Swallowing disorders

Trainee : What might be the difficulties that make swallowing so hard for elderly people ?

Nurse : The swallowing impairments, also called dysphagia, refer to the difficulty initiating the swallow reflex and impaired transfer of food and fluid from the pharynx into the esophagus. Difficulty in swallowing can be also related to the absence of dentition due to old age.

Trainee : Are all old people subject to this problem?

Nurse : Generally, only those who have had health complications such as stroke, dementia or Parkinson’s disease can have high rates of dysphagia.

Trainee : How can we recognize signs or symptoms of swallowing disorders ?

Nurse : Elderly patients suffering from dsyphagia usually show signs of choking, coughing during or after eating or drinking. They may need extra effort to chew and swallow, be reluctant to eat in public or can misinterpret the severity of their medical condition. You should also be vigilant about weight loss which can indicate some difficulty to eat.

Trainee : What are the care or management principles I should implement ?

Nurse : It depends on the patient’s condition. For example, dysphagia resulting from stroke is temporary in most of the cases. However, dysphagia in patients suffering from dementia or Parkinson’s disease will be progressive and need a palliative care approach. In any case, you should consider treating the underlying symptoms, adapting the diet to the patient’s condition and considering swallowing rehabilitation.

Trainee : I don’t get it. Can you be more specific ?

Nurse : Diets should be modified according to the swallowing ability of a patient. For example, we can consider adjusting the texture of food and give either thickened fluids that are more nourishing or nutritional supplements. The taste and temperature of food are also important.

Trainee : What about the swallowing rehabilitation ?

Nurse : There are both direct and indirect strategies to improve swallowing and prevent complications. We can include fluid and diet modification, but also make sure that the patients are sitting up right, that their environment is free of distractions, that they are not rushed and that the amount of food per mouthful is not excessive. We can also consider oral and pharyngeal musculature exercises that can help avoid regurgitation. Or simply ask the patient to sit with the head up right for fifteen minutes after the meal. Some hospitals and care facilities also recommend finger foods.

Trainee : What’s that about ?

Nurse : Finger food menus are specifically made to enhance Alzheimer patients’ autonomy as they may not be able to use cutlery. This consists in elaborating menus using meatballs, fritters, finger or cube-shaped food. Finger food can also help them rediscover the pleasure of eating on their own.

Trainee : Thanks for the explanations !