Swallowing difficulties, known as dysphagia, can pose significant challenges for seniors. It can affect their ability to eat, drink, and maintain proper nutrition, leading to potential health risks. However, with the right support and strategies, seniors with dysphagia can still enjoy a safe and fulfilling eating experience.
In this article, we will explore tips for supporting seniors with dysphagia, including practical suggestions and recommendations to help caregivers and loved ones provide the best possible care for their senior loved ones.
What Is Dysphagia?
Dysphagia, medically referred to as difficulty swallowing, can manifest in various ways. It may involve challenges in swallowing specific foods or liquids, or an inability to swallow altogether.
According to Mayo Clinic, other signs and symptoms associated with dysphagia can include;
- Pain while swallowing
- Inability to swallow
- Sensation of food getting stuck in the throat or chest
- Regurgitation of food
- Frequent heartburn
- Food or stomach acid backing up into the throat
- Weight loss
- Coughing or gagging when swallowing
How It’s Diagnosed
Here’s a snapshot on the diagnosis process of dysphagia to give you an idea if you are planning to get tested or waiting for your appointment.
- A speech pathologist typically administers a swallow test to diagnose dysphagia.
- The swallow test involves the older adult swallowing a barium contrast solution while being continuously x-rayed.
- Different liquids of varying consistencies, such as water, nectar thick, honey thick, and pudding thick, may be used during the test.
- Additional tests, such as visual examination of the esophagus, endoscopic swallowing evaluation, esophageal muscle test, or imaging scans, may be needed depending on the severity of the condition.
- The x-ray swallow test is conducted to detect aspiration, which can lead to pneumonia or other serious conditions when liquid is accidentally swallowed into the lungs instead of the stomach.
If aspiration is present, doctors may recommend managing dysphagia with a diet consisting of thickened liquids and pureed foods.
Tips To Safely Manage Dysphagia at Home
When caring for someone with dysphagia, there are several important things caregivers should keep in mind to provide appropriate support.
Here’s what Daily Caring recommends seniors and their caregivers to remember when trying to safely manage dysphagia.
- Thicken medications safely.
If your elderly loved one previously took oral medications with water, they will now require a thicker beverage to swallow them.
Alternatively, the pills may need to be crushed and mixed with a thicker food, such as pudding or applesauce.
Crushed pills are often unpleasant in taste and can be hard for most people to tolerate, which is likely why they were originally in a coated form.
It’s a good idea to use sweet options like chocolate or vanilla pudding, applesauce, or other sweet foods to mask the bitter taste of medications.
- Avoid using straws
A speech pathologist may advise against using straws for seniors with dysphagia, depending on their condition.
Although straws may appear to be a helpful tool for drinking, they can actually increase the flow rate of liquids in the mouth.
This can make it harder for weakened muscles to properly direct the liquid down the esophagus, potentially resulting in choking or aspiration.
- Avoid ice cream and jello
Although ice cream and jello may be popular dessert choices among older adults, they are not recommended for those following a dysphagia diet due to the risk of aspiration.
This is because both ice cream and jello can easily melt in the mouth, resulting in a thin liquid consistency that may be difficult to swallow safely without the risk of choking.
People with dysphagia have slower tongue and jaw movements, which can delay the transit of food to the back of the throat for swallowing, allowing ice cream and jello to melt and become potentially hazardous.
- Maintain proper body alignment
Maintaining an upright posture while eating and drinking is crucial for individuals with dysphagia. This promotes the smooth passage of food and drink through the throat.
If your elderly loved one is in a hospital bed, wheelchair, or uses a recliner, you may need to adjust their backrest or assist them in keeping their head and upper body in an upright position while they eat and drink.
- Be mindful of timing
Consider timing when managing dysphagia symptoms in chronic illnesses like MS or Parkinson’s. Eating for more than 15 minutes can be exhausting due to fatigue and weakness.
A speech pathologist may recommend short, spread-out eating and drinking periods throughout the day.
Seek medical advice if you notice any swallowing issues. Collaborating with healthcare professionals can help maintain the health of older adults with dysphagia.
- Stay hydrated
Proper hydration is important when caring for older adults with dysphagia. Thickened liquids are necessary, but they take longer to drink, so caregivers need to be patient and attentive. Thickening agents can be purchased in drugstores or online as gels or powders to mix with beverages.
- Watch your nutrition
Many dysphagia patients struggle to obtain sufficient calories, vitamins, and minerals. Replacing meals with drinks like Ensure and Boost can be challenging due to difficulties in thickening them properly, as they contain protein and vitamins. Additionally, these drinks often contain high levels of sugar and artificial ingredients.
So here are other ways to include whole foods and nutritional ingredients in a dysphagia diet:
- High-fat foods like Greek yogurt, avocado, peanut butter, coconut cream, and soft cheeses can boost calorie intake for older adults in both sweet and savory dishes.
- Easily pureed foods such as winter squash, beans, steamed vegetables, and fruits are nutrient-rich and can be added to thickened soups and purees.
- Blending ice cream, heavy cream, milk, banana, squash, and peanut butter can create thickened shakes without artificial additives for those with dysphagia.
- Protein powders or therapeutic drink mixes may be recommended by nutritionists for seniors looking to maintain weight and build muscle.
Ways to Make Meals Easier With Dysphagia
- Carefully plan and serve meals, snacks, and beverages that conform to an SLP’s prescribed dysphagia diet.
- Consider thickening liquids with commercial thickeners or pureed fruit to prevent choking and aspiration.
- Note that the thickness of liquids should be determined based on the individual’s ability to chew and swallow.
- Serve foods with thicker gravies, sauces, or condiments to add moisture and aid swallowing.
- Allow ample time for meals to ensure adequate chewing and swallowing.
- Remove distractions during mealtimes to help the person focus on eating.
- Use eye contact and encouragement, such as visual cues, to assist with sipping or biting.
- Be attentive to cues indicating distraction, choking, or food remaining in the mouth.
- Ensure your loved one is sitting upright while eating, avoiding slumping or reclining.
- Schedule meals during times of the day when your loved one is most alert and cooperative.
- Consider serving smaller portions or finger foods for easier handling and eating.
- Be patient during mealtimes and allow autonomy for your loved one to finish their meal.
- Respect their choices and avoid being forceful.
- Show care and love on your face, rather than frustration with slow eating.
The Dysphagia Diet
The International Dysphagia Diet Standardization Initiative has created a diet plan for people with dysphagia. The dysphagia diet has levels that rate drinks and foods on a thickness scale from 0 to 7. Drinks are ranked from 0 to 4. Foods are ranked from 3 to 7, depending on thickness.
Levels of liquids in a dysphagia diet
Level 0 (thin): These are watery liquids, such as juice, tea, milk, soda, beer, and broth. You can drink them through a nipple, cup, or straw.
Level 1 (slightly thick): These are thicker than water. They need more effort to drink than thinner liquids but still flow through a straw or nipple.
Level 2 (mildly thick): These liquids flow off a spoon but more slowly than thinner drinks. They can be sipped or sucked from a straw with some effort.
Level 3 (liquidized, moderately thick): You can drink these from a cup or sucked from a straw with some effort. These are liquids that may be thick enough to be eaten with a spoon. An example is a thick milkshake. Their texture is smooth without lumps.
Level 4 (pureed, extremely thick): These are usually eaten with a spoon. You can’t drink them from a cup. An example is pudding.
Levels of a dysphagia diet
Level 3 (moderately thick): These are foods that do not require chewing, have a smooth texture without lumps, can be eaten with a spoon but not a fork, and are not stiff enough to hold shape on a plate like molded gelatin.
Level 4 (pureed, extremely thick): These foods can often be eaten with a spoon or sometimes a fork, cannot be drunk from a cup, do not need to be chewed, can be molded like gelatin, are not sticky or lumpy, fall off a spoon when tilted but still hold shape on a plate like pudding, and move slowly if the plate is tilted but cannot be poured.
Level 5 (minced, moist): These foods can be eaten with a fork, spoon, or chopstick with good hand control, can be scooped and shaped on a plate like mashed potatoes, are soft and moist but do not separate into liquid, and may have small lumps that can be mashed with the tongue.
Level 6 (soft): These foods are tender, moist, and bite-sized, can be eaten with a fork, spoon, or chopsticks without needing a knife to cut, and must be chewed.
Level 7 (regular): These are normal everyday foods with varying textures, including soft, stringy, hard, and crunchy, can be eaten by any method such as from a cup or using utensils, and need to be chewed with different textures that may have pieces that cannot be swallowed, such as gristle.
How to prepare dysphagia diet food
Seniors who have dysphagia require liquid food that is thick and smooth to ensure safe swallowing. When preparing liquid food, it is crucial to avoid any foods that could cause choking by chopping, mashing, or blending them. Some guidelines to follow include:
- Avoid purchasing or using foods with nuts, seeds, raisins, olives, or other solid pieces.
- Avoid purchasing or preparing foods with flaky, crusty, or crunchy textures.
- Cook vegetables thoroughly and add sauces to moisten them.
- Cook fruits thoroughly and remove any skins.
- Finely chop all cooked meats, remove skins, and add sauces for moisture.
- Chop all foods as finely as possible.
- When in doubt, mash or blend even full stews and casseroles to ensure a safe consistency for swallowing.
Meal Planning For Dysphagia Diet
When planning meals for a senior with dysphagia, it’s important to carefully consider the meal formats that are suitable for their condition. Some meal ideas to try include:
- Purees and milkshakes
- Soft casserole dishes
- Soft meats with pureed vegetable sides
Preparing these meals ahead of time and freezing them in containers can also save you meal-prep time during the week.
Preparing dysphagia recipes is relatively simple, as they often involve blending ingredients or cooking vegetables or meats. In fact, there are many delicious dysphagia recipes that can be made with just a few ingredients. Some popular dysphagia recipe ideas include:
- Crepes filled with strawberry yogurt: Prepare soft, thin pancakes and roll them up with your preferred yogurt.
- Scrambled eggs with avocado: Enhance scrambled eggs by adding avocado for added flavor and fillingness.
- Tomato basil soup: Roast plum tomatoes, then simmer with canned tomatoes, chicken broth, onion, garlic, and basil in a pot to make a delicious soup.
- Chicken Caesar salad: Create a quick salad by blending lettuce separately from chicken with sauces and spices, and then layering the pureed chicken on top of the pureed lettuce.
- Lasagna: Make lasagna using your favorite recipe and puree a portion for your loved one’s consumption.
- Peanut butter banana milkshake: Blend together peanut butter, banana, cocoa powder, and vanilla ice cream until smooth.
- Rice pudding: Cook rice, milk, sugar, and eggs in a pot, and add flavorings such as cinnamon or jams at the end to make a safe and tasty snack.
- Burrito bowl: Create a quick and delicious dinner by blending separately each ingredient for your burrito bowl, such as rice, black beans, lettuce, corn, tomato, avocado, and sour cream, making sure each is pureed before adding to the bowl.
- Sweet potato shepherd’s pie: Give your shepherd’s pie a nutritious twist by using sweet potatoes. Puree each layer, including the meat and sweet potatoes, to make it dysphagia-friendly.
- Cheesecake: Cheesecake can be enjoyed without alterations for dysphagia, but ensure that any toppings are soft for easier swallowing.
Managing Hydration With Dysphagia
Individuals with dysphagia may be more susceptible to aspirating thin liquids, which may require certain liquids to be avoided or thickened.
Hence, maintaining hydration for older adults with dysphagia requires some extra care. So here are some ways you can manage liquids for an older loved one with dysphagia, according to UC San Diego Health
- You can modify the thickness of liquids by using thickeners, which are flavorless gels, gums, powders, or other liquids.
- Thickeners can be added to any liquid to achieve the desired thickness, and can be purchased at pharmacies or medical supply stores.
- The package of thickeners typically includes instructions on how to use them.
- Alternatively, you can also buy pre thickened liquids, although they may be more expensive.
- If you have questions about preparing liquids with thickeners, consult with your SLP.
- It’s important to note that some people may not enjoy the taste or texture of liquids with added thickeners.
- Thickeners can potentially affect the flavor, cause early satiety, or form lumps.
- Different types of thickeners may have varying tastes, and some people may prefer premade products.
- Experimenting with different types of thickened liquids can help you find the ones that you enjoy the most.
Caring for seniors with dysphagia requires patience, understanding, and proper knowledge of the condition. By implementing the tips and strategies discussed in this article, caregivers and loved ones can play a crucial role in supporting seniors with dysphagia to maintain their health, well-being, and quality of life.
It’s important to work closely with healthcare professionals, follow recommended dietary guidelines, and ensure that seniors receive proper medical care. With the right approach, seniors with dysphagia can continue to enjoy meals safely and comfortably, ensuring that they receive the nutrition they need for optimal health.