People take the act of swallowing for granted, but it is actually a very complex process that starts when you first see food, triggering the salivary glands to start secreting saliva. Swallowing is usually an involuntary process during eating, a reflex activated when food touches the soft palate at the back of the mouth.
Some older adults, however, have a serious condition called dysphagia, which is difficulty swallowing food or liquids. This can cause malnutrition, dehydration, or aspiration pneumonia.
Many swallowing problems are caused by lack of saliva or a dry mouth. There are many reasons the salivary glands may not be producing enough saliva:
- Prescription Drugs: Over 400 medicines, including those for depression, hypertension, seasonal allergies, and urinary incontinence, can reduce the quantity of saliva or alter its chemical composition so that it does not work properly.
- Disease: Diabetes and Parkinson’s Disease can cause dry mouth and Parkinson’s can also weaken the muscles involved in the chewing and swallowing functions. Sjogren’s Syndrome, an autoimmune disease, acting by itself or in tandem with rheumatoid arthritis or other autoimmune diseases, can also impede saliva secretions.
- Cancer Treatment: Radiation therapy targeting the head and neck can impede or even altogether stop the production of saliva. Chemotherapy can lead to thicker saliva, which gives a sticky or dry sensation in the mouth.
- Salivary Gland Trauma: Head or neck injury can impair nerves controlling the salivary glands.
- Oral Health: As chewing is critical for normal food intake, the loss of teeth or poorly performing dentures can have adverse effects on saliva secretion.
Tips to Make Eating Easier
When a loved one is experiencing swallowing problems, there are simple diet modifications that can make eating easier for them:
- Select moist foods. Softer, moist foods like oatmeal for breakfast, or soup for lunch, are easier to swallow. Another lunch option could be soft fish like tuna, or egg salad. For dinner, a soft, noodle-based casserole is a safe choice. Fresh or canned fruits, such as peaches and oranges, have plenty of moisture and are good choices for any meal.
- Avoid foods that crumble. Crackers, for instance, might cause gagging. If only dry foods are available, moisten them in non-spicy sauces.
- Stay away from rough grains and dry particulates. As rice, other grains, and dry particulates (e.g., corn, peas, nuts) may cause choking, look for softer substitutes such as mashed potatoes.
- Avoid spicy foods and salty dishes. These foods absorb more water and make the mouth drier. Spicy foods also irritate soft mouth tissues.
- Steam raw vegetables thoroughly. Raw vegetables are difficult to swallow but steaming them until they get soft will make them easier to eat while preserving needed nutrients. To add flavor to steamed vegetables, top with a simple pasta sauce.
- Pick soft foods for dessert. Try flavored gelatin or a smoothie with a yogurt base. Cookies are fine if you soften them by dipping in liquids such as milk or tea.
- Puree or blend food for elderly with very dry mouths. Though you may need to experiment to see if your loved one finds it easier to swallow thicker or thinner blended or pureed food, the smooth consistency will make it easier to swallow.
- Offer sugar-free gum or candies between meals. These treats may help induce the glands to produce saliva and keep the mouth moist.
- Encourage fluids. Because swallowing problems can lead to a reduced ability to detect thirst, be sure your loved one consumes between six and eight cups of fluids daily. Dehydration can compound the problem by reducing saliva secretions.
Food Preparation Pointers
- Pureeing foods can help people with swallowing difficulties, but it can make eating less enjoyable. A thickening agent, like Thick-It Instant Food Thickener Powder by Milani Foods, can help these foods maintain their shape and provide a more enjoyable eating experience. There are other thickening additives on the market that can help in both hot or cold beverages and pureed food.
- For people with minor swallowing problems, mincing or chopping foods may be enough. Mince the foods in pieces as small as sesame seeds, about 1/8 inch. They can also be fed normal-sized food if it is modified in texture to a soft and moist consistency.
- As swallowing ability improves, the caregiver can start giving ground or diced food, about 1/4 inch in size, or about as big as a grain of rice.
- Eventually you can progress to chopped foods about 1/2 inch in size, about the size of bread cubes.