Common causes of dysphagia in a 90-year-old
While some physiological changes naturally occur with advanced age, difficulty swallowing (dysphagia) is most often triggered by an underlying health problem. For a person of 90, the potential causes can be complex and may involve multiple factors. These are often categorized as either oropharyngeal (involving the mouth and throat) or esophageal (involving the esophagus, the tube to the stomach).
Neurological conditions
Many neurological disorders, which become more common with age, directly impact the nerves and muscles that control swallowing.
- Stroke: A stroke is a leading cause of oropharyngeal dysphagia, affecting over half of stroke survivors. It can damage the brain regions that control the complex, coordinated movements required for swallowing.
- Dementia: Up to 93% of people with moderate to severe dementia, such as Alzheimer's, experience dysphagia. The cognitive decline affects the ability to remember to swallow and can cause a general slowing of motor functions, including chewing and coordinating the swallowing process.
- Parkinson's disease: More than 80% of individuals with Parkinson's will develop dysphagia at some point. The disease's characteristic rigidity and slow movement (bradykinesia) can weaken the muscles in the face, mouth, and throat needed for effective swallowing.
Age-related muscle weakness and frailty
Normal aging involves a loss of muscle mass and strength, a condition known as sarcopenia. In frail elderly individuals, this muscle wasting can affect the tongue and throat, impairing chewing and swallowing efficiency. While not a disease in itself, these changes can significantly increase the risk of dysphagia and its complications.
Structural and mechanical issues
Blockages or damage to the swallowing passages can also create problems.
- Cancers: Tumors in the mouth, throat, or esophagus can cause a physical obstruction that makes swallowing progressively more difficult.
- Poor dentition or dentures: Ill-fitting dentures or missing teeth can compromise the ability to chew food properly, which is the first step in the swallowing process.
- Radiation therapy: Treatment for head and neck cancers can lead to inflammation and scarring, causing tissue to become stiff and narrow over time.
Other medical factors
Several other medical conditions and their treatments can contribute to dysphagia in older adults.
- Medication side effects: Many medications commonly taken by seniors, including antidepressants, antihistamines, and some blood pressure drugs, can cause severe dry mouth (xerostomia), making it difficult to form a food bolus.
- Gastroesophageal Reflux Disease (GERD): Chronic acid reflux can damage esophageal tissue, leading to scarring and narrowing (strictures) that obstruct swallowing.
Recognizing the signs of dysphagia
Being aware of the symptoms is vital for timely intervention. While some signs are obvious, others, like silent aspiration, can be harder to detect.
Signs of oropharyngeal (mouth/throat) dysphagia
- Coughing or choking during or after eating and drinking.
- A wet, gurgly voice after swallowing.
- Food feeling stuck in the throat.
- Excessive drooling or leaking food/liquid from the mouth.
- Prolonged chewing or needing multiple swallows for one bite.
Signs of esophageal (chest) dysphagia
- Feeling like food is stuck in the chest area.
- Pain with swallowing (odynophagia).
- Regurgitation of food, sometimes delayed.
Comparison of common dysphagia causes in a 90-year-old
| Feature | Parkinson's Disease Dysphagia | Dementia-Related Dysphagia | Post-Stroke Dysphagia |
|---|---|---|---|
| Onset | Gradual and progressive; often a worsening of existing symptoms. | Gradual decline in coordination and memory, worsening with disease progression. | Sudden onset following the cerebrovascular event. |
| Mechanism | Muscle rigidity and slowness (bradykinesia) in the face, mouth, and throat. | Cognitive deficits leading to inattention during meals, apraxia of swallow, and forgetting to swallow. | Neurological damage to the brain regions controlling the swallowing process. |
| Primary Challenge | Poor bolus control, repetitive tongue movements, and weak swallowing effort. | Inadequate oral preparation, difficulty with food choices, and reduced appetite. | Inconsistent swallowing ability; may experience silent aspiration without outward signs. |
| Effect on Appetite | Reduced appetite often due to fatigue or fear of choking. | Decreased appetite and food intake, sometimes a refusal to eat. | Appetite may be less affected, but nutritional intake is limited by swallowing safety protocols. |
| Treatment Response | Often responds to rehabilitative therapy, medication timing adjustments, and diet modifications. | Often managed with compensatory strategies and modified diets, as cognitive decline limits rehabilitative potential. | Can be highly treatable with swallowing therapy, with many recovering within weeks or months. |
How to help a 90-year-old with swallowing trouble
First and foremost, it is essential to have a healthcare professional, such as a doctor or a speech-language pathologist (SLP), evaluate the individual to determine the underlying cause and create a personalized plan. Based on their recommendations, a multi-faceted approach can help manage the condition safely.
Dietary and feeding strategies
- Modify food textures: A speech-language pathologist can recommend the appropriate food and liquid textures. This might range from soft, easy-to-chew foods to pureed diets and thickened liquids.
- Ensure proper positioning: The person should sit upright at a 90-degree angle during all meals and snacks, and remain seated for at least 30-60 minutes afterward to prevent aspiration.
- Control pacing and portions: Offer small bites and sips, and encourage slow, mindful eating. A caregiver should monitor the person to ensure they have completely swallowed before offering the next mouthful.
- Enrich meals: To combat potential malnutrition and weight loss from reduced intake, enrich meals with healthy fats and protein. Examples include adding butter to mashed potatoes or cheese sauce to vegetables.
- Stay hydrated: Dehydration is a significant risk with dysphagia. Offer thickened fluids frequently throughout the day, and incorporate high-fluid foods like soup and yogurt. Avoid straws, as they can increase the rate of liquid intake and heighten the risk of choking.
Swallowing therapy exercises
An SLP can prescribe specific exercises to strengthen the muscles involved in swallowing. These may include:
- Tongue-strengthening exercises: Pushing the tongue against a spoon or depressor in different directions can build strength and control.
- Effortful swallow: The person is instructed to swallow with maximum effort, squeezing the throat muscles as hard as possible.
- Expiratory muscle strength training (EMST): This therapy uses a special device to help strengthen respiratory muscles, which can improve cough strength for clearing the airway.
Medication management
Review all medications with the doctor or pharmacist. Some pills may be crushed and mixed with soft food like applesauce or pudding to facilitate swallowing, while others cannot be altered.
Seeking professional help and navigating care
Navigating dysphagia requires a team approach. Regular follow-ups with healthcare providers are essential. In severe cases, where the risk of aspiration is high or nutritional needs cannot be met, a feeding tube may be necessary, but this decision should be made in consultation with the full care team and family.
Engaging the services of a home health professional can also provide valuable support with meal preparation, feeding assistance, and monitoring. For families, focusing on providing emotional and social support during mealtimes helps ensure dignity and reduces the emotional stress associated with eating difficulties.
Conclusion
Trouble swallowing in a 90-year-old, or dysphagia, is a serious condition that requires immediate medical attention. It is not an inevitable part of aging but is instead a symptom of an underlying issue, often a neurological disorder or age-related muscle decline. Accurate diagnosis by a healthcare professional is the first step. By combining medical treatment with strategies like modified diets, swallowing exercises, and attentive care, it is possible to significantly improve swallowing safety and enhance the individual's quality of life. The focus should be on ensuring adequate nutrition and hydration while minimizing the risks of choking and aspiration pneumonia.
