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Swallowing difficulty

Eating is a human basic need. It also makes us content and happy. However, some elderly may face swallowing difficulty. The food cannot be safely delivered from the mouth to the stomach, and the elderly cannot obtain sufficient nourishment.

In the United States, around 10,000 die due to suffocation every year. Among stroke patients, about 20-40% would have swallowing difficulty (dysphagia).

Swallowing difficulty is not rare and must be managed to prevent serious complications.

Symptoms and Consequences of Swallowing Difficulty

  • Coughing or choking while/ after eating or drinking
  • The need to repeat the swallowing movement several times
  • Nocturnal awakening due to choking from saliva
  • Food remaining in mouth after eating, causing bad breath
  • Drooling due to decreased control of mouth muscles
  • Aspiration pneumonia
  • Malnutrition and dehydration (weight loss, dry skin)
  • Food impacted at the throat

Signs of suffocation

  • Hands held around the neck, unable to talk or obvious breathing difficulty
  • Face or neck colour turning blue
  • Loss of consciousness

Factors causing Swallowing Difficulty

  • Too rapid eating/ swallowing
  • Ill-fitted denture affecting chewing process
  • Inappropriate food texture e.g. too hard, too large, slippery or sticky
  • Poor positioning: eating in the lying position increases the risk of choking
  • Distraction

Practical tips for patients with swallowing difficulty:

  • Avoid eating when not fully conscious e.g. just awakening from sleep
  • Reduce environmental distraction
  • Select nutrient-rich food to improve nutritional status
  • Select food with appropriate texture e.g. purees, thick (creamed soup) or semi-thick liquids (pureed fruit juices)
  • Select appropriate utensils or feeding modules e.g. small straw, small spoon, enlarged-handle spoon, adapted chopsticks, scoop bowl, etc
  • Keep proper positioning (i.e. upright sitting, head in upright position and not tilted backwards)
  • Oral-motor exercises can strengthen muscles and improve closure during swallowing, seek the advice from a physiotherapist , occupational therapist , speech therapist or other appropriate health prefessionals.