By Lauren Mahakian Contributing writer. Originally published in Santa Ynez Valley News on 4/28/2021

The English language is filled with both simple and complex words. When someone uses an overly complex word in ordinary circumstances, they’re sometimes accused of using a ten-dollar word when a less expensive word would do.

Dysphagia might seem like a ten-dollar word used to describe trouble swallowing. Like most expensive words, however, there is much more to the meaning than we might see at first. There’s a reason these words exist, of course, and dysphagia is no laughing matter.

Dysphagia is a medical diagnosis associated with trouble swallowing. Unlike occasional difficulty swallowing, which might result from eating too quickly or not chewing food properly, persistent dysphagia often requires medical attention. When it occurs in people with dementia, it presents additional challenges for caregivers, especially family members who are neither trained to assist with dysphagia nor prepared to deal with family and other social impacts.

How common is dysphagia in dementia?

Dysphagia is surprisingly common among older adults, and more so among those with dementia and Alzheimer’s disease. In fact, studies suggest that over 20% of older adults live with dysphagia, with double that rate for those in care facilities. Dysphagia is even more common among those with dementia and worsens as the disease progresses. Some estimates suggest rates as high as 80% among those living with dementia in care facilities.

What causes dysphagia?

Studies point to multiple causes in dementia patients. These include causes related to memory, such as forgetting to chew or swallow. They also include damage to the brain that results in motor impairments or sensory impairments, just as similar damage leads to memory impairments. In these cases, damage occurs to parts of the brain that control swallowing, something most of us take for granted.

How to identify dysphagia

Chronic dysphagia is challenging to identify in its early stages. Most professionals describe early symptoms as subtle, only recognizable in hindsight long after they become worse. These symptoms commonly occur during meals, so vigilance at these times can help spot the situation early and indicate that it’s time to bring in a medical professional for evaluation and diagnosis.

If your loved one is diagnosed with dementia, be aware of the symptoms and don’t take small problems for granted. Many of the symptoms to watch for happen during or shortly after meals. Chewing may become a challenge, and your loved one may expend more energy and take more time to chew. Pay attention to how long your loved one holds food in their mouth, especially if accompanied by even minor choking. Coughing or throat clearing is common in dysphagia, notably after taking a drink. Drooling is equally common for many sufferers, including excess saliva production or spilling food or liquid out of their mouth. Many professionals also note wet or gurgly voices as a warning sign.

In the longer term, loved ones may completely stop eating certain foods and suffer weight loss or dehydration. Eventually, they may start avoiding meals altogether and isolate themselves.

Seeking proper care

As with most issues related to dementia, the key is to always remain calm and seek to understand how your loved one is feeling. Consult with professionals as necessary to help with the process.

Avoid certain food that your loved one has difficulty chewing or swallowing. Certain soft foods may be easier to eat. Some foods might need to be pureed or chopped, a so-called mechanical soft chopped diet that you can find with a quick internet search. Thicker fluids are also less likely to cause choking than watery liquids.

If your loved one is unable to feed themselves, you’re probably aware of the importance of positioning for eating. It’s tough for anyone to swallow with their head too far forward or backward — try it for yourself. You can help by sitting opposite your loved one at eye level. Eye contact then helps assure proper head position for swallowing.

Since we’re on this subject, we can’t ignore the importance of good oral hygiene. Ensure your loved brushes their teeth and maintains good dental practices since oral pain may make eating even more difficult. If your loved one wears dentures, consult with the dentist to assure they’re fitted properly and comfortably.

If you care for someone living with dementia, watch for signs of dysphagia. When in doubt, consult your physician or a speech and language therapist. Addressing these issues early will help both physical and mental health.

Lauren Mahakian is a certified care manager. Check out her free podcast, Unlocking the Doors of Dementia™ with Lauren and Free Support Groups on Zoom.

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