Dealing With Dysphagia: Swallowing Issues in Elderly

Many senior citizens suffer from swallowing issues like Dysphagia, leading to various health problems. Dr. Sanjay Subbaiah, specialist in voice and swallowing problems, elaborates on it and suggests some solutions.

Many senior citizens find it difficult to swallow food, making the whole process of eating a meal a complicated, unpleasant activity for them. Swallowing is a function that all of us take for granted without understanding the complicated processes lying underneath for its smooth functioning. With age the swallowing function can deteriorate, leading to many eating challenges, which can in turn lead to issues like malnutrition, dehydration, weight loss and even aspiration pneumonia. It is estimated that 20 per cent of individuals over the age of 50 and most of the individuals over the age of 80 years, have some form of swallowing issues, medically termed as Dysphagia.

Common symptoms of Dysphagia typically include the following: coughs while or after eating or drinking; choking on food, fluid, or medication; difficulty in swallowing food or fluid; recurrent attacks of pneumonia; dehydration and electrolyte imbalance; malnourishment and facing loss of muscle mass.

An assessment and intervention by a specialised Ear Nose and Throat (ENT) doctor can help alleviate some of the problems with simple techniques like muscle strengthening exercises and change in consistency of food, among others.

This article explains Dysphagia, its cause and effect and the possible ways of treatment.

The Process of Swallowing

Swallowing is a semiautomatic process where an individual transports food from the mouth to the stomach. A normal person swallows roughly about 1500 times a day. The process starts with chewing of the food in the mouth, later this bolus [chewed food] is pushed to the back of the mouth. Until this step, it is a voluntary activity. From here the involuntary part of swallowing starts. As the bolus enters the pharynx, the entry is synchronized with the closing of the wind pipe [Larynx] and opening of the food pipe [Oesophagus], so that bolus is pushed into the opened food pipe. Once in the food pipe, peristaltic waves propel the bolus into the stomach. The second part of the process i.e., the pharyngeal stage, where the wind pipe closes and the food pipe opens is a highly sophisticated process, requiring the coordination of sensory receptors, nerves, muscles and the central nervous system. This stage witnesses the temporary cessation of breathing and opening of the food pipe [which is otherwise always closed]. Timing is clearly everything here!

Swallowing has 3 stages — the oral stage, pharyngeal stage and oesophageal stage. Problems can occur in one or more stages of swallowing. Derangements in the oral stage can lead to:

• Inability to hold food in the mouth.
• Inability to chew food.
• Unable to push bolus into the back of the mouth [pharynx].
• Bolus entering the nose.

Derangements in the pharyngeal stage are common and dangerous, leading to:

• Windpipe not closing properly and bolus entering the wind pipe. This leads to aspiration and sometimes even death. In milder forms, it can cause recurrent attacks of aspiration pneumonia or coughing during or after eating.
• Food pipe not opening properly causing bolus to accumulate in the pharynx.
• Desynchronization or delay in closing the wind pipe can lead to aspiration.

Derangements in the oesophageal stage can lead to:

• Bolus stagnating in the food pipe causing vomiting.

Reasons Behind Dysphagia

It is obvious that swallowing is a complicated process and small derangements can cause dangerous consequences. Reduced sensitivity and strength of the receptors, muscles and nerves are thought to be the main culprit behind this problem. Missing teeth and medications causing dryness of mouth can also add to it. Swallowing problems are also seen in individuals suffering from certain nervous disorders and those who have undergone head and neck surgery. The common nervous disorders with swallowing problems are Stroke, Motor neurone disease, Parkinson’s Disease, Alzheimer’s disease and tumours of the Brain.

The consequences of dysphagia are two folds, including safety and efficiency issues. Safety issues occur due to bolus or even saliva entering the wind pipe leading to coughing during or after eating, aspiration pneumonia and sometimes even death. Efficiency issues occur due to reduced amount of eating because of the problem, leading to dehydration, malnutrition, electrolyte imbalances and sarcopenia [loss of muscle mass with ageing]. Since many elderly people already have some pre-existing diseases, these problems only add to the deterioration.

Dr Subbaiah performs an endoscopic swallowing assessment on a patient.

The Solutions Available

Dysphagia is handled by a Voice & Swallowing specialist, which is a sub speciality of ENT department. The standard investigations include, Clinical Evaluation of Swallowing, Fibro-Optic Evaluation of Swallowing [FEES] and Modified Barium Swallow. These investigations help in deciphering which stage and process of swallowing is affected so that the management is tailor-made to the issue. Dysphagia treatment is broadly divided into Non-surgical and surgical and depends on the cause, symptoms, and type of swallowing problem.

Non-surgical treatment includes:

1. Oro Dental care & hygiene.
2. Oro motor exercises.
3. Neck exercises –Shakers exercises.
4. Swallow manoeuvres.
5. Swallow Postures.
6. Consistency adaptation of food.
7. Nasogastric tube.

Surgical modalities include:

1. Tracheostomy.
2. Percutaneous gastrostomy [PEG].
3. Medialisation laryngoplasty

Any elderly individual with symptoms of Dysphagia must visit a specialist at the earliest for a swallowing assessment. After swallowing assessment, depending on what stage of swallowing is impaired, a tailor-made treatment is started. Most of the times it is managed by exercises and manoeuvres. Surgical methods are employed rarely. So if you or an elderly loved one feel there is a swallowing problem that is hampering your daily life, visit a specialist today for treatment and regain the pleasures of eating.