difficulty/ Choking

• Chronic diseases, especially neurological diseases such as stroke, Parkinson's disease, dementia, etc.
• Eating too quickly
• Elderly with impaired chewing or swallowing abilities, e.g. dental problems, ill-fitting denture, etc.
• Inappropriate food texture e.g. too firm, too hard, too large, too slippery, too chewy or sticky
• Improper positioning: eating in a lying position
• Distraction during eating

Practical Tips for Reducing Risk of Choking in Elderly:

Tip 1: Characteristics of food

Consistency

• Avoid thick pastes (e.g. peanut butter)
• Take care when drinking fluid like water, tea or juice; take it sip by sip
• Thickener could be added to liquid for elderly persons with choking risk according to the advice of doctors and speech therapists

Texture

• Avoid small foods that are too hard or chewy (e.g. peanuts, nuts and melon seeds)
• Avoid hard-to-chew, sticky, and compressible foods (e.g. glutinous rice cakes, marshmallows)
• Avoid foods that are small, too firm or too chewy to break apart (e.g. konjac jellies)
• Avoid crumbly foods (e.g. egg rolls)
• Foods with mixed texture, such as noodles or rice in soup, could pose higher choking risk due to different flow rate after entering the throat. Elderly persons should eat these foods slowly

Shape

• Avoid small round/ oval-shaped foods (e.g. fish balls, beef balls, grapes)

Portion

• Do not put too much foods into the mouth each time
• Use a smaller spoon when eating
• Cut large food items into smaller pieces

Tip 2: Eating posture

• The height of chair and table should be appropriate
• Sit upright with the chin down. Do not eat while lying down

Tip 3: Eating environment

• The environment should be well-lit, tidy and quiet
• Avoid talking while eating
• Stay focused. Do not watch TV or read newspaper while eating
• Put on glasses and properly-fitting denture if needed
• Allow sufficient time for eating. Do not rush
• If choking occurs, stop eating and try to cough out the food immediately

Elderly persons may have different degrees of swallowing difficulty. Please seek advice from healthcare professionals for their further assessment. If frequent choking is observed, please seek medical advice as soon as possible.