Trouble Swallowing? Read This

When the Meal Won’t Go Down
By PAULA SPAN
When an older person regularly gags or chokes in the middle of a meal, it’s obvious that there’s a problem. But what of the more subtle symptoms of trouble while eating?

Say your father gets a runny nose or weepy eyes during meals, or clears his throat repeatedly, or develops a voice that sounds kind of gargle-y. Perhaps your mother takes forever to down a few bites or appears to lose interest in eating altogether. We’re less apt to recognize those signs, but they can be tip-offs to swallowing problems.

Swallowing, I’m learning, is a surprisingly intricate business, involving a number of neurological signals, physical processes and coordinated timing. We unthinkingly do it hundreds of times a day, yet “we don’t know how complicated it is until things go wrong,” said Janet Brown of the American Speech-Language-Hearing Association.

How often is that? The prevalence of swallowing disorders, medically known as dysphagia, varies from about 15 percent of elders living independently to more than 40 percent of those in assisted living and nursing homes, estimated a 2002 editorial in The Journal of Rehabilitation Research and Development by Dr. JoAnne Robbins, a professor of medicine at the University of Wisconsin.

Sometimes swallowing problems are related to illnesses like Parkinson’s, stroke, heart failure or pulmonary disease. Sometimes people simply get dehydrated and don’t produce enough saliva. Even the decreased sense of smell that can accompany aging or dementia can be a factor.

“If you can’t smell food, then there’s no signal to the body and the saliva won’t be triggered,” said Dr. Joel Herskowitz, a pediatric neurologist in Framingham, Mass. (He and his wife Roya Sayadi, a speech pathologist, will self-publish a guidebook this summer called “Swallow Safely.”)

Then there are the multiple drugs that most older people take (this is becoming a persistent theme here, isn’t it?). “Medication is a major cause in reducing the moisture in the body, and it affects the way our muscles respond,” Dr. Sayadi pointed out. Drugs from antihistamines to antipsychotics can interfere with swallowing.

When people can’t swallow properly, they’re at risk — not only from the immediate threat of choking on food, but also from the longer-term hazard of pneumonia caused by aspirating liquids, food particles and bacteria into the lungs. And it’s no surprise that those who can’t swallow risk becoming malnourished.

Speech pathologists — or speech-language pathologists, as they prefer to call themselves these days — have an arsenal of techniques and adaptations to address such problems. They may recommend physical maneuvers, like doing exercises that strengthen the tongue and pharynx muscles, or adjusting the position of one’s chin when swallowing. They may suggest modifying one’s diet with thickened liquids or puréed foods.

The variety of swallowing issues and treatments is too wide for a single blog post, but let me recommend the information on the American Speech-Language-Hearing Association Web site.

And Dr. Herskowitz and Dr. Sayadi have come up with another useful tool. They’ve drafted a letter that a caregiver — or patient — can print out, fill in and bring to a doctor’s appointment. It includes not only a variety of symptoms that might indicate trouble, but also a list of medications someone’s taking, and family contact information.

“People are observing things at home,” Dr. Herskowitz said. “This allows them to record what they’re seeing, whether it’s unexplained weight loss or frequent throat-clearing or a change in voice, and put the information in the hands of a primary care physician. Then the doctor can arrange for assessment and referral, and prevent a small problem from becoming more serious.”

For more information contact Senior Solutions at (954) 456-8984 or toll free at 1-800-213-3524