Dysphagia, or difficulty swallowing, is a common condition that affects many older adults. As we age, changes in the muscles, nerves, and structures involved in swallowing can lead to problems with eating and drinking. Dysphagia is often progressive, meaning it tends to get worse over time. In this article, we’ll explore the reasons dysphagia becomes more prevalent and severe with advancing age and discuss what can be done to manage this condition.
What is dysphagia?
Dysphagia refers to difficulty moving food and liquid from the mouth to the stomach. This can occur at different stages in the swallowing process:
- Oral phase – Problems controlling food and liquid in the mouth, chewing, and moving the tongue to direct food to the back of the throat for swallowing.
- Pharyngeal phase – Difficulty initiating the swallow reflex to move food from the throat to the esophagus.
- Esophageal phase – Food gets stuck in the esophagus or moves too slowly into the stomach.
Dysphagia can range from mild to severe. With mild dysphagia, someone may occasionally need to swallow twice to clear food from the throat. More severe dysphagia can make eating and drinking very difficult or even dangerous if food enters the airway.
What causes dysphagia in older adults?
Aging brings many changes that can contribute to swallowing problems, including:
Weakened throat muscles
The muscles involved in swallowing naturally weaken over time. This includes the tongue, soft palate, larynx, and esophagus. Weaker muscles can’t push food effectively through the throat and into the digestive tract.
Less saliva production
Saliva helps moisten food to ease the passage down the throat. With age, saliva production decreases, making swallowing more difficult. Medications that cause dry mouth can exacerbate this problem.
Loss of sensation
Swallowing requires precise coordination of muscle movements directed by nerves in the face, mouth, and throat. Neurological changes associated with aging can dull the sensations needed to trigger and control swallowing.
Structural abnormalities in the esophagus or vocal cords related to hiatal hernia, esophageal strictures, or thyroid disorders may mechanically obstruct swallowing. Age-related loss of muscle tone in the upper esophagus can also impede the progress of food.
Remembering the proper steps of swallowing, paying attention during meals, and sensing food in the mouth are cognitive tasks. Dementia and other age-related cognitive declines interfere with these processes.
Many common medications have side effects that impact swallowing. These include medications that cause dry mouth, sedation, and muscle weakness.
Why does dysphagia tend to worsen with age?
The natural aging process causes many cumulative changes that make swallowing progressively more difficult over time:
- Continued weakening of throat muscles from lack of use and sarcopenia (age-related loss of muscle mass).
- Worsening nerve dysfunction and loss of sensation.
- Increased prevalence of many age-related health conditions that indirectly affect swallowing like stroke, Parkinson’s disease, and dementia.
- Higher usage of medications with side effects that impair swallowing.
- Greater likelihood of structural changes like hiatal hernia that obstruct the esophagus.
In addition, dysphagia itself can initiate a negative cycle of reduced food and liquid intake leading to further swallowing muscle weakness and atrophy.
At what age does dysphagia become more common?
While dysphagia can occur at any age, it becomes significantly more prevalent after age 50:
- Approximately 10% of people over the age of 50 have some degree of dysphagia.
- After age 70, estimates suggest 15-40% of independent older adults experience dysphagia.
- Among nursing home residents, dysphagia affects 40-60% of individuals.
- 85% of patients with neurological conditions like stroke, Parkinson’s, and dementia develop dysphagia.
So while difficulty swallowing can happen at any age, advancing age past 50 is the primary risk factor. Beyond age 70, the rates of dysphagia escalate rapidly.
Signs and symptoms of worsening dysphagia
How can you tell if someone’s swallowing difficulties are getting worse? Warning signs include:
- Coughing, choking, or gulping while eating and drinking
- Food sticking in the throat during or after swallowing
- Needing to swallow repeatedly to clear the throat
- Gurgly, wet voice after swallowing
- Nasal regurgitation as food escapes upward into the nose
- Unintentional weight loss from eating less
- Dehydration from avoiding thin liquids that are hard to swallow
- Frequent pneumonia caused by inhaling food contents
Worsening dysphagia is serious when it starts leading to negative health outcomes like choking incidents, aspiration pneumonia, weight loss, or dehydration.
Complications of progressive dysphagia
When dysphagia becomes severe and ongoing, a number of harmful effects can occur:
Malnutrition and unwanted weight loss
Difficulty swallowing often leads people to eat less or avoid foods that seem hard to swallow, resulting in inadequate calorie and nutrient intake. Unplanned weight loss and frailty frequently ensue.
Fluid intake is also reduced because drinking becomes laborious or dangerous. Dehydration can cause kidney issues, electrolyte abnormalities, confusion, low blood pressure, and hospitalization.
Food or liquid entering the airway when swallowed can introduce bacteria into the lungs. This causes aspiration pneumonia, a leading cause of death among those with dysphagia.
Severe dysphagia increases the possibility of choking on food that completely obstructs the airway. Choking can rapidly lead to death if not treated immediately.
Impaired quality of life
Progressive swallowing impairment takes away the pleasure of eating and drinking. Social isolation often results as sharing meals becomes difficult. Depression frequently ensues.
How is worsening dysphagia diagnosed?
Doctors use several approaches to evaluate dysphagia and assess whether it is worsening:
A speech-language pathologist performs a clinical swallow evaluation, watching someone eat and drink various textures to look for signs of impairment. This may include a bedside assessment or video fluoroscopic swallow study.
Unplanned weight loss, low protein levels, and electrolyte imbalances may indicate reducing food intake from advancing dysphagia.
Listening to the lungs for wheezing or crackles can reveal aspiration pneumonia caused by food contents entering the airway.
A camera inserted down the throat allows visualization of swallowing mechanics to identify blockages or weakness.
Standardized surveys help quantify symptoms and track changes over time. Examples include the EAT-10 and the SWAL-QOL.
Testing mental status, attention, memory, and dementia provides insight into how neurological issues impact swallowing coordination.
Can dysphagia ever improve with age?
For the majority of older individuals, dysphagia is a progressive condition that worsens over time without treatment. However, in some cases, it is possible for age-related dysphagia to stabilize or even improve. Reasons this can occur include:
- Effective swallowing therapy exercises to strengthen throat muscles.
- Adjustments to food and liquid textures to make swallowing easier.
- Treating underlying medical conditions impacting swallow function.
- Improved oral health and dental status.
- Stopping medications that impair swallowing.
- Addressing acid reflux that burns the throat.
- Removing obstructions, like with esophageal dilation for strictures.
- Using assistive devices that aid swallowing mechanics.
- Adding feeding tubes to provide nutrition if needed.
While dysphagia typically worsens with advancing age, targeted interventions can sometimes restore swallowing function or prevent continued deterioration.
Treatments for worsening dysphagia
To reduce the impacts of progressive dysphagia, the following treatments may help:
Altering food textures and liquid thicknesses can make eating and drinking safer. Examples include pureeing solids and adding thickeners to liquids.
Tucking the chin down or turning the head when swallowing uses gravity assist food passage. Special chairs that tilt forward improve swallowing posture.
Oral motor exercises strengthen the muscles involved in swallowing. Effortful swallowing techniques help force food down.
Certain medications reduce saliva thickening, improve esophageal motility, or have other helpful effects on swallowing.
Specialized cups, straws, and utensils make drinking and eating easier for those with limited lip and tongue control.
Alternative feeding methods
If oral intake is unsafe, feeding tubes provide nutrition directly to the stomach or small intestine.
Procedures like cricopharyngeal myotomy or dilating esophageal strictures can remove obstructions inhibiting swallowing.
Preventing dysphagia progression
While dysphagia usually worsens with age, several strategies may slow its progression:
- Performing regular swallowing exercises to maintain muscle strength.
- Staying adequately hydrated to avoid throat dryness.
- Eating a balanced diet to prevent malnutrition.
- Treating reflux, dental issues, and sinus problems that impact swallowing.
- Using medications judiciously and discontinuing any linked to dysphagia.
- Quitting smoking and excessive alcohol which irritate the throat.
- Practicing steps to reduce risk of strokes like controlling blood pressure.
- Getting early treatment for neurologic issues like Parkinson’s that affect swallowing.
- Using chin tucks and other compensatory techniques when swallowing.
While dysphagia cannot always be prevented, identifying it early and taking proactive measures may help slow worsening.
Coping strategies for progressive dysphagia
Living with advancing difficulty swallowing can be challenging. Helpful coping strategies include:
- Following recommended diet modifications and using adaptive utensils.
- Allowing plenty of time for meals and focusing fully on swallowing.
- Positioning yourself optimally for gravity assist.
- Performing exercises to maintain swallowing muscles.
- Staying socially engaged even if you cannot eat with others.
- Asking for help from professionals like speech therapists.
- Communicating openly with family who can provide support.
- Staying positive and reminding yourself treatment can help.
- Joining support groups to connect with others managing dysphagia.
While dysphagia can be demoralizing, employing constructive coping techniques helps preserve quality of life.
Outlook for progressive dysphagia
The long-term outlook for worsening dysphagia depends greatly on the individual’s health status and access to treatment:
- With prompt therapy and lifestyle changes, some fully regain normal swallowing.
- For many, dysphagia plateaus to a managed chronic condition with careful intervention.
- Without adequate treatment, progressive malnutrition, dehydration, and aspiration pneumonia occur.
- End-stage dysphagia may necessitate alternative feeding through a tube to prolong survival.
- Severe chronic dysphagia is associated with high mortality, especially when complicated by aspiration pneumonia.
While the overall trend is toward declining swallow function, proper supportive care can slow deterioration and extend quality survival even with advancing dysphagia.
In summary, key points to remember include:
- Dysphagia, or swallowing impairment, is common in older adults and typically worsens with age.
- Age-related changes to muscles, nerves, sensation, cognition, and physical structures all contribute to dysphagia progression.
- Worsening dysphagia increases risks of choking, malnutrition, dehydration, and aspiration pneumonia.
- Targeted swallowing therapies, diet modifications, and compensatory techniques can help manage declining swallow function.
- Preventive strategies like swallowing exercises may slow the worsening of age-related dysphagia.
- Coping methods and social support are invaluable for living with advancing dysphagia.
Though dysphagia often progresses with age, a proactive approach combining treatments, adaptation, rehabilitation, and psychological support offers the best outcomes.
Difficulty swallowing is a common and potentially serious issue among older adults that typically worsens with advancing age. Aging brings many cumulative changes to the swallowing mechanism that make eating and drinking progressively harder. Without proper management, complications like choking, malnutrition, dehydration, and aspiration pneumonia can occur. However, various therapeutic interventions can help maintain nutrition and hydration and may improve swallow function or prevent continued deterioration. Coping strategies and community support resources are also invaluable for preserving quality of life. While dysphagia usually advances, an individualized treatment approach focused on adaptation and rehabilitation provides the best prognosis.