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Difficulty Swallowing (Dysphagia) in the Elderly

Difficulty Swallowing (Dysphagia) in the ElderlyMany of the physiological processes otherwise taken for granted is affected to varying degrees with age. Swallowing is among one of these processes that can eventually be problematic or difficult for an older person. It may not affect every senior but difficulty with swallowing is among the more common age related problems. The medical term for any difficulty with swallowing is dysphagia. It should not be confused with another swallowing disorder which is known as odynophagia – painful swallowing.

In the elderly, swallowing problems greatly affects normal nutrition thereby leading to a host of complications which adversely affect one’s health. It should not be assumed that any difficulty swallowing with age is the norm – some of the causes can be very serious and even potentially fatal. In many cases with the elderly though, the difficulty is not actually with swallowing but proper chewing that ultimately causes swallowing problems. It is therefore imperative to differentiate with chewing and swallowing problems.

Normal Swallowing in Humans

Swallowing is a fairy complex process that involves multiple parts of the mouth, throat and brain.

  • First food has to be chewed thoroughly and mixed with saliva to form a small soft ball (bolus) with the help of the tongue and palate.
  • Then the tongues pushes this bolus to the back of the mouth where muscles relax to accommodate the mass. This is the part of swallowing that is voluntary.
  • At this point the complex and muscle movements take effect to push the ball into the throat. From here on the process of swallowing is involuntary.
  • Muscle contractions occur in a coordinated manner to propel the ball of food from the throat, down the esophagus and into the stomach.

It is essentially a three part process but difficulty swallowing (dysphagia) can be categorized as oropharyngeal (meaning mouth and throat) or esophageal (food pipe).

Causes of Difficulty Swallowing

Dysphagia (difficulty swallowing) is not a disease but a symptom of a disease. It is a fairly common symptom with any problem affecting the teeth, mouth, throat and esophagus, especially when structures like the muscles and nerves that are compromised.

Oropharyngeal dysphagia

The term oropharyngeal dysphagia refers to any problems with the swallowing process in the mouth and throat. Although it would include dental problems since chewing food into small and soft pieces is difficult, the causes of oropharyngeal dysphagia focus on specifically on difficulty swallowing rather than problems with chewing. Some of the more important causes of oropharyngeal dysphagia therefore includes :

  • Nerve diseases and nerve damage caused by a stroke, head or spinal cord injury, Parkinson’s disease and multiple sclerosis (MS).
  • Muscle problems such as myasthenia gravis and dermatomyositis.
  • Tumors in the mouth and throat which cause a physical obstruction to the passage of food. These tumors are either benign or cancerous.

Esophageal dysphagia

The causes of esophageal dysphagia are broader. It is sometimes mistaken for reflux or vomiting. If the passage of food down the esophagus is hampered in any way during the swallowing process, it is technically a swallowing problem that is presenting with symptoms of regurgitation. Some of the causes includes :

  • Movement (motility) problems involving the muscles of the esophagus and/or nerves supplying it as well as the flexibility of the esophagus. This includes achalasia, diffuse esophageal spasm, scleroderma and severe esophagitis.
  • Obstructions in the esophagus caused by tumors, strictures, esophageal rings, foreign bodies and scar tissue within the esophagus.
  • External compression of the esophagus may also cause an obstruction although it is not a problem within the esophagus itself. This may occur with a tumor of an organ lying close to the esophagus, aortic aneurysm, enlarged thyroid gland or bony outgrowth from the breastbone.

Treatment

There is no specific treatment for dysphagia as it is a symptom of an underlying disorder. After thorough diagnostic investigation, a medical professional will be able to ascertain the exact cause. Treatment would then be directed at this causative condition and if effective, the difficulty in swallowing should gradually subside or resolve completely. However, several of the causes of difficulty swallowing, particularly like strokes in the elderly, are incurable and there may always be some degree of difficulty for life. The key to managing difficulty swallowing in these instances is to :

  • consume softer foods
  • eat smaller bites
  • acquire a significant part of the nutrition from liquid foods.

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