When you sit down
to dinner with your mother, do you wonder why she
constantly clears her throat?
Are you puzzled as to why her nose
runs after nearly every meal?
When you give your father juice, do
you hold your breath waiting to see if it goes
down the right tube?
When he eats a sandwich, are you on
the edge of your seat ready to
perform the Heimlich maneuver?
Are you forever looking at the
kitchen clock when you eat with
your mother because meals take so long and
you’ve got a million things to do?
Do you wonder how your loved one
can possibly be getting enough food or
liquid to survive?
If you’ve had any of these
concerns, your loved one may have a significant,
potentially serious, swallowing problem.
COMMON AND OFTEN OVERLOOKED
these days know about the dangers of falling in the
elderly. Did you know that swallowing problems are
another major threat to the elderly? They, too, account
for tens of thousands of deaths in the United States
every year. More, perhaps, than falls.
blockage of the airway, takes nearly four thousand
Aspiration of food, liquid, or
bacteria-laden material from the mouth into the lungs
causes fatal pneumonia in tens of thousands.
resulting from swallowing problems causes weakness and
susceptibility to infection that hasten the death of
Nearly 40 million Americans in a
total U.S. population of just over 300 million are
elderly (65 years of age and older). From 15 to 50
percent of the elderly are estimatedsix and 20 million
people and growing.
As common as these problems are,
they are often overlooked. The symptoms and situations
listed above – frequent throat-clearing, a runny nose
while eating, and meals that take forever – are but some
of the clues that suggest your loved one has a
swallowing problem that could be life-threatening.
IT’S NOT JUST THE ELDERLY
You don’t have
to be 65 or older to have a swallowing problem. Persons
with a wide variety of medical and neurologic disorders
are vulnerable. These disorders include stroke, multiple
sclerosis, cancer, ALS, myasthenia gravis, head injury,
congestive heart failure, and COPD.
Here are some typical scenarios:
man with multiple sclerosis was able to chew. But after
he swallowed, some food remained in his throat. It was
sucked into his airway; and, because his cough was so
weak, the material made its way to his lungs to cause
A 56-year-old woman treated for
salivary gland cancer had an extremely dry mouth and
exquisitely painful sores inside her cheeks. Chewing was
painful and made eating unpleasant, leaving her feeling
drained physically and emotionally.
woman with a recent stroke had difficulty drinking
liquids. They caused fits of coughing that brought tears
to her eyes. A bout of pneumonia put her back into the
hospital and delayed her neurologic recovery.
AS FOR THE
A 72-year-old man with Parkinson’s
disease did everything slowly. That included swallowing.
Food often got stuck in his throat and caused him to
cough and gag.
An 82-year-old man with Alzheimer’s
was extremely distractible and could no longer use a
fork or spoon. He had also “forgotten” what to do with
food once it was in his mouth. A single swallow could
take three minutes or longer. Not surprisingly, he
frequently became dehydrated.
WHAT PEOPLE COMPLAIN OF
These are some
of these things people complain of when they have a
“The food doesn’t go
“I have to swallow more than once.”
“My nose runs at
stuck in my throat.”
when I drink water.”
falls out of my mouth.”
“I have a
hard time eating steak.”
swallow, juice goes up my nose.”
“It hurts when I swallow.”
afraid I’m going to choke.”
sounds funny after I eat.”
“I get so
tired, I can’t finish a meal.”
you expect? I’m old.”
Sometimes, however, a person has no
complaint at all – but a very real problem with
WHERE SWALLOWING BREAKS DOWN
how things can go wrong with swallowing, let’s look
briefly at normal swallowing.
Swallowing is a process – a set of
steps that takes food (or liquid or pills) from mouth to
(which, of course, does
not apply to liquids). The tongue, lips, cheeks, jaw,
and teeth work together to reduce food to a pasty ball.
Saliva plays a key role. It glues together the ground-up
food, gathering up flaky bits so they don’t tickle your
throat or get sucked into your lungs.
When jaw muscles are weak, teeth
are missing, or dentures are loose or painful, chewing
will be impaired. That can set the stage for a choking
2. TRANSPORTING the food from mouth
to throat. The tongue acts like a bucket without a
handle. Cancer surgery, neurologic disorders (such as
stroke, MS, ALS, or Parkinson’s disease), or dehydration
can interfere with moving the food along.
3. SWALLOWING itself. This is a
reflex triggered by food or liquid getting to where the
tonsils are (or used to be). Several things happen
pretty much at once to make sure food goes into the
esophagus, not into the windpipe.
When muscles are weak (as with
muscular dystrophy or myasthenia gravis) or nerve
signals are scrambled or absent (as with stroke, MS, or
ALS), the reflex cannot provide for safe swallowing.
4. THE ESOPHAGUS. Muscles at its
beginning and end act like traffic cops. One-way travel
only! Otherwise, you pay the price with heartburn, bad
breath, or worse.
Connective tissue disorders like
scleroderma can constrict the esophagus and prevent
proper movement of food or liquid. Chronic reflux of
acidic stomach contents (as with GERD) can irritate the
lining of the esophagus and cause it to stick together,
preventing food from getting to the stomach.
WATCH OUT FOR DEHYDRATION AND MEDICATION
cause swallowing problems by reducing the supply of
saliva. Food sticks to the throat so leftover material
can get sucked into the lungs after the swallow. Pills
can attach to the esophagus and burn its lining.
medications can cause or contribute to dehydration.
Anticholinergic drugs (such as diphenhydramine,
amitriptyline, or ipratropium) cut down on saliva
formation to interfere with swallowing at any phase of
WHAT’S YOUR NEXT STEP?
your observations, questions, and concerns and get them
to your loved one’s primary medical provider.
If things worsen at any time – if
she has increased difficulty swallowing, threatened
dehydration, labored breathing, or progressive weakness,
for example–seek medical attention at once.
Give yourself a
pat on the back for learning about an important subject
that receives little attention and which can be
life-threatening. Ignoring a swallowing problem can be
disastrous. Now that you have a plan, don’t hesitate to
Ph.D., CCC-SLP, is a speech-language pathologist with
the Natick (Massachusetts) Visiting Nurse Association.
She has had extensive experience in diagnosing and
treating patients with swallowing disorders, working
with families, the elderly, and the chronically ill in a
variety of settings. Joel Herskowitz, M.D., Dr. Sayadi’s
husband, is a pediatric neurologist on the faculty of
the Boston University School of Medicine. They are
authors of SWALLOW SAFELY: How Swallowing Problems
Threaten the Elderly and Others. A Caregiver’s Guide to
Recognition, Treatment, and Prevention (available
through Amazon.com and www.swallowsafely.com). For
further information, contact firstname.lastname@example.org.
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