Meal planning is such a buzzword today. Many swear by its ability to streamline and simplify their lives. There are even apps to help people meal plan in their day to day lives. But, when it comes to swallowing difficulties, planning ahead is more than just a timesaver. In fact, it can be a downright lifesaver.
You probably take your ability to swallow for granted. Swallowing is often relegated to the back burner of our consciousness. Still, we’ve all had the scary experience of something going “down the wrong pipe.”
Sometimes, swallowing issues become a regular occurrence. When this happens, people can feel confused and upset—as if something they’ve relied on to function seamlessly their whole lives is suddenly betraying them.
If this happens to someone you love, they may start to dread mealtimes—fearful their swallow may not work like it should. They may feel alone, as if no one else shares the problem they’re facing. Thankfully, that’s not the case.
If your loved one is experiencing swallowing difficulties, this article is here to help both you and them. In it, you’ll learn about how swallowing works, the risks it presents, and what you can do to address and overcome them.
By the end, you’ll be a regular food detective, armed with all the knowledge you need to stay ahead of swallowing difficulties — before they put a damper on another meal!
What’s the Deal with Swallowing Issues?
Like many things in life—swallowing is one of those skills that’s more complex than it seems. Let’s unpack why.
According to statistics, it’s estimated anywhere from 10-33% of older adults experience difficulty swallowing. That’s a pretty significant portion of the order population.
But why do older adults struggle more with swallowing than other age groups? After all—they’ve been doing it longer. Doesn’t that suggest they should be better at swallowing than others?
On the surface, it does make sense—but when it comes to swallowing, it’s what’s below the surface that matters.
Our swallow mechanism is a surprisingly intricate system. It takes the work of more than 50 pairs of muscles to swallow. Plus, six of our twelve cranial nerves are involved in swallowing.
These muscles and nerves also need to work in perfect, coordinated timing in order to ensure our airway is closed and protected when anything is passing by.
The anatomy of our throats is such that the tube that leads to our stomach sits right behind the tube that leads to our lungs (your esophagus and your larynx, respectively). So, if things go wrong with the timing or coordination of your swallow—they can go really wrong, really fast.
Our lungs and airway aren’t meant to deal with food and liquid getting into them. This can cause pneumonia, or choking. Thankfully, our swallow mechanism has a couple fail-safes in place.
The first is our epiglottis. This small, spoonike flap of cartilage sits atop your voice box and helps protect it when you swallow. When your swallow starts, your brain signals it to fold down, covering the entrance of your larynx.
But, sometimes things still make it past this point. Your body’s next line of defense is your cough. It may feel awful to cough and cough when something sneaks into your airway. But it’s your body’s way of protecting your lungs.
Our body’s last line of defense when something makes its way into our airway is a bit unexpected. It’s our vocal cords.
Fun fact—the primary function of our vocal cords is not to create sound. Their main reason for existence is protecting your airway when you swallow. It goes to show how important airway protection is.
Now that you know more about the anatomy of and physiology of swallowing, let’s look at what can happen when things don’t work as they should.
What are Some Different Types of Swallowing Problems?
Before we dive deep into specific swallowing issues, let’s take a beat to understand how professionals look at the swallow process.
For clinicians who work with swallow function, it’s helpful to separate the swallow response into phases. This way, we can home in on the specifics when a person has difficulty.
The phases of swallow are—
- Pre-oral (aka oral preparatory)—this is what happens while you’re preparing to eat or drink something. Even before you take a bite or sip, your body and brain are getting ready. Sometimes, people with dementia and Parkinson’s Disease can have difficulty with this phase.
- Oral—this is the phase when the food or liquid is in your mouth. It involves your ability to chew, keep control of a bite or sip, and keep your bites cohesive. People recovering from strokes, traumatic brain injuries, as well as people with dementia, Parkinson’s, head and neck cancer, and ALS can often have difficulty with this phase. Even people with poor fitting dentures or muscle weakness can struggle here.
- Pharyngeal—this refers to the phase of swallowing that occurs in your throat. As we discussed, this phase can be fraught, because of the proximity of your airway. People recovering from stroke, dementia, Cerebral Palsy, Multiple Sclerosis, traumatic brain injury. ALS, and other movement disorders can struggle in this stage.
- Esophageal—once a bite or sip clears your airway, it moves into your esophagus. This is the tube that leads to your stomach. But it’s not always a smooth, one-way journey. People with acid reflux, ulcers, hiatal hernias, strictures, and esophageal cancer can experience difficulty with this phase of their swallow response.
Swallowing difficulties can range from mild, to moderate, to severe, depending on where, why, how often they occur, and the overall health of the person experiencing them.
The technical term for swallowing issues is dysphagia. This term derives from Greek origins—with dys meaning “bad” or “disordered,” and phag meaning “to eat.”
It should also be noted—people can have difficulties that span more than one phase. For example, many people receive a diagnosis of oropharyngeal dysphagia (a mix of oral and pharyngeal), or pharyngoesophageal dysphagia (both pharyngeal and esophageal).
If you’ve met one person with a swallowing problem, you’ve met one person with a swallowing problem. Some people have trouble swallowing solids, some liquids, some both. Some only struggle with pills. Others can eat many foods but may struggle with one or two.
The outward signs of dysphagia can also show up differently. Some folks cough. Others have a runny nose, or watery eyes. Some have a gurgly voice after they’ve taken a bite or sip. These can all be outward signs of dysphagia.
Still, some people have no outward signs something’s wrong when they swallow. This is known as silent aspiration, and it’s a big concern. While it’s difficult to say with certainty what percentage of people with dysphagia are silent aspirators—research shows the statistics are fairly significant.
That’s why the gold standard for understanding swallowing function is an instrumental assessment. This is a test that looks at what happens on the inside when a person swallows. There are a few options for these. You can learn more about them in this article.
What else can be done if someone you love struggles with swallowing?
Sometimes, making adjustments and modifications to what your loved one eats and drinks can make a big positive impact on swallowing difficulties. Let’s take a look at some of these.
How Can Meal Planning Reduce Swallowing Difficulties?
Many people with dysphagia can predict which items they’ll have trouble swallowing. This knowledge can help you know where to focus your efforts when meal planning and making tweaks to your loved one’s diet.
Many people with mild swallowing difficulties have trouble swallowing foods that are dry, crunchy, or crumbly. These folks also tend to experience dry mouth (a side effect of many different medications and issues, that can impact the ability to mix foods with saliva to swallow easily).
While one meal planning solution could be to avoid these foods, another would be to modify the texture of these items with liquids. For example—cornbread is dry and crumbly, but many people enjoy soaking it in milk or buttermilk. This changes the texture, making it easier to swallow. Similarly, a cracker is crunchy and crumbly, but eaten with sips of water or juice, it becomes moist and manageable.
Modifying the texture or viscosity of foods can be a powerful tool in preventing risks related to dysphagia.
For professionals who work with people with dysphagia and their families, The International Dysphagia Diet Standardization Initiative (IDDSI) developed a framework to help standardize the levels of diet modifications and liquid thicknesses.
Solid foods are generally divided into three categories—
- Regular solids—anything that’s not texturaly modified. This includes: salads, sandwiches, crackers, crusty bread, meats (whole or on the bone), apples, pizza
- Mechanical soft solids—some foods are naturally this texture, while others are modified to this consistency. This includes items like: soft cookies, pears, bananas, soft sandwiches, and pasta. It also includes modified regular solid items like ground or chopped meats.
- Pureed solids—as with mechanical soft foods, some items can be modified to fit this consistency. This also includes items like: pudding, yogurt, and mashed potatoes. For some, regular solid items can be blended to reach this consistency, allowing the person to still enjoy the taste, without the risks of consuming it in its typical consistency.
Knowing the specifics of these categories can take you far in planning ahead for making meals your loved one with dysphagia will not only consume without difficulty, but enjoy.
Many people benefit from the presentation of more mechanical soft food items during meals. These items are often very similar to regular consistencies and, in many cases, don’t even require modifications prior to being consumed.
Choosing softer food items for your loved one can be a major boon to your meal planning efforts with regards to swallowing difficulties. They often require less chewing, allowing people to conserve energy during meals, thereby increasing their enjoyment and intake, while reducing risks.
If not pre-modifying, you may need to offer to assist your loved one with their meats, as these tend to be items with which many people with dysphagia experience some level of difficulty.
You can grind meats using a food processor, or cut them into bite size pieces. Sometimes, serving drier, chewier meats with extra sauces and gravies can be helpful in easing related swallowing difficulty.
Some meats are naturally softer and less chewy to begin with. You may want to prioritize these, leaving items like steak either off the menu or for special occasions.
They say— “variety is the spice of life.” This is also true when it comes to meal planning. From both a taste and textural perspective, it’s good practice to offer your loved one with dysphagia a variety of options at each meal, and to tailor their meals to their swallowing abilities.
While many people balk at a fully pureed meal, most people enjoy pureed items such as mashed potatoes and gravy. These can be utilized to help ease the transit of other solids, making them easier to manage.
If your loved one struggles with their liquids and would benefit from drinking thickened liquids, either during or both during and between meals, there are several options for home thickeners available, from gels to powders, to pre-thickened items.
Because people on thickened liquids shouldn’t have ice cream (as it melts to a thin viscosity), there are even ice cream products that won’t melt and can be safely offered to people on thickened liquids. You can find one such option here.
While some people consider thickened liquids to be a bridge too far, they’re an important tool in the toolbox of dysphagia management. Many people who try thickened liquids find a few items they enjoy consuming, such as certain juices and milks.
While meal planning for your loved one, it’s important to ensure they have access to both nutritional foods and hydrating liquids. Maintaining your loved one’s adequate nutrition and hydration is vital in supporting their overall health and quality of life.
Now that you’ve mastered meal planning for safe swallowing, let’s learn some strategies you can help your loved one use to further reduce their risks during meals.
What Strategies Can be Used During Meals to Reduce Swallowing Issues?
Strategies can be a great way to compensate for swallowing difficulties. Especially when you have an understanding of the anatomy and physiology of swallow, these tips can be used to help your loved one successfully and safely navigate mealtimes.
Let’s explore some of the top strategies for compensating for swallow difficulties, as well as how they help—
The Hard Swallow—
You’ve heard the expression about two birds and one stone? This strategy embodies that proverb, because it works both in the moment to help you swallow safer and more effectively, AND over time to strengthen your swallow mechanism.
How do you do it? Well, you swallow, but you give it a little extra oomph. Imagine you’re trying to swallow a small rock, or a whole grape. Usually, when you try to swallow hard—you’re doing it. And, the more you practice the stronger your swallow mechanism will get. Hint—This one also works well for swallowing pills.
The Chin Tuck—
Remember in your throat, how your airway’s in the front and your esophagus is in the back? So, when you angle your chin down when swallowing, you’re narrowing your airway and opening up the top of your esophagus. In other words—making the anatomy work for you!
This strategy also works in another way, which is helpful for people who have a delay in getting their swallow going (like people with Parkinson’s). When you take a sip and experience a swallow delay—liquid can easily slip back into your airway while it’s open and unprotected. But, if you angle your chin downward during and after you drink—the liquid stays in the front of your mouth. So, even if you take a little extra time to swallow, it won’t cause a problem.
Other Helpful Tips—
There are other swallow maneuvers and strategies, but these can be complex to learn and are best taught directly by a Speech-Language Pathologist. They can ensure they’re the right strategies for the issue and are performed correctly—we don’t want to increase any risks your loved one may have.
At home, the best safe swallow strategies (apart from those explained above) are fairly common sense. Still, it’s helpful to review so you can see any areas you can improve, as well as recognize where you’re already doing well.
Here are some additional tips to keep swallowing safe and effective—
- Focus on small bites and sips
- Eat slowly, chew bites effectively before attempting to swallow
- Sit upright during and following meals (to reduce risks for reflux)
- Take sips of liquid in between bites
- Make sure the mouth is clear, between bites and when the meal is done
- Practice good oral care—a clean mouth is a happy mouth!
- Use your tongue to keep the space between your cheeks and gums clear
- Reduce distractions during meals—focus is important for safe swallowing
Using these tips, your loved one can enjoy safer, more effective swallowing. When you assist them with remembering to use these strategies, and help them consume the best range of textures for them, you’re offering the support needed to make mealtimes an enjoyable experience again. Thanks for all you do.
At WayWiser, it’s our mission to offer helpful info and insight into the issues you face, caring for an ill or aging loved one. Check out our blog for tons of great articles, covering topics of interest for caregivers like you.