Throat Muscles Get Old, Too
I’m not a Dr. or a nurse. I’m just the oldest daughter of a 95-year-old man, who although he is in an assisted living center and getting lots of good care, surprises us almost every week as a different part of him “wears out,” or ceases to function properly. So this blog is not medical advice. It’s just a cautionary tale of sorts about something else you need to be aware of as your aging patient or loved one gets older.
Until about a year ago, I did not realize that our throat muscles and the other parts of our body that help to safely execute swallowing can wear out or cease to function properly, right along with the rest of us. This can be a gradual process or can occur suddenly as a result of an illness or a dramatic event such as a stroke. The inability to swallow properly is generally referred to as dysphagia, and it can get to the point where it becomes dangerous for several reasons. Little did I realize that swallowing is such a complex process that depends on both automatic and voluntary actions in the mouth and esophagus. Check out Swallowing in Wikipedia for a primer.
If your elderly patient or loved one develops swallowing or choking problems, they probably won’t follow exactly the same course as what is happening to my dad. I’m just sharing his/my story to let you know you’re not alone and that different kinds of help are available.
One Man’s Story
My dad has had pneumonia seven times and is on oxygen 24/7 for the pulmonary fibrosis (lung damage) it has caused. His last episode was about a year ago. After a short period of hospitalization, he was sent to a rehab center to help regain his strength. While there, he frequently choked while eating, so extensive tests were ordered on his throat and swallowing process. What they discovered/reported then was that his throat muscles had weakened to the point where they were not automatically forcing food all the way down into his stomach. They also discovered that some of the pills he was taking were only making it as far as the opening to his stomach and just sitting there. They ordered that all his pills be crushed and gave him speech/swallowing therapy to help strengthen the weakened muscles and gave him some strategies to help the food go down.
That treatment seemed to help for a while, although his failing memory made it difficult for him to remember the strategies and continue the exercises. We had to keep reminding him not to talk with food in his mouth. Another strategy was to stop eating or drinking immediately, if he felt something was stuck in his throat, and to put his chin to his chest and force a voluntary second swallow.
In mid-December of 2014, circumstances necessitated that we move Dad to an assisted living/senior care facility. Without his wife there to watch him every time he ate, he began having choking incidents that were very severe. He scared all the other diners, and at least twice the staff called their doctor and the EMTs. He had periods of not choking at meals, but they became infrequent enough that additional tests were ordered.
I accompanied Dad to the throat imaging center, where I was allowed to watch on the screen as they had him eat and drink various foods and liquids containing barium. This time an even more dramatic conclusion was evident, even to me. Any time he drank a clear liquid, some of it went down his trachea (airway). Dad didn’t choke at all during the test. I was surprised to learn that in some elderly people sensation is impaired and aspiration does not provoke a cough response every time, which is a particularly dangerous condition. Liquids and sometimes food can go straight to the lungs, increasing the risk of pneumonia. In Dad’s case, they surmise that if enough liquid builds up and blocks the trachea, violent, long-lasting choking begins reflexively.
As a result of the test, the doctor ordered speech therapy and that Dad drink only liquids that are thickened to the consistency of nectar (like V-8 or the juice in a can of sweetened fruit). Fast-dissolving powders like Thick-It can be purchased over the counter at almost any pharmacy. I recommend that you get very specific orders from the doctor as to exactly how much of the powder to mix with a certain number of ounces of liquid. At first, the food services people where Dad lives were mixing in approximately 3 times the needed amount of powder, and he refused to drink it. When I called the speech pathologist and got the ratio of teaspoons to ounces, Dad was much happier with the results.
There is still a risk of dehydration if the patient does not consume enough liquids. Dad’s gerontologist told me that the caregivers of some resistant elderly patients have to decide which is more important—quality of life or the risk of aspiration.
Check with Your Doctor
I learned that Aspiration Pneumonia caused by swallowing problems causes about 40,000 deaths in the US each year. In light of the rapidly growing elderly population, attention to swallowing problems is becoming increasingly important. Beverly Unrath, DTN Home Care Partner/VP, told me, “We have had to refer clients for Speech Therapy to do swallow studies, and some of our clients are on thick fluid diets as a result. One popular drink our caregivers mix for clients on a thick fluid diet, is Ensure with ice cream. Ensure is full of nutrients and the ice cream makes it taste good!”
If your patient or loved one is choking frequently while eating or drinking, you should be aware that it’s a condition that could produce serious side effects and should be looked into by a medical professional.
By Marti Lythgoe, DTN Home Care Writer/Editor