A Speech Pathologist Explains Common Swallowing Issues Part 1: Causes and Coping

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A few months ago, a gerontologist told us her story about how she coped as a family caregiver when her father developed swallowing problems (dysphagia). Considering the seriousness and frequency of these issues with aging adults, I felt that we needed further information from a specialist. I contacted speech-language pathologist Kathryn Kilpatrick who has spent four decades helping people cope with these issues.

Kilpatrick is the author of the popular 5-volume “Therapy Guides for Language and Speech Disorders workbooks.” Her website, Communication Connection, is an excellent resource for memory fitness and successful aging. Below, she gives us insight into causes and coping with swallowing problems.

Knowing when swallowing problems can occur

Something most of us take for granted is our ability to swallow. There are many things that can contribute to swallowing difficulties (dysphagia) including stroke, brain injury, Parkinson’s disease, multiple sclerosis, ALS, oral cancer or problems with teeth or dentures. In some situations the symptoms are obvious, but in others a person may see gradual changes and not realize that the problems a person is having could be due to dysphagia.

Periodic choking, especially on certain foods, frequent throat clearing or the feeling that foods are sticking in their throat are a few of the complaints we often hear.

As a speech-language pathologist in home health care, many of my referrals are for a person who was in the hospital for aspiration pneumonia because food or liquid went into their lungs. It is not unusual to learn that there had been some changes in swallowing abilities for a period of time prior to this incident, but the issue was never mentioned to their doctor.

In one example, I evaluated a man who had been coughing and choking on liquids and solid/liquid combinations like cold cereal and soup for years. Eventually, his physical therapist recommended a speech evaluation to see if I could help him.

Another example is a woman who told me she no longer liked meat. She also said that dry and chewy foods were a problem for her. She was avoiding foods that were good for her because of swallowing issues.

Many of my other clients experience the progression of Alzheimer’s disease and have difficulties with handling certain food textures and liquids resulting in problems which can impact nutritional intake and hydration.

Caregivers can watch for similar issues to see when a speech-language pathologist may be called in to determine the cause of the swallowing issues and teach the family how to adjust to the needs of their loved one.

What should someone do if they are concerned about a swallowing issue?

First of all, contact your physician to report any type of swallowing difficulties. If a modified barium swallow is recommended, the person may be given a modified diet level for solids and may include thickening liquids to decrease coughing or choking and prevent aspiration pneumonia. A follow-up by a speech-language pathologist is strongly recommended and can be provided in the hospital or at other levels of care. Treatment includes patient and caregiver education, swallowing strategies and menu modifications specific to the person’s test results.

What you need to know

One of the advantages of having a speech-language pathologist in the home health care setting is that since they are in the home environment it is easier to implement recommendations for diet modification using the patient’s previous diet preferences. Typically the experience of figuring out what types of food to prepare is overwhelming when the swallowing test is completed and the recommendation is to switch to a pureed or mechanical soft diet. In some cases, a person may be afraid to eat some foods based on a previous experience, or the care partner is worried that they might do something wrong. A professional in the home care setting can help with these adjustments.

An integral part of the swallowing program could include a wide variety of strategies specific to each person’s swallowing challenges including but not limited to eating slower, taking small bites and not talking with food in their mouth.

If a person has dementia, then it often becomes harder for them to remember to use these recommendations without frequent reminders appropriate to their swallowing issues. In such cases, the therapist will be able to offer suggestions so that care partners are more comfortable preparing meals which can lead to increased intake and more balanced nutrition for the person with swallowing problems.

Part two will give you tips about how to proceed with food preparation.

Carol is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. She runs award winning websites at _ www.mindingourelders.com and_www.mindingoureldersblogs.com.  On Twitter, f_ollow Carol @mindingourelder and on Facebook:_ Minding Our Elders

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