Coughing while eating is common in older adults, often indicating swallowing difficulties. While coughing clears the airway, persistent or frequent coughing during meals can signal issues requiring attention. These range from age-related changes to medical conditions, affecting safe food and liquid consumption.
Understanding Why It Happens
As individuals age, physiological changes influence the swallowing mechanism, known as presbyphagia. Muscles involved in swallowing, like those in the tongue and throat, can weaken, reducing their strength and coordination. Decreased saliva production can lead to dry mouth, making it harder to form and transport food. Protective reflexes that prevent food or liquid from entering the airway also become slower, increasing the likelihood of coughing or aspiration.
Several medical conditions contribute to swallowing difficulties in older adults. Dysphagia, or difficulty swallowing, is a common cause, where food or liquid may enter the airway instead of the esophagus, leading to coughing or choking. Gastroesophageal Reflux Disease (GERD) can also contribute, as stomach acid refluxing into the throat can irritate tissues and trigger a cough.
Neurological conditions often impair the complex coordination needed for swallowing. Conditions such as stroke, Parkinson’s disease, dementia, and multiple sclerosis can affect the nerves and muscles responsible for a safe swallow. Dysphagia affects around 50% of older adults with neurological conditions like Parkinson’s disease.
Certain medications commonly prescribed to older adults can also cause side effects like dry mouth or impact muscle control, complicating swallowing. Drugs for urinary incontinence, depression, insomnia, and high blood pressure, for instance, can reduce saliva production. Poor dental health, including missing teeth or ill-fitting dentures, can make chewing food difficult, leading to larger, less manageable pieces that are harder to swallow and increase coughing risk.
Practical Approaches to Eating
Modifying food consistency is a practical first step to help reduce coughing during meals. Thickening liquids with commercial thickeners can slow their movement, allowing more time for the individual to control the swallow and protect the airway. Naturally thick liquids like fruit nectars or milkshakes are also good options. Opting for soft or pureed foods, and avoiding crumbly, sticky, or mixed textures, can make chewing and swallowing easier and safer.
Eating techniques can also make a significant difference. Maintaining proper posture, sitting upright at a 90-degree angle during and for 30-45 minutes after meals, helps align the throat and esophagus for safer swallowing. The “chin tuck” maneuver, where an individual lowers their chin towards their chest just before swallowing, can help narrow the airway entrance and position the epiglottis to better protect the airway.
Minimizing distractions during meal times, such as turning off the television or limiting conversation, helps the individual focus solely on the act of eating and swallowing. Encouraging small, manageable bites and a slow eating pace can prevent overwhelming the swallowing mechanism. Taking adequate time for meals without rushing and promoting double swallowing for each mouthful can also enhance safety. Maintaining good oral hygiene is also important to reduce bacteria in the mouth, which could otherwise lead to infection if aspirated into the lungs.
When to Consult a Healthcare Professional
Recognizing warning signs is important for seeking medical evaluation for persistent coughing during eating. Frequent coughing or choking episodes during or after meals indicate food or liquid may be entering the airway. Recurrent respiratory infections, like bronchitis or pneumonia, can signal aspiration pneumonia, where inhaled food or liquid leads to lung infection.
Other concerning signs include unexplained weight loss or dehydration, which can result from avoiding eating or drinking due to swallowing difficulties. Voice changes, such as a “wet” or gurgly voice after consuming food or liquids, suggest material might be lingering near the vocal cords. Pain during swallowing or a persistent feeling of food getting stuck in the throat also warrants prompt medical attention.
A healthcare professional will likely conduct a thorough evaluation, which may include a referral to a Speech-Language Pathologist (SLP). An SLP can perform a comprehensive swallowing assessment, like a Modified Barium Swallow Study (MBSS) or Flexible Endoscopic Evaluation of Swallowing (FEES), to visualize the process and identify issues. The SLP can then recommend tailored swallowing exercises or dietary modifications. Reviewing current medications is also a common step, as some drugs can contribute to swallowing problems. Early intervention prevents serious complications like malnutrition, dehydration, and aspiration pneumonia, improving quality of life.