The aging process can be quite intimidating as we start to climb in age. Watching our parents age right before our eyes can be quite terrifying especially if they run into medical issues along the way. Some medical problems make it more difficult for our parents to live “normal” lives. Many times we have to adapt as best as we can. Eating is something that we do everyday but some people gradually loose the ability to do that safely, especially during the aging process. That being said, the elderly can require fewer calories as they age.
At first, it’s hard to tell what’s part of the aging process and what can be more complicated is a medical issue that needs attention. If your parents aren’t eating enough and they are starting to lose weight, keep reading to see if we can offer you some guidance. A common medical problem that affects aging parents is losing the ability to safely swallow food. If your parent is eating or drinking hardly anything, it’s time to seek medical intervention.
Chewing already becomes difficult sometimes due to poor dentition or ill-fitting dentures. There an be a bigger medical issue known as dysphagia.
What Is Dysphagia? And why does it cause difficulty eating?
Dysphagia is defined in simple terms, a malfunction of the swallowing process resulting in swallowing difficulty. Dysphagia can occur at multiple points of the swallowing process. To understand potential causes of dysphagia, it’s important to know the anatomy of the upper GI and how swallowing your food normally works.
When food enters your mouth, it’s met by your teeth, tongue, and saliva. The role of teeth and saliva is to help you break down the food. Your tongue helps you move the food around your mouth. Your saliva has some enzymes in it that help you break down carbohydrates. When the food begins to make it’s way down, you have a flap called the epiglottis that protects your lungs from receiving food particles. The food then goes down the esophagus. The key take away here is that the esophagus is right next to the airway. A malfunctioning swallowing mechanism puts people at risk of blocking their airway which can be dangerous. There’s the possibility of choking, getting aspiration pneumonia, or getting malnourished or dehydrated. In rare cases, a choking incident can be fatal.
What Causes Dysphagia?
It can be caused by a number of factors. It can be caused by a neurological medical condition such as Alzheimer’s or Parkinson’s disease. It can also be caused by a head injury or stroke affecting the part of the brain that is responsible for swallowing. The progression of certain cancers, such as any cancers on the head or neck can also cause dysphagia. Some people can have temporary swelling of the throat from a temporary illness like the flu. And some people are just born with an abnormal swallowing mechanism and have lacked the ability to swallow since birth.
Types of Dysphagia
There are 4 types of dysphagia and they are based on where the malfunction is. The first two are the most common types of dysphagia diagnoses.
1. Oropharyngeal dysphagia is swallowing difficulty related to the mouth or throat and is most common in the elderly
2. Esophageal dysphagia is swallowing difficulty that gives the sensation of something being stuck in the throat after the swallowing process has begun
3. Esophagogastric dysphagia is when there’s an impairment at the end of the esophagus and the top of the stomach
4. Paraesophageal dysphagia is when there’s a something physical in the way of the esophageal wall causing an obstruction
What are the Signs and Symptoms of Dysphagia?
Every type of dysphagia has a different source. Some obvious signs (not always experienced by everyone) are frequent coughing or gagging while eating. Some people experience the food coming back up when they try to swallow it. Some people people also get the feeling of food being “stuck” in their throat or even lower like in their chest. Other people may not show obvious signs but they’re doing things like refusing to eat and may be unable to verbalize why.
This could be because swallowing is causing them pain or discomfort. If this is something you have noticed as a new behavior, it’s time to be concerned. Make an appointment with their primary care provider as soon as possible. While you wait for the appointment to come up, write down what exactly is happening (what signs and symptoms you’re noticing) and write down what foods you notice it happening with. Knowing what the problem foods are and how frequent the issues are makes it easier for the medical team to help you get to a correct diagnoses. Also, make sure you review the basics of the Heimlich maneuver and CPR in case you need to take action during an emergency.
What to expect after a Dysphagia Diagnosis?
After a dysphagia diagnosis, take some time to decompress. Having a diagnosis means knowing how to approach a situation. Then, begin making adjustments. Typically the diagnosis will come with a lot of information. You’ll be told exactly what kind of dysphagia it is and you’ll be told exactly what you need to do to avoid the symptoms. You’ll also be told if things like speech therapy can be beneficial.
From there, your provider will also give you a guideline for exactly what kind of food, and fluids as well as how much they can eat (for example, bite size pieces only) to minimize the risk of choking and aspiration. In some cases some people have to have the consistency of the fluids and/or the texture of their foods modified. Depending on the extent of the modifications, this can sometimes make the food unappetizing. While texture and consistency should be modified to meet the needs of the parent with the dysphagia diagnosis, I recommend not compromising on the flavors. Great flavors make it a lot easier for our parents to be compliant patients.
Diet Modifications for Dysphagia diagnoses
If the dysphagia is something that cannot be treated, you may get a prescription for foods types and textures that are safe for them to use. We are in a weird transition where our healthcare system is navigating between two diet systems in hopes of transitioning to the International Dysphagia Diet (IDD) via the International Dysphagia Diet Standardization Initiative (IDDSI). I hope to have a blog article discussing the specifics of the IDD. Until then, I do recommend checking out
Recommended Products
For liquid thickening agents, check out Simply Thick. They have it in packet form for nectar consistency as well as packet form for honey consistency. Simply Thick also comes in dispenser form. An alternative to Simply Thick is a brand called Thick It. You are not limited to these two brands. Those, at the time of me writing this article are the most popular ones. For pureed foods, you just need a blender.
References
- National Institute of Health Website
- Medscape Article on Dysphagia
- International Dysphagia Diet
- Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Chapter 82
