Dysphagia, the medical term for difficulty swallowing, is a common concern among older adults, often complicating their daily nutrition and hydration. The risk increases with age due to muscle weakness, neurological conditions, or diseases like stroke and dementia. This impairment can lead to serious health issues, including malnutrition, weight loss, and dehydration. A major danger is aspiration, which occurs when food or liquid accidentally enters the airway and lungs, potentially causing aspiration pneumonia. Addressing this challenge requires careful observation and the implementation of safe feeding strategies to maintain the individual’s health and quality of life.
Recognizing and Assessing Severe Swallowing Difficulty
Recognizing the signs of a swallowing problem is the first step in providing a safe feeding environment. Caregivers should watch for frequent coughing or choking during or immediately after eating and drinking. Another sign is a “wet,” gurgly, or breathy sound to the voice after swallowing, which may indicate material has entered the airway.
Food pocketing, where a person holds food in their cheeks instead of swallowing it, is also a symptom of difficulty. Unintended weight loss or recurrent bouts of pneumonia should prompt a thorough investigation. If these signs are present, seek a professional assessment from a physician or a Speech-Language Pathologist (SLP). The SLP is the specialist who can diagnose the exact nature and severity of the dysphagia before any major changes to the diet are implemented.
Modifying Food and Liquid Textures
Once a swallowing difficulty is identified, modifying the texture of food and liquids is a primary strategy to improve safety. Thin liquids, such as water or juice, are often the most difficult to manage and can be made safer by adding commercial thickening agents. These thickeners create different levels of consistency, typically described as mildly thick, moderately thick, or extremely thick.
For solid foods, the goal is to reduce the need for chewing and ensure a cohesive texture that holds together. Examples include pureed foods, which are smooth and lump-free, and minced and moist foods, which are very soft, easily mashed, and uniform in size.
The International Dysphagia Diet Standardization Initiative (IDDSI) provides a standardized framework for describing these textures and thicknesses. This system uses eight levels, numbered 0 to 7, to ensure consistent communication about the exact diet required. Following the level recommended by the SLP is essential, as the wrong texture can still pose a high risk of aspiration or choking. Dry, crumbly, or sticky foods are discouraged because they are difficult to control in the mouth.
Techniques for Safe Assisted Oral Feeding
Correct positioning is a fundamental technique for safe assisted oral feeding, as it uses gravity to help direct food downward. The individual should be seated as upright as possible, ideally at a 90-degree angle, during the meal and for at least 30 minutes afterward to minimize the risk of reflux and aspiration. The feeder should also encourage a slight chin-tuck position when the person swallows, which helps protect the airway.
Feeding should proceed at a slow pace, with small amounts offered at a time, such as a half to a full teaspoon of food. Wait until the person has completely swallowed one mouthful before offering the next, which can be confirmed by checking for lingering food in the mouth. Minimizing distractions, such as turning off the television, helps the individual focus on the process of eating.
After the meal, a careful “oral sweep” or check of the mouth should be performed to ensure no food particles are left behind, especially in the cheeks or under the tongue. Maintaining excellent oral hygiene is important, as bacteria from food residue can be inhaled if aspiration occurs. Providing a small sip of thickened liquid or encouraging a dry swallow after the last bite helps clear the throat and reduces the risk of later aspiration.
Non-Oral Feeding Options
When texture modification and safe feeding techniques are no longer sufficient to provide adequate nutrition or if the risk of aspiration remains too high, non-oral feeding methods become necessary. These methods deliver nutrition directly to the stomach or small intestine through a tube. The decision to transition to tube feeding is complex and should involve the entire medical team, including the physician, SLP, and family.
One option is the Nasogastric (NG) tube, a thin, flexible tube inserted through the nose, down the esophagus, and into the stomach. This method is considered a short-term solution, typically used when swallowing function is expected to recover within four to six weeks.
For long-term nutritional support, a Gastrostomy tube, such as a Percutaneous Endoscopic Gastrostomy (PEG) tube, is often placed directly into the stomach through a small incision in the abdomen. The PEG tube is generally more comfortable for the individual and easier for caregivers to manage over an extended period. Caregivers must be instructed on basic tube site hygiene to prevent infection, which involves keeping the area clean and dry according to medical guidelines. A dietitian tailors the liquid formula administered through the tube to ensure the individual receives all the necessary calories, protein, and hydration.