Swallowing difficulties in older adults, when recognised early, can help prevent unnecessary hospital admissions. The medical term for difficulty swallowing is dysphagia. When food or fluid enters the lungs instead of the stomach, this is called aspiration, and it can lead to serious chest infections.
Dysphagia and aspiration are most common in the early stages after a stroke, because of changes in the brain. Swallowing difficulties can also develop in the advanced stages of Parkinson’s disease, Alzheimer’s disease, and brain cancer, or in any condition that affects cognition.
When the brain is affected, the areas that control swallowing can become impaired. This disrupts the network of nerves and muscles that work together to move food safely from the mouth to the stomach.
Signs and Symptoms of Swallowing Difficulties
Damage to the nerves or muscles anywhere along the upper airway and upper digestive tract can cause dysphagia. Families and carers should watch for the following signs.
1. No cough in a stroke patient
A missing cough may mean the patient cannot sense food or fluid entering the airway. A weak gag reflex may also mean they cannot swallow reflexively. Coughing is an important defence that helps clear the lungs of aspirated material.
2. Coughing after drinking
Coughing after sips of water or other fluids can signal weakness in voluntary swallowing. It can also mean reduced sensation at the back of the throat caused by nerve damage.
3. Weak or changed speech
The muscles used for speech sit close to the muscles used for swallowing. Weakness in speech can therefore be an early sign of swallowing difficulties.
4. Excessive drooling
People with Parkinson’s disease produce less saliva, so drooling is usually a sign that they cannot swallow automatically. They may need to be reminded to swallow.
5. Secondary warning signs
Watch for weight loss, avoiding certain foods, dehydration, and repeated chest infections. These can all be secondary signs of dysphagia.
Testing for Dysphagia
Every stroke patient should have a swallowing assessment before being discharged from hospital.
Modern technology allows clinicians to use a camera to view the swallowing process and see whether food is going into the lungs. Because of nerve and muscle changes, food can collect in several small pockets in the throat. A camera assessment identifies exactly where the problem is, so the care plan can be precise.
Correct Positioning to Prevent Aspiration
Correct positioning is one of the simplest and most effective ways to manage swallowing difficulties at home.
- Sit upright for all meals and drinks, with the shoulders back.
- Tilt the chin slightly towards the chest while keeping the shoulders back, unless a speech therapist has advised otherwise.
Families are often unsure where the chin should be. A slight chin tuck helps position the epiglottis and narrows the entrance to the windpipe (trachea), which lowers the chance of food or fluid going the wrong way. The same position also helps people who struggle to swallow tablets, and it reduces the risk of choking and regurgitation.
Try it yourself. Our nurses show families the difference between drinking a sip of water with the chin slightly tucked towards the chest and drinking with the chin raised. You will feel the difference straight away.
Oxygen During Meals for Breathing Conditions
Patients with breathing conditions such as COPD (chronic obstructive pulmonary disease) or CHF (congestive heart failure) may need supplemental oxygen through a nasal cannula during meals. This keeps their oxygen levels stable while the throat focuses on swallowing. Oxygen use requires a physician’s assessment and a medical order.
Home Nursing and Physiotherapy for Swallowing Difficulties
Home care is recommended for older adults with dysphagia to help strengthen the muscles involved in swallowing. Speech and language therapists and physiotherapists use targeted exercises to strengthen these muscles and to help the patient keep a correct sitting position at mealtimes.
Home nurses from accredited organisations are trained to spot the signs and symptoms of dysphagia and to use safe positioning techniques that prevent aspiration.
When swallowing is no longer safe, some patients need tube feeding. Read our guide on PEG tube and tracheostomy care at home to learn how families and carers can be trained.
Why Choose Enayati Home Nursing
Enayati Home Nursing is recognised by Accreditation Canada International for providing safe home nursing care. Our teams are trained in:
- Patient safety
- Elderly care
- Parkinson’s disease
- Dementia and Alzheimer’s disease
- Stroke (CVA) care
If your loved one is showing signs of swallowing difficulties, contact us to arrange a home nursing assessment in Dubai.
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