Eating is a human basic need. It also makes us satisfied and contented. However, some elderly persons may have swallowing difficulty. In such cases, the food cannot be safely delivered from the mouth to the stomach causing the elderly persons unable to obtain sufficient nutrition and fluid. Swallowing difficulty is not rare and must be managed to prevent serious complications.

Symptoms and Consequences of Swallowing Difficulty

• Coughing or choking while/ after eating or drinking
• The need to repeat “swallowing” several times
• Nocturnal awakening due to coughing
• Backflow of food into nose
• Food remaining in mouth after eating, causing bad breath
• Drooling due to decreased control of oral muscles
• Obvious alternative compensation: the elderly persons change their eating habits due to difficulty swallowing while eating. For example, likely to eat more porridge or soften food, added soup or water to rice.
• Food impacted at the throat
• Reflux of food
• Aspiration pneumonia
• Tracheal obstruction
• Malnutrition and dehydration (weight loss, dry skin)

Signs of suffocation

• Hands held around the neck, unable to speak or with obvious breathing difficulty
• Engorged face and neck veins, lips turning blue, loss of consciousness in severe cases

Factors causing swallowing difficulty

• Have chronic diseases such as stroke, Parkinson’s disease, dementia, etc.
• Too rapid eating/ swallowing
• Ill-fitted denture affecting chewing process
• Inappropriate food texture e.g. too hard, too large, too slippery or sticky
• Improper positioning: eating in lying position increases the risk of choking
• Distraction during eating

Practical tips for patients with swallowing difficulty: Different elderly persons have different degrees of swallowing difficulty. Please seek advice from healthcare professionals and for their further assessment

• Avoid eating when not fully conscious e.g. just awaken from sleep
• Reduce environmental distraction
• Select food with appropriate texture e.g. purees, thick (creamed soup) or semi-thick liquids (pureed fruit juices)
• Use appropriate utensils or feeding modules e.g. small spoon, enlarged-handle spoon, adapted chopsticks, etc.
• Keep proper positioning (i.e. upright sitting, head in upright position and not tilted backwards)
• Oral-motor exercises can strengthen oral muscles and improve chewing ability, seek advice from a physiotherapist, occupational therapist, speech therapist or other healthcare professionals
• Select nutrient-rich food to improve nutritional status