Elderly people choke and cough when drinking water and have difficulty swallowing. What are the considerations for diet and training?

Author: Sun Xiaohong, Chief Physician, Peking Union Medical College Hospital

Reviewer: Qu Xuan, deputy chief physician, Peking Union Medical College Hospital

Poor swallowing function and easy choking are more common among the elderly.

For example, in the community, even among elderly people who are able to take care of themselves and have relatively strong ability to live independently and are in good physical condition, there is a certain proportion of them who experience dysphagia related to frailty, about 10%.

But if the patients are elderly people hospitalized, the rate can reach 20%, 30% or even higher. Most elderly people over 90 years old have difficulty swallowing.

If you live in a nursing home, for example, you cannot take care of yourself and there is no one at home to take care of you, so you need to live in a nursing home, the incidence of dysphagia may be as high as about 60%.

1. How do elderly people with difficulty swallowing choose food?

We generally hope that the elderly will make an assessment when choosing food.

For example, ask about his eating solid food. Can he chew beef? If he can't chew it, you need to check his teeth. If he can swallow it easily after the food is broken into pieces, just chop the meat into stuffing and eat it.

If the patient is prone to choking when drinking porridge with rice and soup, we should think that he may need to eat relatively sticky food, that is, thicker food. At this time, we need to adjust the viscosity of the food. For example, add a little thickener to the porridge, or add a little thickener when taking enteral nutrition preparations, so that swallowing difficulties will not occur easily. This is actually to help the elderly choose the right food.

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Most patients who need to add thickeners have relatively severe dysphagia. For patients whose dysphagia is not that severe, what they need is to steam and cook the food as much as possible.

In addition, from the perspective of balanced nutrition, we also hope that the elderly can eat some fresh vegetables and fruits containing fiber, but often because their teeth cannot chew them, it will also affect the intake of cellulose, trace elements, etc., but these nutrients are indispensable. At this time, we must pay attention to the oral health of the elderly.

2. What should elderly people with difficulty swallowing pay special attention to when eating?

First, don’t eat and talk at the same time, be focused.

Because the esophagus and airway are two parallel organs, and the upper ends of both are in the throat, it is particularly easy to cause choking when talking while swallowing. In fact, not only the elderly, but all of us should avoid talking while eating.

Second, try to eat uniform food.

When a normal person eats, they may chew a mouthful of food in their mouth and swallow it in one go, which shows that our neuromuscular regulation is relatively complete. The elderly are slightly weaker in these aspects, so they should try to chew it into a bolus. For example, when eating rice, try to chew the rice into a bolus in the mouth and then swallow it in one bite.

Third, adjust your eating posture.

When eating, in addition to concentrating, you also need to lower your head. When you lower your head, you can use the strength of your neck to increase your ability to swallow food. If you have swallowing dysfunction on one side, you need to turn your head toward the affected limb to expose the pharynx on the healthy side, so that the swallowing area can be increased and the strength can also be increased.

Fourth, eat small meals frequently.

Many elderly people feel that they will have bloating after eating too much, which affects the amount of food they eat at each meal, and may lead to malnutrition over time. In order to avoid increasing the amount of each meal and causing bloating and discomfort, it is recommended that the elderly supplement some food between meals, such as enteral nutrition preparations, which is more convenient for the elderly.

Therefore, in the outpatient clinic, we often screen elderly people with swallowing problems and malnutrition problems, and ask them to supplement themselves with snacks or enteral nutrition preparations between meals.

3. What should elderly people with dysphagia pay attention to when eating through nasogastric feeding?

First, when infusing nutrient solution from a nasogastric tube, a 30-degree slope is recommended, and the supine position should be avoided as much as possible.

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Second, after nasogastric feeding, try to keep the elderly in a semi-sitting position at an angle of 30-45 degrees for about 30-40 minutes, which can reduce the occurrence of reflux.

Third, if the patient still has difficulty swallowing after nasogastric feeding, sometimes you have to pay attention to the body position of the elderly. For example, when lying flat, the saliva in the mouth may easily choke. At this time, the patient should be changed to a side-lying position so that the saliva that cannot be swallowed can flow down the corners of the mouth.

Fourth, you should also pay attention to oral hygiene.

It is worth noting that for elderly people who have been bedridden for a long time, if they have fecal blockage, some mineral oil will be injected through the nasogastric tube to lubricate the intestines and relieve constipation. For elderly people with difficulty swallowing, once the feces enters the trachea, it will cause aspiration pneumonia. Therefore, for such elderly people, we should pay special attention when using mineral oil to relieve constipation, or try to use other methods, such as enema or warm water enema to relieve constipation.