Swallowing Problems Are A Problem

When you give your father juice, do you hold your breath waiting to see if it goes down the right pipe? When he eats a sandwich, are you on the edge of your seat ready to perform the Heimlich maneuver?

When you sit down to dinner with your mother, do you wonder why she constantly clears her throat? Are you forever looking at a clock because meals take so long?  Do you wonder how your loved one can possibly be getting enough food or liquid to survive?

If you have had any of these concerns, your loved one may have a swallowing problem, which may potentially be serious.


Common and Often Overlooked

Many people know about the dangers of falling in the elderly. Did you know that swallowing problems are another major threat to the elderly? They, too, account for tens of thousands of deaths in the U.S. every year. Even more, perhaps, than falls.


Problems Resulting In Death:

  • Choking, a blockage of the airway, takes nearly four thousand lives.
  • Aspiration of food, liquid, or bacteria-laden material from the mouth into the lungs causes fatal pneumonia in tens of thousands.
  • Malnutrition resulting from swallowing problems causes weakness and susceptibility to infection, which hasten the death of thousands more.

Clues to Look For:

  1. Frequent throat clearing
  2. A runny nose while eating
  3. Meals that take forever


It’s Not Just the Elderly

You don’t have to be 65 or older to have a swallowing problem. People with a wide variety of medical and neurological disorders are vulnerable. These disorders include stroke, multiple sclerosis, cancer, ALS, myasthenia gravis, head injury, congestive heart failure, and COPD.


Some Typical Scenarios:

• A 49-year-old man with multiple sclerosis was able to chew. But after he swallowed, some food remained in his throat. It was sucked into his airway, and, because his cough was so weak, the material made its way to his lungs to cause pneumonia.

• A 56-year-old woman treated for salivary gland cancer had an extremely dry mouth and painful sores inside her cheeks. Chewing was painful and made eating unpleasant, leaving her feeling drained physically and emotionally.

• A 64-yeaar-old woman with a recent stroke had difficulty drinking liquids. They caused fits of coughing that brought tears to her eyes. A bout of pneumonia put her back into the hospital and delayed her neurological recovery.


And When It Is About the Elderly:

• A 72-year-old man with Parkinson’s disease did everything slowly. That included swallowing. Food often got stuck in his throat and caused him to cough and gag.

• An 82-year-old man with Alzheimer’s was extremely distractible and could no longer use a fork or spoon. He had also “forgotten” what to do with food one it was in his mouth. A single swallow could take three minutes or longer. Not surprisingly, he frequently became dehydrated.


Swallowing Complaints

  1.  The food doesn’t go down.
  2. I have to swallow more than once.
  3. My nose runs at mealtimes.
  4.  Pills get stuck in my throat.
  5.  I cough when I drink water.
  6. The food falls out of my mouth.
  7. I have a hard time eating steak.
  8. When I swallow, juice goes up my nose.
  9. It hurts when I swallow.”
  10. I’m afraid I’m going to choke.
  11. My voice sounds funny after I eat.
  12. I get so tired, I can’t finish a meal.
  13. What do you expect? I’m old.

Sometimes, however, a person has no complaint at all – but a very real problem with swallowing.


Why Swallowing Becomes A Problem

To understand how things can go wrong with swallowing, let’s look at normal swallowing. Swallowing is a process, a set of steps that takes food (or liquid or pills) from mouth to stomach.

1.      CHEWING (which, of course, does not apply to liquids.) The tongue, lips, cheeks, jaw and teeth work together to reduce food to a pasty ball. Saliva plays a key role. It glues together the ground-up food, gathering up flaky bits so they don’t tickle your throat or get sucked into your lungs.

When jaw muscles are weak, teeth are missing, or dentures are loose or painful, chewing will be impaired. That can set the stage for a choking emergency.

2.      TRANSPORTING the food from mouth to throat. The tongue acts like a bucket without a handle. Cancer surgery, neurological disorders (such as stroke, MS, ALS, or Parkinson’s disease), or dehydration can interfere with moving the food along.

3.      SWALLOWING This is a reflex triggered by food or liquid getting to where the tonsils are (or used to be). Several things happen pretty much at once to make sure food goes into the esophagus, not into the windpipe. When muscles are weak (as with muscular dystrophy or myasthenia gravis) or nerve signals are scrambled or absent (as with stroke, MS, or ALS,) the reflex cannot provide for safe swallowing.

4.      THE ESOPHAGUS.  Muscles at its beginning and end are like traffic cops. One-way travel only! Otherwise, you pay the price with heartburn, bad breath, or worse.  Connective tissue disorders like scleroderma can constrict the esophagus and prevent proper movement of food or liquid. Chronic reflux of acidic stomach contents (as with GERD) can irritate the lining of the esophagus and cause it to stick together, preventing food from getting to the stomach.


Watch Out for Dehydration and Medication

Dehydration can cause swallowing problems by reducing the supply of saliva. Food sticks to the throat so leftover material can get sucked into the lungs after the swallow. Pills can attach to the esophagus and burn its lining. Diuretic medications can cause or contribute to dehydration. Anticholinergic drugs (such as diphenhydramine, amitriptyline, or ipratropium) cut down on saliva formation to interfere with swallowing or any phase of the process.


When To Take Action

Gather together your observations, questions, and concerns and get them to your loved one’s primary medical provider. If things worsen at any time, such as increased difficulty swallowing, threatened dehydration, labored breathing, or progressive weakness, seek medical attention at once.


And Just A Little More to Swallow:

Give yourself a pat on the back for learning about an important subject that receives little attention, yet can be life threatening. Ignoring a swallowing problem can be disastrous. Now that you have a plan, don’t hesitate to use it.


Lois Young-Tulin

Lois Young-Tulin, PhD, is an Assistant Geriatric Care Manager at Complete Care Strategies