Swallowing Problems in the Elderly

Updated on May 18, 2020
Eldercare Nurse profile image

I am a Registered Nurse specializing in geriatric care. My patients tell me I do a good job explaining complex medical concepts.

Swallowing difficulties—or “dysphagia”—are particularly common in the elderly and can lead to dehydration and malnutrition. Dysphagia can be related to a variety of other medical issues, or it can occur as a part of the progression of dementia.


Brief Overview of the Swallowing Process

Although the act of swallowing seems like a no-brainer, it is actually a fairly complex process involving a variety of nerves, as well as voluntary and involuntary muscles. The swallowing process can be broken down into three distinct stages: oral, pharyngeal (throat), and esophageal (esophagus). Swallowing problems can occur during any of these three stages.

During the oral stage, food is moistened with saliva as it is chewed, and it is formed into a soft, easy-to-swallow ball called a “bolus.” The bolus is then propelled by the tongue toward the back of the mouth in preparation for swallowing.

In the pharyngeal stage, involuntary muscle activity occurs to close off the airway, preventing food from entering the nasal cavity, trachea, and lungs. The food is then swallowed and propelled into the esophagus.

During the esophageal stage, a series of involuntary muscle contractions moves the food down the esophagus to the stomach.

Causes of Swallowing Problems in Older Adults

Swallowing difficulties in adults can be caused by conditions that are structural, neurological, or muscular in nature. Determining the cause of the problem can be helpful in coming up with strategies to improve swallowing.

In the elderly, poor dentition--no teeth or ill-fitting dentures--is a common cause of swallowing problems, and is one of the more easily addressed issues. Decreased saliva secretion caused by medications or dehydration can make formation of a soft, easy-to-swallow bolus difficult.

Neurological diseases such as Parkinson’s, Multiple Sclerosis, and ALS frequently cause swallowing problems as the disease progresses. GERD and acid reflux can cause esophageal narrowing due to the formation of scar tissue. Stroke survivors may lack the muscle strength and control needed for safe and effective swallowing. Persons with cancers of the head or neck, or those who have sustained a head or spinal injury may also subsequently experience swallowing problems. People with Alzheimer’s will frequently demonstrate increasing difficulty with swallowing as the disease progresses.

Signs and Symptoms of Swallowing Problems

Most of the time people with swallowing problems will exhibit one or more of these signs and symptoms:

  • Frequent throat-clearing
  • Pain while swallowing
  • A sensation that something is “stuck” in the throat
  • Clear nasal secretions dripping from the nose
  • Coughing or choking
  • Shortness of breath
  • “Pocketing” food: food accumulates in the cheeks as the person continues to eat
  • A voice that sounds “wet” rather than clear
  • An increase in chest congestion after eating
  • Drooling and difficulty managing saliva

Stroke survivors and others with decreased sensation may sometimes not exhibit signs of swallowing difficulties. This may lead to a condition called “silent aspiration.” In silent aspiration, food “goes down the wrong pipe,” and ends up in the airway instead of the stomach, causing a type of pneumonia known as aspiration pneumonia.

Diagnosing Swallowing Problems

Aside from a thorough physical exam, a physician may order one or more tests to gain a better understanding of swallowing problems.

A “barium swallow” involves a series of xrays taken after the patient drinks a liquid containing radioactive barium. The barium helps to illuminate the throat and esophagus on the xrays so that they can be observed. The physician may then observe the appearance of different consistencies of food as they travel from the throat to the stomach, noting how the muscles involved with the swallowing process are functioning. The test also indicates whether food is being aspirated into the respiratory system.

The doctor may also recommend an endoscopy, or visual examination of the esophagus. This is performed by placing a thin tube with tiny camera down the throat so that the esophagus can be examined for any scarring, lesions, or ulcerations.

Coping With Swallowing Problems

Working with a speech therapist can be beneficial for those with swallowing problems because the therapist can recommend exercises to strengthen muscles involved with swallowing as well as safe swallowing techniques. The speech therapist can also make recommendations regarding diet.

Changing the consistency of solid foods and liquids can make a big difference, and a speech therapist can help to determine which consistency would be appropriate. Depending on the severity of the swallowing problem, changing from solid food to a minced or puree diet may be needed. Frequently, people with severe swallowing problems have a great deal of difficulty with regular-consistency--or “thin”-- liquids. A thickening agent can be added to liquids to make them easier to swallow, and a speech therapist can determine the correct consistency for liquids.

Suggestions for People with Swallowing Problems:

  • Sit in a quiet room with no distractions--people with swallowing difficulties need to focus on their swallowing!
  • Sit upright at a 90 degree angle with the head tilted slightly forward
  • Use a spoon for portion control, taking small half-teaspoon sized bites
  • Chew thoroughly
  • Swallow, then swallow again two or three more times to make sure all food is cleared from the mouth
  • A spoon can be used for thickened liquids to control portion size
  • Don’t use straws
  • Many medications can be crushed and mixed with applesauce for easy (but bad-tasting!) swallowing. Check with the doctor as to whether there are any medications that should not be crushed

Dealing with dysphagia can be very frustrating for older adults, especially for stroke survivors. It can lead to depression and loss of self-esteem, as well as malnutrition and dehydration. Providing emotional support to people with swallowing difficulties is crucial; they are facing the loss of one of their most basic functions, and it can be devastating. Offering words of encouragement and demonstrating patience can show them that you understand and care.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


    0 of 8192 characters used
    Post Comment
    • profile image


      2 years ago

      I cough every time I drink or eat something cold and often when I just see regular shoes that is not stop can you tell me what is that a sign of symptoms of a swallowing problem

    • FlourishAnyway profile image


      7 years ago from USA

      Extremely well put together and explained to the lay person. You have a gift for explaining. Nice job.

    • Eldercare Nurse profile imageAUTHOR

      Eldercare Nurse 

      7 years ago

      Thank you for your comments! As a new hubber it means a lot to know someone is actually reading my hubs.

      I think we've all had the experience of feeling like something is stuck in our throats--or didn't go down the right way--from time to time. But imagine if you were to feel that way every time you eat! It would totally take away any pleasure associated with eating, and would make it a frustrating and anxiety-provoking experience. I think it is important for caregivers to recognize how this impacts people on a daily basis.

    • old albion profile image

      Graham Lee 

      7 years ago from Lancashire. England.

      An extremely informative hub. I face these difficulties daily, everything you have said is correct. Thank you for making it clear to caregivers that understanding is required.

      Voted up and all / following.


    • L.L. Woodard profile image

      L.L. Woodard 

      7 years ago from Oklahoma City

      I found the information on swallowing difficulties informative and easy to read. It must be frustrating to lose a physical ability so many of us take for granted.

      Voted up and Shared.

    • Faceless39 profile image

      Kate P 

      7 years ago from The North Woods, USA

      This is a well-detailed hub explaining both the importance of swallowing, as well as the more scientific side of how we swallow, and why some people have trouble swallowing (dysphagia.)

      At first sight it may seem like a simple problem, but people suffering from dysphagia can suffer greatly, and their quality of life can take a downward turn. The author does a great job explaining how we can help someone with this problem.

      Voted up, interesting, and useful.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, healthproadvice.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://maven.io/company/pages/privacy

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)
    ClickscoThis is a data management platform studying reader behavior (Privacy Policy)