Imagine sitting down for a meal and being unable to eat without choking on your food.
Or living with the risk of inhaling your drink, which could end up making you seriously ill – or worse.
Dysphagia is the medical term used to describe the difficulty some people have with swallowing.
According to Speech Pathology Australia, around one million Australians currently experience dysphagia.
And around 50 per cent of people in aged care live with the condition.
“It’s one of those things that people who are caring for older people will come across but won’t necessarily know what it is,” says speech pathologist Natalie O’Brien.
What is dysphagia?
Humans swallow up to 900 times a day on average.
When we do, we use 26 different muscles, several nerves and a series of internal pumps and valves to move food and drink from our mouth to the stomach.
For example, in our throat, a tube branches in two directions – one that leads to our stomach, while the other leads to our voice box and lungs and is used for breathing.
It’s a sophisticated system, particularly the epiglottis, the movable flap near the base of the throat that keeps food and liquids from going down the windpipe.
But when this system doesn’t work as well as it should, there are many associated risks.
According to Ms O’Brien, who recently appeared on Maggie Beer’s Big Mission for ABC TV, dysphagia is not a disease.
“It’s often a symptom of a neurological diagnosis such as dementia, motor neurone disease, Parkinson’s disease and multiple sclerosis, or part of the ageing process.”
“It’s also a very common occurrence after a stroke.”
Dysphagia can impact children too, often the result of a neurological event in utero or early in life.
And it can also be a result of anatomical causes.
“If you’ve had head and neck cancer and you had to have part of your tongue removed, for example, then that would obviously cause some dysphagia as well,” Ms O’Brien says.
The signs of dysphagia
There are a number of symptoms that can signal that a person could have dysphagia. These include:
- regular coughing during mealtimes
- choking or experiencing a choking feeling while eating or drinking
- ‘wet’ or gurgly voice, which can often mean fluid is sitting on the vocal chords
- considerable effort or pain when swallowing
- food or drink coming up and out of the nose
- difficulty swallowing medication
- feeling as if something is stuck in the throat.
If dysphagia is suspected, a visit to the GP should be arranged for a referral to either a specialist or a speech pathologist.
The risks of dysphagia
Ms O’Brien says there is a difference between an older person who has begun to slow their chewing and someone who is struggling to swallow their food.
“When we’re looking at dysphagia, we look at what’s going on for that person. How are they functionally impaired? And then what can we do to reduce the impact of that for them?” she says.
In other words, howsafe it is for that person when they eat or drink?
There are some significant risks associated with dysphagia.
For example, aspiration can occur when food, fluid or saliva ends up in the lungs instead of the stomach.
“Because it’s not meant to be there, our body essentially tries to fight it. We can grow bacteria as a result of that and we end up with aspiration pneumonia. Just like any pneumonia, aspiration pneumonia can be life threatening, particularly to our older or our vulnerable people,” Ms O’Brien says.
Choking can also occur when food or drink obstructs the airwaves and hinders airflow.
“That’s a medical emergency. Choking can lead to death or can lead to lifelong complications as well,” Ms O’Brien says.
“Aspiration and choking however are not mutually exclusive. You can aspirate as you choke so it’s possible to have a choking emergency and then 24 hours later develop aspiration pneumonia.”
Dysphagia can also lead to dehydration and malnutrition.
“When people have swallowing problems, they tend to start to eat and drink less because it’s harder for them.”
How can you treat dysphagia?
There are a number of strategies that can help people cope with dysphagia.
For example, swallow rehabilitation done by a speech pathologist can help improve someone’s swallow function. Although the person needs a reasonable amount of cognition for this to be successful, making it an ineffective option for some dementia patients.
Safe swallowing strategies include ensuring the person is sitting upright when eating and drinking, to allow gravity to do some of the work.
“If you’re lying backwards, it’s got a much harder pathway to travel to get down into the stomach. It’s much more likely something will go wrong,” Ms O’Brien says.
Also taking one sip at a time makes it more likely that muscles will be able to control that sip, rather than the much more complex action of consecutive sips.
There’s also the option to modify food and drink to make it easier to consume.
“We make sure that the texture of their food and drink is meeting both their safety and quality of life requirements. So we can do things like thicken their drinks, which can improve the safety of their swallow,” Ms O’Brien says.
Carers could also introduce finger food, because the action of holding food and knowing food is coming can help those who have dysphagia to better control their swallow. But it’s not a safe option for some and shouldn’t be offered unless a safety assessment has been done by a speech pathologist.
Finally bread should be reconsidered, as it can be a complex item of food for someone with dysphagia.
“Bread is one of the biggest reasons people choke in residential care facilities because it’s so complex to swallow – it sticks to your mouth and it’s hard to form a bolus to go down,” Ms O’Brien says.
Dealing with medication
Currently there is no medication available to treat dysphagia directly.
However, for those with an underlying diagnosis such as Parkinson’s disease, careful medication management will often help improve their ability to swallow.
“If a doctor can manage Parkinson’s symptoms with medicationand the person has a reduction in their Parkinson’s symptoms, then they may also have an improvement in their swallow,” Ms O’Brien says.
She adds that carers should give medication with a puree rather than water, as it can be difficult to swallow a solid within liquid.
“The combination of liquid and solid is quite complex, so if someone starts to have increased difficulties swallowing their tablets, that’s often a good sign that their swallowing system is starting to struggle with more complex tasks.
“We might tell people to put their medication in a teaspoon of some kind of puree – there are now commercially available products – as this will often help them swallow it more easily.”
Can you lead a long life with dysphagia?
For some people, dysphagia can be lessened and, in a few instances, even reversed.
For example, those who develop dysphagia as the result of a stroke might find the issue is resolved at the end of their rehabilitation process.
However, dysphagia cannot usually be reversed for those with a neurodegenerative condition or for an older person.
Yet Ms O’Brien says living a long life with dysphagia is entirely possible.
“If it’s well managed, then yes absolutely you can live a long life with dysphagia and it doesn’t always end up in choking and/or aspiration.
“The speech pathologist’s role is important in assessing a person’s dysphagia and then reviewing them on a regular basis to make sure that the treatment and management options that person currently has are still meeting their needs.”
This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.
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