Older people in hospital - Swallowing problems

Swallowing is a complex process that involves numerous nerves and muscles of the mouth, throat and oesophagus.

If you cough or choke when you are eating, or find that food or medication ‘sticks’ in your mouth or throat, you may have a swallowing problem. The medical term for swallowing problems is dysphagia.

If you have a swallowing problem, it is important to find the cause so that it can be treated or managed. A swallowing problem can affect your health and your recovery.

Swallowing problems are more common in people who are very ill, people who have had a stroke, and people who have Parkinson’s disease or dementia. Some medication can also affect swallowing.

Signs and symptoms of swallowing problems

Common complaints by older people with swallowing problems while eating include:

• food or medications sticking in the mouth, throat or chest
• coughing or choking
• having undigested food or fluid coming out of the nose or mouth
• poor mouth hygiene
• tongue, facial or lip weakness
• a wet-sounding voice, or gurgled breathing after swallowing
• increased respiration (breathing) rate.

Some older patients will not report swallowing difficulties to hospital staff because they may:

• be embarrassed
• not want to eat when other people can see them
• not recognise the severity of the problem
• have difficulty communicating
• have been dealing with swallowing difficulties as a longstanding issue and have adapted their diet.

Addressing swallowing problems in hospital

Having trouble swallowing can cause much greater health problems if it is not addressed. There is a chance of choking, and of getting severe chest infections, including pneumonia, as a result of accidentally inhaling some food or drink.

If you have problems swallowing, it can be hard to get enough to eat and drink, and to take your medications, which can slow down your recovery. Swallowing problems can also make people anxious or depressed, or stop them being around other people, because they feel embarrassed.

Tips for when you are eating include:

• Make sure you are sitting up to eat.
• Brush your teeth or rinse your mouth before you eat.
• Take small mouthfuls.
• Take sips of water between each mouthful.
• Chew your food slowly and thoroughly.
• Don’t rush your meal.
• Minimise distractions while you are eating.

If you need it, ask for help with eating, drinking or sitting up. Eating well is important to your health and recovery.

Support with swallowing problems during your hospital stay

Tell hospital staff if you have or think you may have a swallowing problem, or if you have lost weight or often get chest infections. You may be referred to a speech pathologist for a swallowing assessment. Some patients (such as people who have suffered a stroke) are tested for swallowing problems as part of their normal care.

If you have a swallowing problem, ask for training for you and your family and carers in how to:

• prepare food and fluids
• brush and care for your teeth
• take your medication
• minimise the risk of choking.

If your swallowing problem is severe and you cannot be fed by mouth, your medical team will talk to you and your family about whether being fed by a tube through your nose or stomach would be a good option for you.

What to expect if you have a swallowing problem

If you have a swallowing problem, a management plan will be developed for you. You and your family or carers will be involved in creating it. Your speech pathologist will recommend a dietary plan as part of your treatment. It is important that your family and carers understand it and that you follow the recommendations.

Your management plan will treat the cause of the problem, as well as recommend changes to your diet if required.

Changes to help you swallow include introducing:

• more fluids, as being dehydrated can make it difficult to swallow
• easy-to-swallow foods, such as minced or pureed food or thickened drinks.

Nutritional supplements may also be recommended and your pharmacist may recommend changes to the way you take your medications.

Swallowing problems – when you are discharged from hospital

You may need regular support from health professionals when you go home. Your discharge plan will include what you are able to safely eat and drink and how to take your medications when you leave hospital.

Make sure you have all this information written down before you leave.

Where to get help

• Your GP (doctor)
• Allied health staff
• Nursing staff
• Patient liaison officer