The Agency for Health Care
Policy and Research estimates that more than 60,000
Americans die from complications associated with
swallowing difficulties each yearómore than liver and
kidney disease, as well as HIV/ AIDS combined.
Swallowing difficulties are a
serious problem for many loved ones and a stress factor
for caregivers nationwide. There are four main families
of dysphagia, which have many of the same symptoms, but
different causes and treatments.
preparatory dysphagia is the actual loss of smell or
taste sensation and saliva. It also includes weak
chewing muscles as well as painful gums and cheeks.
oral dysphagia is caused when part of the tongue is
missing and there is then impaired tongue control and
Esophageal dysphagia is the
sensation of food sticking in the base of a loved oneís
throat or chest. There are quite a few causes of this
dysphagia, ranging from narrowing or weakening of the
esophagus muscles to food or other objects causing
Oropharyngeal dysphagia relates
to nerves and weakened throat muscles, making it
difficult to move food from the mouth to the throat and
esophagus. This is mainly caused by neurological
disorders or cancer, causing choking, gagging or
coughing when a loved one attempts to swallow.
Regardless of the type,
dysphagia can be debilitating to a loved oneís daily
life, but is also treatable. Each diagnosis and
treatment is as unique as the person suffering from the
The signs and symptoms that a
caregiver should be aware of if suspecting dysphagia
- Pain while swallowing
- Inability to swallow
- Sensation of food getting
stuck in the throat or chest, or behind breastbone
- Increased drooling
- Bringing food back up
- Frequent heartburn
- Food or stomach acid
backing up into a loved oneís throat
- Unexpected weight loss
- Coughing or gagging when
Itís important to seek immediate
help if obstructions are interfering with breathing or
swallowing. If occasional swallowing difficulty becomes
ongoing, or is accompanied by weight loss, regurgitation
or vomiting, a caregiver should seek medical treatment
for a loved one.
If left untreated, dysphagia can
lead to serious issues such as malnutrition, dehydration
and respiratory problems. When preparing for the initial
doctorís appointment to discuss swallowing issues, a
caregiver can help make the most of the short time with
the professional by preparing information.
First, make sure that there are
no pre-appointment conditions such as diet restrictions,
then prepare a list of a loved oneís symptoms (including
their severity and frequency), as well as lists of
current medications and questions for the practitioner.
Some things to discuss with a
health care provider are cause, treatments, longevity of
issue, side effects from treatment, alternatives,
existing health conditions, resources, etc.
Swallowing disorders affect each
person differently and a specialist will look at those
particulars to come up with a specific treatment plan.
Itís not a ďone size fits allĒ way of addressing the
issue, and a loved oneís plan will be tailored to their
The goals of treatment, however,
- To be at a place where
swallowing is done as safely as possible, and
minimizes the risk of choking or aspiration, and
- Ensure the correct amount
of nutrition and hydration is able to be provided
for a loved one.
An important thing for a
caregiver to realize is that treatment for dysphagia
involves a loved oneís family and other support systems.
Swallowing can be improved by addressing the overall
condition, including strength, stamina, motivation and
First, a loved one and caregiver
will need to understand what is wrong with the
swallowing. A basic understanding will help them connect
with the therapies the specialist recommends.
For oropharyngeal dysphagia, a
speech or swallowing therapist may be recommended by the
doctor. Common therapy includes exercise and learning
With a diagnosis of esophageal
dysphagia, treatment may be more aggressive, including
esophageal dilation, surgery or medications.
If a medical professional
recommends medications, professionals suggest a loved
one help a person sit upright, stay calm and take one
pill at a time during administration. Use plenty of
liquid and applesauce to help with the swallowing of
pills. They should be taken early in the day, and a
loved one remains upright for 30 minutes after
Treatment for a swallowing
disorder most likely will include a diet modification. A
caregiver should make sure their loved one is avoiding
foods that may have caused problems in the past, such as
tough meats, crusty breads, raw vegetables, whole nuts,
some fruits, and sticky foods like peanut butter or
Another thing to monitor is food
with mixed consistency, meaning both liquid and solid
elements. An example is cereal with milk. The milk can
get to the throat sooner and cause swallowing issues.
Mushy cereal may be a good fix.
Salad is another big no-no for
those with swallowing concerns. Lettuce is very
difficult to make manageable. The dressing is the other
concern, as with the milk and cereal scenario. It can
get to the throat sooner and be swallowed before the
person is ready.
Fruit is many times a mixed
consistency food, with skin and juices blending, as may
be ice cream and gelatins that start out as solids and
melt to a thin liquid in the mouth.
While lifestyle changes are
likely, many people with swallowing issues find ways to
manage the concern and live full, social lives. A
caregiver can help with the embarrassment factor,
especially in public settings, by planning ahead,
whether itís calling the restaurant or talking to the
ONGOING TREATMENT & EVALUATION
Even if treatment is going well,
caregivers must not let themselves or a loved one feel
that the dysphagia has been completely overcome and get
comfortable. Itís still a very dangerous,
life-threatening condition if not monitored properly and
Here are some tips for living
with chronic dysphagia:
- Watch for respiratory
difficulties such as coughing, rapid breathing,
wheezing, chest pain or changes in voice.
- Continue with the
therapist-approved swallowing exercises that involve
breathing, coughing and chewing.
- Continue to work on overall
fitness, muscle strength, balance and posture.
- Keep the mind and body
active with reading, games and word puzzles, etc.
- At bedtime, keep a loved
oneís head elevated to 30 degrees to minimize
aspiration and reflux.
Part of a caregiverís challenge
is to help a loved one find support. A counselor,
therapist and even support group can help those involved
find encouragement, support, and even information on the
Prevention of dysphagia is not
usually possible. While some of the symptoms cannot
completely be erased, especially if neurological, early
detection and treatment can help minimize the lasting
effects. Eating and chewing slowly is an important
technique for those already diagnosed, and a lesson in
patience for loved ones, albeit a lesson well worth the
Treatment of swallowing problems
is ongoing, and a caregiver and loved one must
understand that the initial plan is likely not the final
one. The swallowing specialist will cater the treatment
to a personís progress and also changes in health if
necessary. A caregiver must always keep a health care
provider in the loop of a loved oneís advance
directives, and changes in condition, in case the
treatment is no longer necessary or pertinent.
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