Dysphagia: Swallowing Difficulties As We Age

ARTICLE TO BE ATTRIBUTED TO SPEECH THERAPY, NG TENG FONG GENERAL HOSPITAL

Swallowing difficulties, a condition known as dysphagia, do more than take away the pleasure of eating – it can lead to malnutrition, increase the risk of choking and even lead to pneumonia.

Dysphagia is a growing health concern in an ageing population. The incidence of dysphagia in the elderly is likely to have a significant impact on the cost of healthcare as well as the quality of life. 

Dysphagia in Elderly: A Growing Concern

Some studies indicate that about 15 percent of the elderly population is affected by dysphagia. One reason is that as we age, the mechanics of how we swallow change. 

As with other muscles in our body, the muscles involved with swallowing also decrease in strength and mobility as we age. This can lead to difficulties chewing, moving the food around our mouths and transferring food to our stomach.

These changes often happen slowly, so there is usually time for healthy people to adapt and continue to swallow safely.

However, over time the subtle but accumulative changes in swallowing function can contribute to an increased risk of food and fluids entering the ‘wrong pipe’ – into the airway instead of the food pipe or oesophagus.

Dysphagia risk is also higher in those with diseases associated with old age, such as dementia, stroke and Parkinson’s disease, as does being on multiple medications.

Related: Dysphagia

How Do You Swallow Food?

Many muscles work together to prevent food or water from entering the nose or lungs when you eat or drink. When the muscles involved in swallowing become weak or uncoordinated, food or liquid can enter the wrong 'pipes' and cause choking.

Signs of Dysphagia

• Difficulty constricting the throat to swallow food or liquids
  
• Feeling a "lump" of food or liquid stuck in the throat or chest
  
• Choking or coughing when swallowing
  
• Food or fluid "coming back up" through the throat, mouth or nose after swallowing
• Pain when swallowing
  
• Feeling pain or pressure in the chest when eating
• Weight loss due to the inability to swallow

Related: Good Oral Care for Patients

Therapy and Treatment for Dysphagia

Dysphagia can diminish the joy of eating because of the fear of choking and the blandness of mushy texture modified food. To increase the appeal and nutritional quality of meals, serve a variety of brightly coloured foods that have been pureed, mashed, minced or thickened.​

Management of swallowing impairment is a team effort with a speech therapist playing a central role.

Intervention for swallowing difficulties can be either compensatory or be a more intense rehabilitation.

​Compensation techniques focus on the implementation of techniques that are meant to improve the safety and efficiency of a person’s ability to swallow food. These include changes to posture during feeding, positioning food differently in the mouth and diet and fluid modifications (e.g., thickening fluids to make them easier to swallow). It may also include the use of alternative feeding such as a feeding tube to meet nutritional needs.

Rehabilitation techniques focus on improving the physiology that is impaired in the swallow. Most of these techniques involve a form of exercise that trains the muscles to improve swallowing function and minimise or prevent dysphagia-related conditions.

Getting treatment for dysphagia is important to prevent not only nutritional deficiencies but also stave off related conditions such as pneumonia (caused when food particles enter the lungs and cause infection).

Early intervention to improve swallowing also goes beyond just functional benefits – it improves patients’ enjoyment of food and life.

Read the original article here.

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