Dysphagia in the Older Adult and the Role of Speech Language Pathology

By Megan Swavely, M.S., CCC-SLP
Speech-Language Pathologist

Speech-language pathologists play a lead role in helping older individuals swallow safely.

According to the Agency for Health Care Policy and Research over 60,000 Americans die each year due to complications associated with dysphagia, including aspiration pneumonia. SLPs can evaluate, educate, and train with an ultimate goal of improving swallow functioning.

Achieving this goal can bring about many positive outcomes for the individual, such as improved safety and overall quality of life improvements. Dysphagia treatment is often provided in the form of prevention and/or rehabilitation: improved swallow functioning to reduce the risk of aspiration pneumonia, in order to achieve each individual’s personal goals and maintain quality of life.

Dysphagia treatment can be provided in the form of prevention or management.

Prevention plays a key role for optimizing swallowing functioning. Preventing weight loss/muscle loss through meal selection, diet modification, home exercise programs, and compensatory strategy training is crucial to maintain gum structure for dentures to fit securely which aids in mastication, maintain muscle strength and endurance, promote a strong immune system, and maintain skin integrity.

Simple strategies and postures can be extremely effective for improving bolus control and tolerance of diet. By safely meeting a person’s hydration and nutrition needs, you can also reduce their risk of decline and maintain dignity of the person being treated.

Rehabilitation is dependent upon the area of deficit. Often times, the therapy program can include multiple approaches, thus increasing the likelihood of success. Impairments can be anatomical, physiological, or both. A person can experience one or more deficits in the different phases of swallow functioning: oral, pharyngeal, and esophageal.

ORAL

Oral phase can be caused by, but not limited to, poor regulation of size and rate of intake, difficulty cutting food, impaired self-feeding, positioning, attention, or alertness.
An oral deficit may result from weight loss, contributing to impaired denture fit or loss of dentition, resulting in reduced and/or ineffective management of the hard food, such as tough vegetables or meat. Weakness or loss of functioning can occur from neurological disease, as a symptom from other diseases, impaired appetite, or from generalized weakness.

PHARYNGEAL

Pharyngeal dysphagia symptoms can include globus sensation (I.e., “something stuck in my throat”), coughing, throat clearing, tearful eyes, wet vocal quality, or aphonic speech. A person can experience reduced airway protection, reduced sensory responses, and impaired respiratory-swallow coordination. Pharyngeal deficits can result in fear of choking, anxiety while eating or eating alone and reduced intake and aspiration pneumonia.

ESOPHAGEAL

Esophageal deficits, diagnosed by a gastroenterologist or radiologist, can be noticed or suspected during SLP interventions. This can lead to appropriate referrals to other professionals. Many people experiencing emesis, discomfort, or reverse aspiration can benefit from treatment with a speech pathologist.

Speech-language pathologists can educate residents, families, caregivers, and medical care providers for the definition, symptoms, etiologies, management, associated risks, and clinical reasoning for dysphagia. A trained and educated individual or caregiver can make wise decisions for menu selection and meal preparation, as well as problem solve when an issue occurs in order to continue safe meal consumption.

We can support a patient and family through difficult decisions related to alternative forms of hydration and nutrition and for end-of -life hydration and nutrition. Having a skilled professional to provide education and answer questions during difficult times can bring the family peace and support. Training can also be provided to promote comfort to the patient through reduced fluid overload, xerostomia management, and safely provided pleasure feeds.

There is a high prevalence of swallowing disorders in the aging population, but many people do not recognize their symptoms. They can also experience impaired motor or sensory responses. Or, older adults may not know that dysphagia can be managed.

A patient’s ability to swallow safely can result in improvement across many areas of a person’s life. Improved swallow functioning can increase their quality of life, continue to maintain their independence to age in place, meet their nutrition and hydration needs, maintain a strong immune system, and increase strength for management of chronic diseases. Dysphagia management can do so much more than just helping a person swallow.

This is a real FOX clinician and patient in photo, though they are not mentioned in this article.