Dysphagia affects 10% to 33% of older adults (1).
This article will explain the basics of dysphagia and the diets used in its treatment.
What is dysphagia?
Dysphagia is the medical term for difficulty swallowing, which can result in decreased ability to obtain adequate nutrition and hydration.
Different phases of swallowing may be affected for different people:
- Oral: issues with using the mouth, lips, or tongue to manipulate food
- Pharyngeal: relating to part of the throat from the back of the nose down the neck
- Esophageal: relating to the tube that connects the throat to the stomach
Who gets dysphagia?
Dysphagia can occur as a symptom of neurological disorders such as: stroke, multiple sclerosis, amyotrophic lateral sclerosis, myasthenia gravis, dementia, Parkinson’s disease, just to name a few.
Some suffer from dysphagia, particularly esophageal dysphagia, due to structural issues (e.g. strictures, malignancies, etc).
The elderly can suffer from swallowing difficulties after a generally debilitating event, such as a fracture. The muscles used in swallowing get weakened from decreased use just as the other muscles of the body do.
Dysphagia can also occur as a general part of aging for some of the geriatric population, as muscle mass decreases and generalized weakness occurs.
Signs and Symptoms
The following may indicate dysphagia is occurring:
- Coughing/choking during eating or drinking
- Loss of food/fluids out of the mouth
- Pocketing food/fluids in the mouth
- Food residue in mouth after meal
- Wet, sometimes gurgly voice
- Runny nose or watery eyes while eating
- Poor intake of food/fluids
- Prolonged chewing/moving food around mouth
- Throat clearing
- Weight loss
- Complaints of food not going down or foods getting stuck
- Tongue thrusting
It is also possible for some to not exhibit any obvious signs. During some dysphagia, “silent aspiration” may occur. Food or fluids may be going into the lungs without any observable indication. Various testing methods are used for diagnosis.
Mechanically Altered Diets
Changing the texture of food and fluids is used for the treatment of dysphagia. Dysphagia diets consist of altering food’s texture to make them easier and safer to chew and swallow.
IDDSI: International Dysphagia Diet Standardisation Initiative
While National Dysphagia Diets are still widely followed in healthcare settings across the U.S. there is a current initiative to move towards the international standardized dysphagia diet framework.
Read IDDSI Explained to learn more.
National Dysphagia Diet Level 3: Dysphagia Advanced
This dysphagia diet is a slight step down from a regular diet. Most foods are included as long as they are bite-sized, with the exception of anything very hard or sticky.
National Dysphagia Diet Level 2: Mechanically Altered
The main difference with this texture is that meats are mostly served ground (or minced) and moisture, from gravy or sauce, is preferable. Hard foods should be avoided: raw or fresh fruits and vegetables (except bananas), nuts, seeds, etc.
Some people may have increased difficulty with dry foods or naturally harder to chew foods like rice, corn, peas, beans, or pineapple.
This dysphagia diet may also be referred to as mechanical soft or mechanically ground in some settings.
National Dysphagia Diet Level 1: Pureed
The most “strict” or downgraded of the dysphagia diets.
Foods are cohesive and everything served is the consistency of mashed potatoes. This texture is the easiest to manipulate in the mouth and swallow.
Most foods and recipes and be pureed using a food processor (or blender on a smaller scale).
Liquids can be especially challenging to manipulate and swallow during dysphagia. Anything liquid at room temperature is considered a thin liquid. This includes jello, ice cream, and soup broth.
There are different levels of thickened liquids:
- Nectar thick or mildly thick
- Honey thick or moderately thick
- Pudding thick (spoon-thick) or extremely thick
Pre-thickened products can be purchased. Or different thickening agents can be used to thicken preferred beverages to the appropriate consistency. Gel or powder thickeners are commonly used.
With onset of dysphagia, people typically participate in speech therapy performed by a Speech Language Pathologist (SLP). This may be the health care professional that initially diagnosed the dysphagia.
Some people are able to recover from their dysphagia depending on their individual situation. For safe oral intake, swallow strategies may be required. Others will require long term altered diets or need to avoid high risk foods altogether.
In severe cases no oral intake whatsoever may be safe. These cases either require long term nutrition via feeding tube vs. palliative care. This is particularly common in end stage progressive diseases.
Aspiration Precautions are individualized safe swallow strategies to be used when eating and drinking with dysphagia or feeding someone with dysphagia. These strategies assist in safer swallowing to reduce the risk of choking and aspiration (when food or fluids go into the lungs).
These may include:
- Small bites and sips
- Alternating liquids and solids
- Avoiding gulping or chugging
- Avoiding shoveling food
- Tucking chin
- Sitting upright while eating/drinking
- Staying upright at least 30 minutes after meals
- Avoiding straw use
- Avoiding talking while eating
- Ensure mouth is clear of food residue after meals
Risks vs. benefits of Dysphagia Diets
Dysphagia diets are an effective way to eliminate or reduce the risk factors associated with dysphagia, however changing the texture of food and fluids does impact taste.
Some may decide, for quality of life or taste preference reasons, that despite risks of dysphagia they prefer to eat regular texture foods and drink thin liquids.
- Aspiration: food/fluids go into the lungs instead of down to the stomach
- Pneumonia: inflammation and infection of the lungs, which can be life threatening
While many older adults may encounter swallowing difficulty as they age, there are dysphagia diets and other interventions that can be utilized to promote safe, adequate nutrition and hydration.
Now that you have an understanding of dysphagia diets, learn about therapeutic diets here.