Dysphagia (also known as difficulty swallowing) is a chronic health condition that causes eating and drinking function impairment. Dysphagia can be caused by nervous system dysfunction, brain disorders, muscle disorders, physical blockages and ailments as well as the natural aging process. For instance, over 80% of those suffering from Parkinson’s disease and more than 50% of stroke survivors experience dysphagia.

According to the NDIS Quality and Safeguards Commission, people with disabilities who have dysphagia are more likely to die from choking or respiratory illnesses or have serious health complications due to poor management. 

Individuals who suffer from dysphagia can experience increased fear of eating, prolonged loss of appetite, malnutrition, and serious complications such as aspiration pneumonia and airway obstruction.

Creating a Safe Eating Environment 

For individuals with dysphagia, creating a safe eating environment is crucial to minimising the risk of choking, aspiration and enhancing the overall dining experience to support healthy and balanced nutrition. 

According to the Aged Care Quality and Safety Commission, safer swallowing strategies are an important part of mealtime support and should be created in collaboration with the individual’s needs in mind. Some simple ways to ensure that those with dysphagia are supported during meal times, and engaging in safe and enjoyable mealtimes, are as follows:

Posture and Head Position

Ensure the person is seated upright (90 degrees) during meals to help with swallowing and reduce the risk of aspiration. The chin should be slightly tucked (chin-down position) while swallowing to help narrow the airway and reduce the risk of choking. The head and neck should always be aligned with the body, and utilising things like cushions or supports can help maintain stability.

Sturdy Seating

Sturdy chairs with armrests will help provide support when sitting and standing. Avoiding soft or excessively low chairs will also ensure that the individual’s feet are flat on the floor or on a footrest, and promote stability and comfort without stretching or straining.

Environmental Adjustments

Minimising distractions and noise can help those with dysphagia focus on swallowing. Adjusting the table height and creating a well-lit area to support increased food visibility. Encourage a slower pace during meals, allowing time for proper chewing and swallowing. 

Adaptive Utensils

The addition of adaptive utensils (such as specially designed forks and spoons or weighted utensils) can also help aid safer meal times. These utensils have added weight, angles or design features specifically created to assist individuals with limited or weakened grip strength or coordination.

By implementing these safer swallowing strategies, caregivers can create a safer and more supportive eating environment for individuals with dysphagia, helping to enhance their mealtime experience and reduce health risks.

Tools & Aids That Make Dysphagia Management Easier 

Managing dysphagia effectively often involves using various tools and aids designed to enhance safety, comfort, and independence during mealtime. This can include adaptive and weighted utensils that make use of built-up handles and angled designs for those with limited wrist mobility, deeper bowls for more manageable bites, two-handles for extra support and spouted or straw cups to better regulate the flow of liquid. 

Other feeding tools to help with dysphagia at home are feeding bottles (ideal for those who struggle with traditional cups), enteral feeding products and suction plates and bowls, which feature suction mechanisms that keep them anchored to the table and reduce spills.

Smart Food & Drink Modifications: Texture Changes and Thickened Liquids 

When managing dysphagia, making appropriate dietary modifications when it comes to food and drink textures is essential to ensure safe and comfortable mealtimes - as well as to ensure appropriate nutritional needs are being met. Integrating high-calorie and easy-to-swallow nutritional supplements and other nutritional drinks is a simple way to ensure that individuals meet their dietary needs, while also ensuring a seamless dining experience.

Some easy home remedies for dysphagia as well as dietary modifications that can be employed are as follows:

Pureed Foods

Foods that have been blended to a smooth consistency completely eliminate the need for chewing. Pureeing is a technique that can be used for foods that would traditionally risk choking or aspiration such as fruits, vegetables, proteins (mixed with gravy or broth) and grains (cooked and pureed with water or milk).

Thickened Food and Drinks

Thickened liquids and other thickeners are products that have been designed to create a consistency that is safer for swallowing; they flow slowly and are less likely to be aspirated. They can help prevent aspiration by allowing the throat more time to react while swallowing, and come in commercial powders and gels which can be added to existing liquids to achieve the required consistency.

Thickeners tend to follow the below consistency ranking: 

• Nectar-thick: Flows like nectar (e.g., fruit juices and smoothies) with a consistency that is thicker than water but still pourable.

• Honey-thick: Pours slowly and resembles a honey consistency (e.g., certain soups and gravies). Thicker than nectar but still manageable for many individuals.

• Pudding-thick: Very thick and hold their shape (e.g., yogurt, thin pudding). Difficult to pour, and meant to be eaten with a spoon.

Texture Modified Diets (Soft)

Consisting only of foods that are easy to chew and swallow, a texture modified diet means providing a diet of soft-textured foods that can be easily chewed and require minimal biting. According to the Agency for Clinical Innovation, a texture modified diet includes a variety of dishes that make use of soft proteins (such as tender meats, fish, eggs and legumes), soft fruits and vegetables (think bananas, cooked vegetables and applesauce), dairy (soft cheeses, yogurt and some puddings), and grains (including bread, oatmeal and pasta).

A texture modified diet can help make mealtime easier and less stressful while still providing essential nutrients where needed. However, to prevent complications during meals, it's important to avoid foods that are dry, tough, or sticky, as they can pose significant swallowing risks. 

Breakthrough Cancer Research have published an article detailing specific foods to avoid, which include: 

• Dry bread or crackers

• Mixed consistency foods

• Nuts and seeds

• Sticky candies or foods like peanut butter

• Stringy and fibrous foods

• Tough meats

• Raw vegetables or salad mixes

Simple Swallowing Techniques for Safer Eating 

Implementing specific swallowing techniques can significantly improve safety and enjoyment during mealtime for individuals with dysphagia. The following safe swallowing techniques can help reduce the risk of choking, and ensure that individuals can enjoy their meals more comfortably. 

Chin Tuck

While preparing to swallow, bring the chin slightly down toward their chest. This position helps narrow the airway and prevent aspiration. It also reduces the likelihood of food or liquid entering the airway and encourages better alignment of the throat structures during swallowing.

Pacing

Allowing for a slower eating pace, pacing involves taking more time between bites or sips and reducing the overall speed of mealtime. This will provide more time to chew and swallow effectively, minimizing the risk of choking, and allowing for better control over food consistency.

Small Sips

Instead of taking large sips or bites, take very small amounts of liquids or food at a time. This makes it easier to manage and swallow, reduces the risk of aspiration, and helps the swallow reflex respond effectively without becoming overwhelmed.

Controlled Chewing

Focus on thoroughly chewing food before swallowing, ensuring that it is adequately broken down (especially important for those on texture modified diets). This can help reduce the workload on the throat muscles and decrease the risk of choking.

Double Swallowing

After swallowing, wait a moment and then take another swallow for added safety, especially if there is uncertainty about a previous swallow. This will provide extra assurance that food or liquid has been fully cleared from the throat, and help prevent aspiration. 

These swallowing techniques can be integrated easily into mealtime routines by practicing in a calm environment, using visual or tactile cues such as using reminder cue cards during meals, and education of caregivers and family members that are likely to be around during mealtime.

Warning Signs That Require Medical Attention 

Recognizing warning signs associated with dysphagia is critical for ensuring timely medical intervention. Below are key warning signs that should prompt immediate medical attention:

Choking

If the individual suffering from dysphagia experiences a sudden inability to breathe or speak due to an obstruction in the airway, seek immediate action. If the individual cannot cough forcefully to expel the obstruction, consider performing the Heimlich maneuver or calling for emergency medical help.

Significant Weight Loss

Unintentional weight loss (a good rule of thumb is generally considered more than 5% of body weight in 6 months) can indicate a lack of adequate nutrition. Keeping track of weight changes can help identify whether nutritional supplements or other nutrition products are required.

Coughing During or After Eating

Frequent coughing while eating or drinking can indicate that food or liquid is entering the airway, suggesting a risk of aspiration. If coughing occurs repeatedly during meals, it’s essential to consult a healthcare provider to assess swallowing safety.

Breathing Issues

Difficulty breathing, wheezing, or shortness of breath during or after eating could be a sign of aspiration. Signs of aspiration can include coughing, choking, a wet or gurgly voice after eating, or the presence of a fever that might indicate aspiration pneumonia. Changes in breathing patterns or difficulty catching breath should be taken seriously and warrant medical assessment.

Conclusion 

Dysphagia is a challenging condition that requires careful management and tailored interventions to ensure safety and well-being during mealtime. Ongoing support from healthcare professionals, family, and caregivers is crucial in creating a safe eating environment and implementing effective swallowing techniques. By addressing dysphagia proactively, individuals can experience significant improvements in their quality of life, allowing them to enjoy safe and satisfying dining experiences while minimizing the risks associated with swallowing difficulties.

 

Sources

Aged Care Quality and Safety Commission. "Supporting safe and enjoyable mealtimes for people with swallowing difficulties." (ND).

Agency for Clinical Innovation. "Texture modified diet-soft-dysphagia." (March 2017).

Breakthrough Cancer Research. "Eating Well With Swallowing Difficulties." (ND).

Health Stand Nutrition. "Feeding Tools to Help with Dysphagia." (15 September 2021).

Mayo Clinic. "Unexplained weight loss." (17 August 2022).

National Library of Medicine. "Dysphagia in Parkinson's Disease." (21 November 2015).

National Library of Medicine. "Dysphagia after Stroke: an Overview." (1 September 2014).

NDIS Quality and Safeguards Commission. "Practice Alert: Dysphagia, safe swallowing, and mealtime management." (ND).

Therapy Insights. "Dysphagia Compensatory Strategies Cue Cards." (ND).

Wollongong Speech Pathology. "Enjoyable Mealtimes for Older People with Dysphagia." (ND).