By Chef Beth Scholer, CC, CDM, CFPP
Growing older affects the body’s ability to get vital nutrition and stay hydrated - from a reduced sense of smell and taste to slowed digestion to changes of the swallowing reflex. Dysphagia is the term used to describe difficulty chewing and swallowing. It can caused by physiological changes from age or chronic disease like Alzheimer’s. As many as 600,000 people are affected each year, with that number growing as baby boomers continue to live longer.
Who is At Risk?
Individuals advanced in age, with late-stage dementia, those who have suffered a stroke or with Parkinson’s or other neurological conditions are at highest risk for dysphagia and related complications.
Along with poor food and fluid intake concerns, choking and aspiration (food entering the airways or lungs), respiratory infections, aspiration pneumonia and even pressure ulcers (skin breakdown) are common complications.
Individuals advanced in age, with dementia, stroke, Parkinson’s or other neurological conditions are at highest risk for swallowing disorders and related complications.
While the term dysphagia sounds technical and complex, caregivers can take simple steps to lessen the risk through changes to food choice, texture and mealtime management. Advanced cases should be referred to medical professionals who specialize in swallowing disorders.
Serve with Caution
It is very important to respect an elder’s food culture and serve favorite foods, but some may pose a risk for choking or aspiration. Be very careful when serving round foods like grapes, meatballs, hot dogs or sausages. Avoid tough pieces of meat, raw fruit or vegetables, corn, peas or black beans, hard or chewy candy and nuts or seeds. Sticky foods (think peanut butter), soft bread or starchy pasta can block the airways. Crunchy foods like chips and crackers are also hard to swallow.
Better Food Choices
Many favorite foods can be modified in size or texture to lessen the risk. Cut into bite-sized pieces, mash, shred, grind or puree foods to ease swallowing or if chewing is too difficult or exhausting. Make sure foods have a moist consistency or serve with extra gravy or sauce. Below is a list of safer foods:
Flaked fish, ground meat or meat and poultry that has been finely sliced and served with gravy.
Creamy or pureed soups (without chunky meat or vegetables)
Cooked (canned) fruit and vegetables, applesauce
Lightly toasted bread with butter
Short pasta pieces (elbows, penne) with extra sauce
Pudding or gelatin, ice cream, sorbet or popsicles
Thickened beverages and small (1/2 cup) portions of fluids
The body’s position and alignment of the digestive system also play a role. Support the elder’s head and body by having them sit upright in a chair with armrests. The hips should be back, and the weight centered. Position the chair close to the table and have the elder slightly tuck the chin when eating and drinking. If sitting isn’t possible, consult a medical professional for advice.
Other Mealtime Tips
Make sure the elder is fully awake and alert before serving a meal. Remind them to eat slowly and chew each bite carefully. Encourage 1 drink for every 5 bites of food to help clear the mouth. If dementia is affecting an elder’s cognitive function, additional interventions may be needed. Learn more in the course Mealtime with Alzheimer’s and Dementia.
Sit near the elder during mealtime, but don’t engage them in conversation while eating – talking and chewing don’t mix. If distraction is a problem, turn off the TV or radio or ask others to leave the room. When eating is complete, always check the cheeks for food left pocketed (not swallowed).
Enlisting Medical Professionals
If you are concerned with an elder’s ability to safety chew and swallow, consider contacting an Occupational Therapist or Speech-Language Pathologist for a swallowing evaluation. They can recommend a modified texture diet and even teach elders techniques for safer chewing and swallowing.
While dysphagia can negativity impact an elder’s health and well-being, it doesn’t have to. Partner with a therapist, direct care staff and others on the care team to make significant improvements to mealtimes and their nutritional health.
Herrick, Jean. Dysphagia, Aspiration and Choking. No Date. Accessed 1-17-2019. https://shriver.umassmed.edu/sites/shriver.umassmed.edu/files/documents/Aspiration%20Webinar_full%20page%20slides2.pdf
Sura, L. Madhavan, A. et al. Dysphagia in the elderly: management and nutritional considerations. (2012) Clinical Interventions in Aging, 2012 (7): 287-298.
 Chef Beth Scholer, CC, CDM, CFPP, is a food scientist, culinary instructor, author and founder of Caregivers Kitchen. She is passionate about empowering caregivers to make positive nutritional changes and mealtime meaningful for those in their care. She can be reached at firstname.lastname@example.org.