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For the Elderly, Merely Swallowing Food Can Be a Life-Threatening Hazard

HIGHLIGHTS:

  • If someone is choking, it is recommended that the person is assuming a slightly bent-over position or lays down on one side. Fingers should not be placed inside the oesophagus under any circumstance. If the person choking is struggling to breathe, looks pale or has discoloration of the lips, the person should be taken to hospital immediately.
  • It is possible to assess the risk level of a patient’s dysphagia using the Dysphagia Severity Rating Scale. It is a potentially life-threatening issue if the risk rating is over 10%.

Elderly bodies start to slow down as their age increases. The immune system weakens and they are not as strong as they were when they were young. Relatively small things, such as swallowing food, can potentially become a huge problem. For example, food entering the lungs through airways can cause lung infections. Elderly people who find it hard to swallow properly may become fearful of eating altogether which can lead to issues in nutrition. Elderly people who have problems of cleaning their own phlegm or saliva are at risk of choking, which can lead to respiratory failure. Taking all this into consideration, geriatric dysphagia should not be a subject that is easily dismissed, as it can severely damage health and can be a precursor to various life-threatening illnesses.

Choke Risks in the Elderly

Although the swallowing process itself does not change and still uses the same muscles as before: as people age, their organs start to deteriorate. This begins with the mouth and teeth. Elderly people often encounter problems, such as brittle or broken teeth and gum disease. Furthermore, as our bodies get older, our mouths tend to dry out, which leads to problems when chewing and swallowing food. Additionally, some elderly people suffer health issues related to muscle control, such as Parkinson’s disease, paralysis or Alzheimer’s, which place them further at risk of choking.

Which symptoms should be considered serious enough for that person to see a doctor?

  • Choking on their food or drink regularly
  • Choking which leads to them being left red in the face, breathing heavily, coughing or struggling for breath when eating
  • Having a history of respiratory infections caused by choking
  • Choking to the extent that they are losing weight due to under-consumption of food
  • Having one of the following conditions which means that they are at high risk when swallowing food: Parkinson’s, paralysis, Alzheimer’s or other types of dementia

How to tell how serious someone’s dysphagia is

A Dysphagia Video fluoroscopy is one way to tell how serious a person’s dysphagia is. This is done by inserting a camera slowly into the patient’s mouth and asking them to swallow. The footage can then be assessed to find out more about their swallowing action, including how much they swallow in one time and the rhythm of their swallowing. Patients can then be given a dysphagia rating which, if higher than 10%, means that they are at severe risk of choking. Moreover, if their swallowing action results in their larynx not closing properly, it can put them at risk of ingesting food into their lungs, which further heightens the health risks involved for that patient.

How to approach to a patient who might be suffered by dysphagia

  • The basic bedside swallowing test, such as water swallowing test, should be assessed.
  • An assessment should be made as to what foods cause the patient difficulty when swallowing: e.g., solid or liquid foods.
  • A fluoroscopic camera should be used to assess where the patient falls on the Dysphagia Severity Rating Scale.
  • The frequency should be observed with which dysphagia occurs in the patient and what health issues arise from the dysphagia.
  • A full body checkup should be carried out to assess whether the patient displays any signs of Parkinson’s, paralysis or dementia.
  • Blood checks should be performed to see if the patient has any electrolytes or mineral deficiencies that could be causing dysphagia.

Caring for patients with dysphagia

  • Investigate possible causes of their dysphagia, such as mineral deficiency, medicine that may potentially lead to difficulty when swallowing, or other illnesses that cause dysphagia.
  • Where possible, patients should practice swallowing with a trained occupational / physical therapist. This is limited to patients who are not under any pre-oral eating restrictions, are aware of their actions and are still in control of their muscle movements. This physiotherapy has two main effects:
    • It mobilizes and strengthens the muscles involved with swallowing, which are facial muscles, throat muscles, tongue and esophagus.
    • It can assist the patient in using the correct rhythm and technique when swallowing, which can reduce dysphagia.
  • Change their diet to include plenty of food, which is as smooth and thick as soft-boiled rice congee, ice cream, yogurt, soft pudding or honey. Odourless thickening agents can also be added in food and drink to increase its viscosity and therefore reduce the risk of dysphagia. Food that is too dry or hard or too liquified should be avoided, as this is more likely to cause dysphagia.

Directions for patients and carers

  • Large meals should not be given to patients, their daily menu should consist of meals in small but frequent portions.
    The patient should chew their food properly, drink slowly and avoid distractions, such as watching TV or chatting with others, so the patient is more able to concentrate on the act of swallowing.
  • The patient should sit up straight while eating and avoid laying down right after the meal. If the patient is bedridden, the carer should position the head at a 45-degree angle when eating.
  • Patients should clean their mouth, teeth or dentures before and after each meal to prevent colonization of bacteria that can cause lungs infection after choking.

First steps when dealing with geriatrics who show sign of choking.

  • Stop eating immediately.
  • Assume a slightly bent over position or lay on one side.
  • Remove any food and dentures from the oral cavity.
  • Do not, under any circumstances, place fingers inside the oesophagus.
  • When someone is struggling to breathe, has turned pale or has discoloration of the lips, the person should be taken to hospital immediately.

Geriatric dysphagia should not be viewed as small matter that can be overlooked as normal. Dysphagia can have serious consequences. Keeping an eye out for geriatric dysphagia is essential so that initial care can be provided and a doctor can be alerted immediately.

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Tippapa Chutikankosol, M.D. Summary: Geriatric Medicine