Difficulty swallowing & coughing while eating in older adults
What to do about difficulty swallowing while eating in older adults
Older adults may experience a number of symptoms as they age or develop certain health conditions, and one common symptom shared by many older people is difficulty swallowing while eating. Here, we are exploring why some older adults may have problems with swallowing or coughing while eating, what dysphagia is and what causes it, the signs and symptoms to be aware of, treatment and support options for dysphagia, when to see a doctor about the issue, and how a home carer may be able to help.At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about dysphagia in older adults, we can help.
Why might older adults experience swallowing problems, or cough when eating?
Swallowing problems or coughing can be an indication of a long list of underlying issues, however when this happens during eating, it is usually referred to as dysphagia – the medical term for difficulty swallowing. This can affect any part of the swallowing process, from mouth to oesophagus. Some common reasonsfor developing this problem include:
- Age-related muscle weakening – This can affect the coordination and strength needed for swallowing, which can lead to difficulties swallowing and coughing when food becomes lodged in the throat.
- Neurological conditions – Conditions such as Parkinson’s disease, stroke or dementia can impair the nerves and muscles involved in the swallowing process. Dysphagia is thought to affect around 50% of older adults with neurological conditions.
- Chronic conditions – Anyone who suffers from chronic acid reflux, chronic obstructive pulmonary disease (COPD) or a similar condition might find they experience swallowing difficulties.
- Certain medications – Some of the medications commonly prescribed to older adults can have side effects that impact the swallowing mechanisms, such as dry mouth.
- Decreased saliva production – Producing less saliva is a common issue for ageing adults, which can make it difficult and uncomfortable to swallow food, increasing the risk of choking or aspiration.
- Dental issues – Many older adults suffer from issues with their teeth, and may require dentures. This can make chewing food more difficult, which as a result can make food harder to swallow.
Why is it important to address dysphagia in older adults?
For most people, swallowing is an almost unconscious process that happens without much thought, but for older adults experiencing any of the above issues, mealtimes can become stressful and even frightening if they fear they may choke on food. Dysphasia is thought to be particularly prevalent in older adults, with an estimated 50-75% of nursing home residents experiencing it. For this reason, addressing swallowing or coughing issues while eating is important for this age group, and could be crucial to avoid other health complications. For example, difficulty swallowing increases the risk of aspiration, meaning food or liquid enters the airway which can lead to issues such as pneumonia. If swallowing problems persist long-term, an older adult might also end up with nutritional deficiencies or dehydration due to limited intake of food and fluid, leading to potential weight loss, weakened immunity, and an overall decline in health. You may find our guide to the symptoms of dehydration in older people helpful to learn more.In addition, older adults taking regular oral medications may struggle to ingest these if they are unable to swallow medications in pill form. One study found that almost 60% of respondents had difficulty swallowing their medication. As well as the physical issues that could result from difficulties swallowing, not being able to eat can have effects on a person’s mental health, too. Anxiety around eating or even social isolation could start to develop as a result, which can have a negative impact on a person’s quality of life. Early diagnosis and management can prevent these complications, ensure better health outcomes, and help to maintain the wellbeing of older adults.
What are the signs and symptoms of dysphagia?
Those who suffer from dysphagia will be extremely aware of the problem themselves due to the sensation of food or liquid becoming stuck in the throat. However, for family members or care professionals looking after an older adult, knowing the signs and symptoms of dysphagia can help to know when intervention is needed, and could even save a life in extreme cases. With dysphagia, you may notice your loved one:
- Frequently coughing or choking during meals
- Regurgitating food
- Drooling
- Putting their hands on their throat while eating
- Making gurgling noises after eating or drinking
- Choking, or looking panicked while trying to swallow
- Unable to speak
- Losing weight for unexplained reasons
- Refusing food (you may find our article on handling appetite loss in older adults helpful to understand why a loved one is refusing food)
- Getting recurrent infections (such as pneumonia) due to aspiration
In some cases, there may be a need to cut food into smaller pieces or avoid certain foods altogether. If choking does occur, loved ones or carers should encourage the person to cough forcefully until the food is regurgitated. If this does not work and the person is conscious, back blows may be necessary, which means giving 5 firm hits to the area between their shoulder blades with the heel of your hand to dislodge the blockage.If food remains lodged in their throat and they cannot breathe, abdominal thrusts should be carried out as a first-aid procedure for a choking emergency:
- Stand behind the person and put your arms around their waist
- Make a fist with one hand and place it above the person’s belly button
- Grasp your wrist with the other hand
- Quickly jerk the fist into the stomach until the food is dislodged and coughed up
This can be an extremely scary experience for all involved, so focus on addressing dysphagia with the person’s GP if you can, and ensure their food is optimised for easy swallowing to avoid this situation.
Can dysphagia be treated?
Yes,dysphagiacan be treated, depending on the underlying cause and severity. If an older adult is having persistent difficulties swallowing and getting enough nutritional intake, a doctor will discuss treatment options. These might include undergoing swallowing therapy with a speech-language therapist who will teach the person exercises and techniques to improve their swallowing ability. They may also need to make dietary modifications – such as altering food textures and liquid thickness – in order to make swallowing easier and safer. If a doctor decides to recommend certain medical interventions, these might include treating the underlying conditions, such as acid reflux, in order to make swallowing easier. In some cases, surgical procedures may be necessary to address structural or muscular issues in the throat or oesophagus. In extreme cases, assistive devices such as feeding tubes may be used to ensure adequate nutrition and hydration for an older adult. Effective treatment for dysphagia usually relies on early intervention in order to fix the issues before they lead to any long-term damage to health.
When should you see a doctor about difficulty swallowing?
You should see a doctor aboutdysphagiasymptoms (or encourage a loved one to seek help for this) if you experience persistent difficulty swallowing, pain while swallowing, or you feel a sensation of food being stuck in your throat or chest. If you frequently cough or choke during meals, have unexplained weight loss, or notice signs of infection, you should seek urgent medical attention as this could be a more severe case that needs to be addressed promptly to avoid malnutrition, aspiration pneumonia, or similar infections.
How can a home carer help with difficulty swallowing?
Difficulty swallowing or frequent choking can be particularly scary and dangerous for older adults who live alone or who have additional health issues (such as mobility issues) limiting their ability to correct a choking situation themselves. Having a home carer with experience in this area could help to promote safety, increase confidence, and ensure nutritional and hydration needs are met. A carer might be able to help by:
- Preparing appropriate food textures and liquids to make swallowing safer and easier
- Ensuring the person eats and drinks slowly and takes small bites
- Providing a calm and supportive eating environment, and giving reassurance that someone is there to help if anything goes wrong
- Monitoring for signs of aspiration or choking
- Providing emergency assistance or calling for help if needed
- Encouraging and assisting with prescribed swallowing exercises
- Ensuring medication is taken correctly
- Keeping in regular contact with the person’s healthcare team to help them adjust care as needs progress
If you feel you or a loved one could benefit from support from a home care professional to help with swallowing difficulties or similar symptoms – and would feel safer knowing someone was there to help if needed – you can get in touch with your local Home Instead office to learn more.Our Care Professionals are the best of the best, and highly trained to deliver the services you need. No matter what type of home care you are looking for, we can provide a tailored service that suits you or your loved one. We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.
Michelle Tennant, Clinical Governance Lead
I am a Registered Nurse of 20 years and have been in the care sector since I was 17 years old, I have had experience in every role that exists in a care company, including Registered Manager, care consultant, recruiter, scheduling, auditing, complaints, and networking! My role in the National office is Clinical Governance Lead, and most recently have been working with DHSC and Chief Nurse Deborah Sturdy to develop a clinical governance framework for the delegated healthcare activities in social care, I am continuing to take the lead on our Healthcare at Home service and drive this in the network. In addition to my nursing role, I’m 4 years into my PhD in Aging at Lancaster University, with a key focus on the retention of Care Professionals in the social care sector.