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Understanding Dysphagia
By Jeri Logemann, Ph.D., Charles A. Stewart, M.D., Jane Hurd, MPA,
Diane J. Aschman, MS, Nancy L. Matthews, MA

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While it’s important to educate care providers about dysphagia, it’s also crucial that seniors themselves learn to recognize symptoms and seek treatment. For this to happen, a number of longstanding barriers need to be overcome:

Many people with symptoms of dysphagia fail to report them to physicians or caregivers, often to avoid embarrassment. They may fear loss of independence, or reduced enjoyment from meals.

In its early stages, individuals may be unaware of the signs and symptoms of dysphagia, or may choose to ignore them.

Dysphagia may be seen as a “normal” part of the aging process.
A person may be unaware of the mechanics of swallowing and of safe swallowing strategies.

Individuals may not realize that there is a clinical specialty dealing with swallowing problems, and that help is readily available.

Most importantly, people may see swallowing issues as insignificant, and remain unaware of the potential consequences.

The Happy Ending

With her daughter’s help, Maxine’s story began to turn around. Her daughter arranged for Maxine to visit her primary care physician, who referred Maxine to a speech and language pathologist in the outpatient department of a local medical center. Janice, the SLP, asked Maxine about her medical history and her current medical status. Then Janice performed a “tabletop clinical evaluation,” examining Maxine’s facial and throat muscle strength, and watching her swallow measured amounts of water, pudding, and Lorna Doone cookies. This wasn’t at all an unpleasant or threatening experience. In fact, Maxine began to feel better right away because Janice assured her that there were definitely ways to improve her swallowing even if she were found to have a dysphagia.

Janice recommended that Maxine’s doctor refer her to the medical center’s radiology department for an x-ray procedure called modified barium swallow, or MBS. Maxine was impressed by the fact that the radiologist would watch her swallowing in real time and could see exactly where she was having a problem - but she was also apprehensive about having to swallow the small amount of barium. But it turned out to be no problem, and no more uncomfortable than the “tabletop clinical evaluation,” and Janice was with her the whole time.


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