What actions would you take to support someone with swallowing difficulties?

Although caring for someone with a swallowing disorder can be a rewarding experience, it also presents a unique set of challenges. Below are several strategies you can use to promote a safe, healthy, and fulfilling life for your loved one.

Maintain optimal nutrition and hydration.

For many patients with dysphagia, staying hydrated and getting enough calories, as well as vitamins and minerals, can be difficult[i].

To ensure your family member maintains proper nutrition and hydration, consult with a speech-language pathologist, dietitian, or healthcare professional trained in treating swallowing disorders to design a modified dysphagia diet. Such modified diets usually include thickened foods and liquids that are safer and easier for patients to chew and swallow.[ii]

While no two patients are alike, some foods such as yogurts and smoothies, soups, meatloaf, applesauce, soft fruits, and cooked vegetables can be easier for your family member to swallow and can deter dehydration. On the other hand, crusty breads, tough meats, and sticky foods like peanut butter are not recommended for those with swallowing difficulties.[iii]

Providing your loved one with thickened beverages that look and taste natural can also increase beverage consumption and prevent dehydration. Thick-It® Clear Advantage® ready-to-drink beverages offer those with dysphagia a variety of enjoyable beverage options – including coffee, tea, and juice varieties, in addition to water, which can be flavored to the patient’s choosing.

Promote safe feeding and swallowing techniques.

Dysphagia can increase the risk of aspiration; however, the following tips can help you optimize food intake and safety for your family member during mealtimes:[iv]

• Make sure your loved one is sitting in an upright position while eating and drinking by providing a sturdy chair that allows them to sit comfortably with their feet on the floor.
• Alternate between small bites and sips, encouraging your family member to eat slowly to prevent aspiration. Small bites can also give your loved one more control, reducing the possibility of the food slipping back into the throat before it is properly chewed.
• Ensure all foods and liquids are swallowed before feeding the next bite. Check the mouth to make sure there is no accumulation of food in the cavities of the cheek or on the tongue.
• Prior to feeding, ensure dentures are clean and well-fitted and that your loved one is maintaining good oral hygiene throughout the day. Poor oral health is one of the leading risk factors of aspiration pneumonia, a potentially life-threatening bacterial infection, in individuals with dysphagia.

Enhance quality of life.

To prevent aspiration, many patients with dysphagia must eat slowly and carefully, tilt or turn their heads in a certain direction while swallowing, and modify their diets by switching to soft or liquefied foods. When mealtimes become a burden, many people avoid eating with family and friends and stop going to restaurants, leading to social isolation and depression.[v]

As a caregiver, you can help instill confidence and a sense of independence in your loved one. Involving them in food preparation by including them in meal planning and shopping can raise their self-esteem. During the meal, you can help your family member remain independent while dining by providing adaptive eating tools, such as plates with large rims, cups with lids and wide bases, and non-slip placemats to keep dishes from moving on the table. If they are able, allow your loved one to fully participate in your family’s mealtime routine by letting them help clean up the kitchen.

Before eating out or attending a social gathering, plan ahead by calling the host or restaurant to make sure proper preparations are made for your family member. Taking steps to ensure a smooth outing can help reduce stress and anxiety for you and your loved one.

Are you a caregiver for a loved one with dysphagia? Help other caregivers by leaving your tips and strategies in the comments.

Pruitt, D. W., & Tsai, T. (2009). Common medical comorbidities associated with cerebral palsy. Physical Medicine and Rehabilitation Clinics of North America, 20(3), 453–467. https://doi.org/10.1016/j.pmr.2009.06.002

Coping with an ill loved one’s difficulty swallowing can be frustrating and frightening for everyone involved. Caring for someone we love means nurturing and nourishing them, but when the ability to offer pleasure through food is taken away, caregivers may end up feeling defeated.

Of course, that’s illogical, but when our best efforts result in an elder coughing or gagging, it’s hard to feel good about the care we provide. What we need to understand is that this is not our fault. Many diseases can cause swallowing issues. As caregivers, all we can do is learn as much as we can about our loved ones’ conditions and cope as well as we can.

Hospice personnel often work with patients who have dysphagia. Antoinette Ryba, RN, a patient advocate, care manager, and health coach with nearly a decade of hospice experience offers caregivers suggestions for recognizing symptoms of dysphagia and helping a senior eat safely.

What Is Dysphagia?

Difficulty swallowing is clinically known as dysphagia and occurs when one’s esophagus does not function properly. When a person with dysphagia eats or drinks, they cannot swallow correctly. This swallowing disorder causes discomfort, coughing, choking and even aspiration of food particles and saliva into the lungs, which can lead to a serious, potentially life-threatening infection.

What Causes Dysphagia?

Ryba explains that difficulty swallowing can occur for a variety of reasons, including multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD), stroke, and various forms of dementia. These conditions can affect the muscles and/or nerves involved in the process of swallowing. Other conditions can contribute to swallowing difficulties, such as gastroesophageal reflux disease (GERD) and growths in and around the esophagus.

Signs and Symptoms of Swallowing Difficulties

Knowing what to look for is imperative since dysphagia is common in seniors with Alzheimer’s disease and other types of dementia. Patients may not be capable of communicating discomfort or difficulties to their caregivers.

“There are recognizable, yet often subtle, signs and symptoms that indicate dysphagia. When these signs occur, it is important for caregivers to address them as soon as possible,” Ryba urges. “Treatment and management will depend on an official assessment called a ‘swallowing study,’ which is commonly performed by a speech-language pathologist (SLP).”

Signs of dysphagia include:

• Additional time and effort spent at meals
• Food, liquid or saliva leaking out of the mouth at any time
• “Cheeking” foods instead of swallowing them
• Gurgling sounds or voice during and after meals
• Frequent coughing, gagging or choking while eating
• Weight loss
• Dehydration
• Chest congestion
• Aspiration pneumonia

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The Connection Between Dysphagia and Dementia

In Alzheimer’s and dementia patients, some degree of difficulty swallowing will occur during the disease trajectory, and it is a common indicator of disease progression. “In this case, the cause is a loss of gag reflex and/or decrease in level of consciousness, which requires increased care and supervision,” explains Ryba.

Dementia progresses differently in each person, so it can be difficult to know what to expect and when. However, dysphagia often presents in late-stage dementia patients who tend to have difficulty communicating and may even be nonverbal. For this reason, dementia caregivers should watch carefully for any signs of swallowing issues. “Aspiration pneumonia is one of the most common causes of death in Alzheimer’s patients,” Ryba laments.

If swallowing issues present in the early or middle stages of dementia, a family member may misconstrue the subtle signs and assume that their loved one is acting out or does not enjoy the food they are being served. However, perseverance and encouragement can’t solve this dilemma. Undiagnosed and untreated dysphagia could jeopardize a dementia patient’s well-being.

Treatment for Dysphagia

The first thing to do is make a doctor’s appointment and see if a referral to a speech-language pathologist may be necessary. An SLP will run tests (such as a swallow study, if necessary) to assess the type and severity of a senior’s dysphagia and determine next steps for minimizing choking and preventing aspiration. Swallowing disorders are often managed through diet modification with a focus on texture and moisture levels.

The type of dysphagia diet an SLP prescribes will depend on the cause and extent of a senior’s swallowing difficulties. For some, a normal diet with emphasis on softer foods and smaller bites may be effective, while others may need their foods pureed and their liquids thickened to a certain consistency. Finding the right dysphagia diet requires the expertise of a speech-language pathologist, otherwise incorrect diet modifications can make eating and drinking with dysphagia more dangerous.

10 Ways to Make Meals Easier With Dysphagia

Family caregivers may grow impatient during meals as we sit and wait for each bite or sip to be swallowed. Handfeeding is one of the best approaches for those with more advanced dysphagia, but it can be especially trying. Ryba offers the following suggestions for facilitating mealtimes and promoting safe eating habits.

1. Carefully plan and serve meals, snacks and beverages that conform to an SLP’s prescribed dysphagia diet. Try thickening liquids with a commercial thickener (like Thick-It) or pureed fruit, such as apricots and prunes. Thickened liquids won’t trickle down the throat as readily as thin liquids and are less likely to cause coughing, choking and aspiration. Note that certain thicknesses are recommended depending on one’s ability to chew and swallow. Part of undergoing a professional assessment is determining what food texture is safest for your loved one.
2. Serve foods with thicker gravies, sauces or other condiments to add moisture that assists with swallowing.
3. Make ample time for meals to allow adequate chewing and complete swallowing.
4. Remove distractions at mealtimes to allow for full concentration on eating.
5. Use eye contact and encouragement with visual cues, such as opening/closing your mouth when the person is supposed to sip or bite.
6. Be cognizant of and alert to cues that indicate distraction, choking or food retained in the mouth.
7. Ensure your loved one is sitting as upright as possible while eating, not slumped forward or reclining.
8. Schedule meals for times of the day when your loved one is most alert and cooperative.
9. Try serving smaller, less intimidating portions. Some Alzheimer’s patients do better with finger foods than those that require utensils. Finger foods are less challenging to maneuver and allow dementia patients to tap into the automatic rhythms and movements they have used all their lives when eating.
10. Regardless of whether a loved one is still feeding themselves or you are helping them, mealtimes require lots of patience. Give them as much autonomy as possible and all the time they need to finish their meal. Let your loved one make choices and honor those choices—don’t be forceful. Let care and love show on your face rather than fleeting irritation at their slowness.

Struggling to Swallow and End-of-Life Care

In many instances, such as temporary difficulties that result from a stroke or prolonged intubation, working with an SLP who specializes in dysphagia can maintain or restore a person’s ability to eat and drink safely. Each patient is different, which is why a professional assessment is crucial for devising customized care and nutrition plans.

In other cases where dysphagia is related to a progressive neurodegenerative disease like Parkinson’s or Alzheimer’s, swallowing exercises, thickening agents and eating techniques recommended by speech-language pathologists will eventually lose their effectiveness. Sadly, as these conditions progress, so does the severity of swallowing difficulties. Put simply, seniors with late-stage dementia “forget” how to swallow, lose weight and become increasingly frail.

“Once dysphagia becomes so severe that swallowing is no longer possible, the disease may have progressed to the point of considering an evaluation for hospice care,” Ryba advises. “For example, weight loss and the inability to feed oneself and swallow are fundamental hospice criteria. An evaluation by a hospice professional would be appropriate to determine if end-of-life care is appropriate.”

Feeding tubes are often presented as an option for preventing dehydration and malnutrition in seniors with severe dysphagia, but this treatment option is an invasive one with limited success. For this reason, many seniors specify their preferences for life-prolonging treatments like tube feeding using written advance directives to guide their caregivers.

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