Swallowing difficulties in elderly can be fatal: Nutritionist shares 3 tips to prevent aspiration pneumonia

As people age, their swallowing function can begin to deteriorate, potentially leading to fatal risks. A nutritionist warns that elderly individuals often choke while drinking water, which can cause serious complications like aspiration pneumonia. 

Frequent Choking on Water Increases Aspiration Pneumonia Risk

Nutritionist So Zit-wing posted on his Facebook page that difficulty swallowing is a very common problem for those aged 65 and above. For seniors with declining swallowing function, "thin liquids" like plain water, milk, and tea are actually hidden dangers. The risk lies in their fast flow rate; they can enter the windpipe before the swallowing reflex can react, causing intense coughing.

For the elderly, what's more frightening is "silent aspiration”. According to the American Speech-Language-Hearing Association (ASHA), about 28 percent of healthy older adults do not cough at all when aspiration occurs. Some studies also show that about 27 percent of acute stroke patients experience silent aspiration. Once these un-coughed fluids and the bacteria they carry enter the lungs, they can continuously damage the lung tissue, leading to "aspiration pneumonia”.

How to Drink Water Safely Without Choking?

He shared three suggestions for safe drinking for the elderly, all aligning with the guidelines of the International Dysphagia Diet Standardisation Initiative (IDDSI):

1. Sit upright, tuck your chin slightly
This is the most basic yet crucial posture. Seniors must sit upright while drinking, with the chin slightly tucked down. This action narrows the entrance to the throat, enhancing safety.

2. Control the amount per sip
Use a cup with a smaller capacity, allowing the senior to drink slowly, one small sip at a time, giving the throat sufficient time to react.

3. Choose an appropriate container
Choose cups specially designed for people with swallowing difficulties. Their special design allows the user to drink without tilting their head back, preventing the nose from hitting the cup rim, making it easy to maintain the safe "chin tuck" posture.

So reminds that if seniors still cough frequently during meals or drinks even after making these adjustments, or if a gurgling sound is heard in the throat after eating, or if there are recurrent fevers or pneumonia with no clear cause, it is essential to be highly alert. It is recommended to take the elderly person to an ENT specialist for examination, allowing the doctor to assess whether a referral to a speech therapist is needed for treatment.

What are the Health Risks of Swallowing Difficulties in the Elderly?

According to information from the Hong Kong Department of Health, swallowing difficulties in the elderly can lead to coughing or choking while eating or drinking, food stuck in the esophagus or flowing back into the nose, waking up coughing at night, bad breath, and drooling. In severe cases, it can cause aspiration pneumonia, airway obstruction, or lead to malnutrition and dehydration. Depending on the severity of the swallowing problem, seniors should be assessed by healthcare professionals for improvement recommendations. 

To ensure eating safety, the following general principles are usually recommended for seniors with swallowing difficulties:

• Avoid eating when mentally confused, e.g., right after waking up.
• Reduce environmental distractions during meals to improve concentration.
• Choose food textures suitable for the elder's oral function, such as pureed foods, full-liquid (thicker cream soups) or semi-liquid (thicker fruit juices) consistencies.
• Use appropriate utensils for eating or feeding, e.g., smaller spoons, spoons with thick handles, chopstick aids.
• Maintain a good eating posture; sit upright correctly, avoid eating while lying down, and never tilt the head backward while eating.
• Oral muscle exercises can improve chewing ability; consult a physiotherapist, occupational therapist, speech therapist, or other healthcare staff.
• Choose highly nutritious foods to ensure adequate nutrient intake.

What is Aspiration Pneumonia?

According to information from the University of Hong Kong Swallow Research Laboratory, aspiration pneumonia is a lung infection caused by foreign material, including food, liquid, saliva, secretions, entering the trachea and lungs. Under normal circumstances, foreign material does not easily enter the airways. Even if a small amount is aspirated, healthy individuals can usually cough it out.

However, patients with weaker self-protective mechanisms might lack the cough reflex to clear foreign material from the airways. Coupled with swallowing problems that can cause repeated aspiration of pharyngeal material into the lungs, aspiration pneumonia can occur. 

Aspiration pneumonia is common in patients who are bedridden long-term, have had a stroke, are in a coma, or have swallowing difficulties. Besides increasing hospital stays, it can lead to respiratory failure and even death in severe cases.