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Dysphagia: Navigating Difficulty With Swallowing and Dementia

By | November 19th, 2020

Meals are often a time when friends and family gather. But older adults, especially those living with Alzheimer’s and related dementias, may be sitting out social dining events due as swallowing — and so, eating and drinking — becomes more difficult. Speech-language pathologists provide a primer on the conditions that cause trouble with swallowing, known as dysphagia, for people living with dementia.

Healthy people swallow about 600 to 1,000 times a day, with hardly any thought of the precise brain and muscular coordination that it takes to move food, liquid, saliva and medication from the mouth to the stomach. In older adults, this coordination may become impaired, leading to trouble with swallowing characterized by swallowing disorders collectively known as dysphagia. As many as 22% of older adults live with dysphagia — and its prevalence grows to between 40% and 50% for older adults who live in care facilities. 

According to Nicole Rogus-Pulia, a speech-language pathologist and an assistant professor of medicine at the University of Wisconsin-Madison, dementia and dysphagia often go hand in hand. People with dementia who experience dysphagia — along with its common symptoms such as coughing and choking during meals — will often recuse themselves from family dining, which can be isolating for them, and distressing for their loved ones, she said.

Being Patient spoke with Rogus-Pulia and speech-language pathologist Rinki Varindani Desai about how caregivers can spot dysphagia, and what steps to take.

Warning Signs of Dysphagia

Subtle signs of dysphgia include throat-clearing, during meals, or changes in voice quality, such as a wet or gurgly voice. According to Desai, at the University of Mississippi Medical Center, other symptoms include spilling food from the mouth, holding food, chewing for too long or fatigue. As Desai wrote in an article for the National Foundation of Swallowing Disorders, people with dysphagia may also avoid certain foods, experience weight loss, dehydration or repeated chest infections.

“I’ll have caregivers saying ‘Just do whatever you can to get my loved one to eat something,’ because they’re concerned that [their loved one] isn’t getting enough nutrition and hydration,” Desai told Being Patient. The lack of nutrition and hydration can lead to deconditioning of the body, reducing people’s ability to participate in activities of daily living. At the most extreme degree, malnutrition and dehydration can also be fatal. 

Causes of Dysphagia

Difficulty swallowing is considered, to some degree, part of the normal aging process, but experts say that the neurodegeneration in the brains of people with dementia likely compounds the decline, which may ultimately lead to dysphagia.

Other causes of dysphagia include age-related-illnesses like stroke and chronic obstructive pulmonary disease, Desai said, and hospitalizations related to such illnesses. Side effects of medications can effect people’s ability to swallow effectively. Cognitive impairment and attention deficits, Rogus-Pulia and colleagues wrote in a review article in Current Physical Medicine and Rehabilitation Reports, can impact people’s ability to swallow safely. Past research shows that people who have difficulties with staying oriented are at a 31 percent increased risk for liquid aspiration, which occurs when liquid enters the airway or lungs and can potentially lead to pneumonia. Those who are unable to follow single-step verbal commands have 57 and 48 percent increased risk for liquid and puree food aspiration respectively. 

Caring for Someone With Dysphagia

Desai wrote that caregivers can help prevent complications related to dysphagia by identifying its early symptoms and consulting with a physician who can refer them to a speech-language pathologist to assess and treat dysphagia. 

Following a clinical swallow examination by a speech-language pathologist, the pathologist may conduct further testing to determine the cause of a patient’s dysphagia and provide treatment.

Contact Nicholas Chan at nicholas@beingpatient.com

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