Eating, Drinking and Swallowing Difficulties (Dysphagia)

What is dysphagia?

Dysphagia is difficulty, pain or discomfort when eating, drinking or swallowing – foods or fluids going “down the wrong way”

Difficulties with eating, drinking or swallowing can affect people at any stage in life including babies, children and adults.

Some individuals with dysphagia have problems swallowing certain foods or liquids, while others cannot swallow at all.

Dysphagia can improve, remain the same or get worse over time, depending on the underlying cause.

What are the signs of dysphagia?

Signs of dysphagia in both adults and children may include (but is not limited to):

• coughing or choking when eating or drinking
• change in breathing pattern when eating or drinking
• colour change after swallowing a food/drink
• bringing food back up, sometimes through the nose
• a sensation that food is stuck in your throat or chest
• persistent drooling of saliva
• being unable to chew food properly / prolonged chewing time
• a ‘gurgly’ wet sounding voice when eating or drinking
• difficulty holding food or fluid in the mouth
• spitting out food or saliva
• taking a long time to finish a meal / bottle / breast feed or refusing to eat
• weight loss
• recurrent chest infections

Causes of dysphagia

In adults, eating, drinking and swallowing difficulties are usually (but not always) caused by another health condition, such as:

• a condition that affects the nervous system e.g. stroke, head injury, multiple sclerosis or dementia
• head or neck cancers
• learning disabilities, physical disabilities
• gastro-oesophageal reflux disease (GORD) – where stomach acid leaks back up into the oesophagus
• COPD
• mental ill health

Eating, drinking and swallowing difficulties can also occur as result of aging, frailty or following recovery from an illness.

Statistics

Almost one in three people over 76 years of age living independently may have some swallowing difficulties¹rising to half of those living in nursing homes².

Percentages of patients with a medical condition that are affected by an eating, drinking or swallowing difficulty (Royal College of Speech & Language Therapists, 2019):

• 95% of people with Motor Neurone Disease
• 85% of people with Huntington’s Disease
• 68% of people with dementia in care homes
• 65% of people who have had a stroke
• 50% of people with Parkinson’s Disease
• 33% of people with multiple sclerosis
• 32% of people with Alzheimer’s Disease
• 25% of people with traumatic brain injury
• 15% of people with a learning disability

References:

1. Smithard, DG (2016) ‘Dysphagia: A Geriatric Giant’ iMedPub Journals Vol 1.2. No 1:5
2. Royal College of Speech and Language Therapists (2020) ‘Giving Voice to People with Swallowing Difficulties’

Problems swallowing difficulties can cause

Aspiration and choking

When someone has a swallowing difficulty, food & fluid can go down the wrong way into the lungs (aspiration) which can lead to chest infections or pneumonia (known as aspiration pneumonia). Swallowing difficulties can also lead to choking.

Aspiration pneumonia and choking can be fatal.

Weight loss and malnutrition

Often people find they eat less because meals can take much longer to eat and are less enjoyable. There may also be certain foods they are unable to eat safely so they may have less variety in their diet.

Poor nutrition affects every system in the body and always results in increased vulnerability to illness and increased health complications. Losing weight rapidly can lead to loss of muscle strength, which can affect an individual’s ability to mobilise and care for themselves independently.

Older adults should note that frailty / weight loss is not an inevitable part of aging. If you or someone you are caring for is losing weight unintentionally, contact your GP.

You can find out more about malnutrition and work out if you are at risk at
www.malnutritionselfscreening.org/

Dehydration

Often people drink less because they are anxious about choking on drinks or dislike drinks that have been thickened. This can lead to problems such as urinary tract infections, tiredness or constipation.

Opportunities to get involved

If you have experience of living with an eating, drinking or swallowing difficulty or are caring for someone who does and would like to get involved, please contact us.

Please send your name and contact details to: dysphagia.supportteam@northerntrust.hscni.net.

Further details are available on the Engage website.