How can I help my dad with dysphagia, difficulty swallowing?

What a conundrum.

Dysphagia can lead to aspiration, which goes no where good.

Is he having problems with liquids? Those may need to be thickened.

Garden Artist is our dysphagia expert; hopefully s/he will be along shortly!

Ask the primary if the Home Health agency providing care for the after affects of pneumonia can send out a speech language pathologist to do an assessment, or get one via telehealth.

In this case, a diagnosis with a speech therapist familiar with dysphagia is an absolute must.

I was able to get a therapist to come to my home to evaluate my mother, but it was about 20 years ago. Still worth a shot.

It is essential because if he DOES have disrupted swallowing he may indeed aspirate swallowed material into his lungs and risk the reoccurrence of pneumonia, but almost just as serious, if he does NOT have a swallowing disorder, he may unnecessarily be placed on thickened fluids and foods, reject them, and lose his desire to eat and drink.

Please FIND out ASAP if you can arrange the home evaluation. Hopefully you’ll have even better information than taking him to a therapist, since he’ll be in familiar surroundings.

Hoping……

What type of pneumonia? There is Aspiration pneumonia. If this is what he had, its now serious. Some liquids have to be thickened to get them down.

Barb, thanks for the compliment. (I am a "she"!)

Abby, I can't find specific previous threads on dysphagia, although I do recall participating and writing a long response recently. So I'll start over.

You're wise to recognize the danger of dysphagia, and puree your father's food. There are different levels of dysphagia, which dictate different preparations. Sometimes food can be pureed, but the foods vary with the different levels, such as "mechanically soft".

Liquids generally need to be thickened, again in accordance with the levels of dysphagia.

Click on the white magnifying glass to the left of your avatar on the blue to green bar at the top of this page, and search for "dysphagia". There are a lot of threads addressing this subject.

I would agree that a swallowing test is mandatory, but it should not be performed by anyone other than a speech therapist knowledgeable of dysphagia. Specific equipment (like a "camera" that reflects the mouth and related areas) is used to provide videoscopic identification of the routes traveled when swallowing and/or aspiration occurs.

Small bits of fluids and solids are given to the patient, and the equipment shows whether they're aspirated directly or go into the stomach. Since I'm not skilled in assessment, I don't know how the speech pathologist determines the level of dysphagia. But it is something that's necessary.

I've watched a few of these; it's hard to follow the route of the consumed liquids and/or foods; hence, a specialist needs to interpret them.

At one rehab facility where my father stayed, a speech pathologist was able to visit, and bring the equipment as well. I don't know whether or not equipment could be brought into a home, but I think it could. Your father's primary might be able to make some arrangements with a referral to a speech pathologist so that the equipment could be brought directly to your father.

To me, given his condition, the state of the pandemic, and safety issues, this would be the better solution than taking him to a hospital. OTOH, the primary might suggest transit via a non-emergency ambulance. This is what we used for several visits. They aren't cheap though, but your father's health is too important to risk.

Was your father's pneumonia diagnosed? I.e., as "aspiration pneumonia"? If so, that's an indication that some portion of foods are going directly into his lungs.

Cite: Aspiration pneumonia Information | Mount Sinai - New York

(I'm having problems getting the actual URLs, as the browser reconfigures them, but search for "aspiration pneumonia", then click on the Mt. Sinai hospital link.)

Also check out the different levels of dysphagia diets, ranging from mechanically soft to pureed food, and including thickened liquids. At one time there were 3 levels, but I believe that's changed.

"dysphagia diets at DuckDuckGo" (again, a truncated URL)"

I suspect though since you seem to be knowledgeable that you may already be aware of these issues.

Another fact concerns me, i.e., his being alone at home. I don't want to stress you unnecessarily, but if he does aspirate and begin choking, it could have disastrous results.

I would raise with his primary the issue of having in home medical care from someone experienced in aspirations to act as an observer. He/she could call for medical help quicker than your father could if he begins choking.

I would also get a medical alert pendant with a very reliable company so that your father could press a button and get medical help ASAP. With the pendant we got through an already existing safety monitoring company, there were 3 choices for notice of an emergency. I was first, EMS was second, and I forgot who was third.

But this company was so alert that it responded even when Dad just bent over. You would (if I remember correctly) provide information on medical conditions, especially aspiration potential, so that this could be provided to EMS.

Abby, I ran out of space, but please feel free to ask any questions on issues I might have missed.

And, honestly, I haven't quite figured out the best way to get mealtime support other than from 3 different people, or one who returns 3x daily. And to me, that's a big issue.

Hi Abby.,
My husband has this happen often.
Following a bout with GERD or acid reflux, Tums helps with the heartburn, but his esophagus is inflamed.
Until things calm down in that location, he’s learned to turn his head side to side slowly a few moments to ‘move things along’.

A friend of mine has some swallowing issues, and she has joined a disphagia (maybe dysphagia) support group on Facebook. They share information. I have a different issue : Schatzi's ring, which is basically a fibrous tissue, that gives the sensation of something being stuck in my throat. My friend needs to puree har food, as you do for your dad, but I just have to eat bite-sized pieces of solid food. The point of all this is that there can be different reasons for swallowing issues, so once your dad is able, I'd have him see a specialist, as his Primary Care Physician suggests, perhaps an ENT and/or a gastroenterolgist, to run some tests. Also, sometimes it's a trial and error process, regarding what's the "Goldilocks" sweet spot in terms of what's too thick and what's too thin, regarding the consistency of the food, (judging by what my friend is going through). Best of luck.

Hello, my father had difficulty swallowing when he was 93. He had a cold sore on his lip and he kept licking it transferring the virus to his esophagus and he couldn’t swallow. After a hospitalization, he was discharged with speech therapy at home. He was given exercises to do and he can now swallow. The herpes simplex left scar tissue on his esophagus so he avoids certain foods now and he’s off all medication because he is afraid the pill will get stuck. Luckily, his meds turned out to be duplicative and he no longer needed them anyway. He’s now 96 and swallowing issues are no longer a problem. He’s moved on to balance issues. Everyone needs to drink water every day to keep our throats supple and moist, and in the elderly, it’s even more important. Lack of water will cause confusion and a host of other problems. Speech therapy was our answer.

The doctors might want him to drink some dye so they can see if his esophagus has a stricture and the food can get stuck. If the dysphagia is from a stroke then that is a different story But if his esophagus has a stricture and some of his food gets stuck going down then there is a simple procedure to fix it. If it isn’t addressed he could get food stuck in the esophagus and can’t pass it all then it would be considered an emergency. Can you get your Dad to a GI Doctor. The dysphagia could be caused by a stricture in the esophagus. He is a little old but there are procedures that can help.
It isn’t painful. Usually a person with dysphasia can get a EGD (Upper Endoscopy) where a small scope is passed into his esophagus and stomach. If the GI doctor sees a stricture then a small deflated balloon can be inserted thru a port in the scope it comes out the end
of the scope then the GI doctor has the balloon inflated to different sizes. He can see all this on video as it is happening cause the scope has a camera. He can inflate the balloon
several times till the stricture is gone
There are other tools that can be used to open a stricture. The GI doctor can also just inserts a rubber like dilator into the mouth down the esophagus these dilators come in different thicknesses till the stricture
is gone. All of this is done in an Endoscopy Lab or Endoscopy in a Hospital. They use lite Sedation.
What is actually happening is the stricture in the esophagus is getting ripped. The GI drs are inserting dilators bigger then the stricture in the esophagus. There is no pain
the person does not feel anything
except swallow the small end of the scope. Your Dad would be given lite sedation. He would have to travel to
an Endoscopy Unit. There are free standing Endoscopy Units or
most hospitals have an Endoscopy Unit. Because of his age most GI
doctors would probably tell you
to go to the Hospital Endoscopy Unit. It is lite Sedation. The person is still considered an outpatient and goes home after it is done. His Primary physician can refer your father to a GI doctor unless he already has one. Your dad could have a Schatzki's ring is a ring of tissue that forms inside the esophagus, the tube that carries food and liquid to your stomach. This ring makes the esophagus narrow in one area, close to where it meets the stomach. It can make it hard to swallow. You may feel like food gets stuck in your esophagus.
This Ring could cause a chronic
Problem which means your might
have to have this done yearly
due to scar tissue reforming.
If he has the Ring then your dad
might have to have his esophagus
dilated every year or 2.
Most GI Drs. also do Colonoscopies. So if your dad has ever had a Colonoscopy you can use that same GI physician for the procedure I described above. The back of the throat is sprayed with a numbing spray. It is very easy and most people don’t remember to much. Usually after the procedure
your dad should be able to eat
normally. He mite have a minor
sore throat for a day or so
As soon as he recovers from PNEUMONIA you should really get it
this addressed before your dad.
can’t swallow at all or the stricture gets bigger. If his swallowing issues
are the results of a stroke that is
a different issue all together. He still
could end up seeing a GI dr.
it depends on how severe symptoms
are after a stroke. It isn’t a painful
procedure but you do not want to wait till it becomes an emergency.
I was a GI Nurse for years and we were always on call 24/7 the main thing I was always called to come to
the hospital in the middle of the night is because a person got food
or meat impactions stuck in the esophagus. U do not want to wait to long then u have to bring your dad to the ER they will try to clear his esophagus first by giving him A coke or sprite because the carbonation might loosen the food impaction & it will force the food thru to the stomach. Most of the time the esophagus will be scoped in the ER. Do Not Wait 2 long. Good Luck

Abby, thank YOU for responding to my post. Most posters don't, and we never hear from them again. So I feel good that my suggestions offered some insight.

I wouldn't disagree with the "mine field" comparison! That's very appropriate.

On the issue of finding someone to help in the home, my only experience with outside assistance was hiring a reputable home care service, with staff who allegedly had dysphagia experience background.

That was a falsehood for 2 of them. One admitted that she had observed speech pathologists in rehab and other facilities, but never managed food prep and/or eating. The other one was just so unqualified, with not even common sense knowledge. I dismissed her on the first visit when I found her "cleaning" an electrical strip (plugged in to the frig) with a wet wash cloth.

My father too didn't want to leave his home, and I understood that, but when he was unable to stand or even walk, I had no choice but to find a placement. I still feel guilty about that 4 years later, but I knew that it was the best decision under the circumstances.

Something I should share is that I found a wonderful care group; I was very impressed with them. Two of the officers were former military and they ran the business in a very professional manner. I met with, interviewed and had a proposed caregiver accompany me to one of the rehab facility's staff meetings, but when she realized the extent of the dysphagia, she consulted management and reported that they felt the potential liability was too great. So she didn't get hired. I was very, very disappointed.

I wish I had more suggestions as to your father's situation and apparent decline. It may also be that once he adjusts to "the new norm", he may feel more comfortable and adapt. I certainly hope so.


TriedandTrue raises an issue I forgot about, but was critical for my father's recovery after a long (7 month) hospitalization and rehab. The exercises combine consonants, creating a gutteral sound, a sort of "caveman" language. Apparently this strengthens the muscles.

I did them along with my father, but the speech therapist cautioned against this, given that I didn't have any speech difficulties and didn't need them. and she stated that the exercises could actually damage my own swallowing ability.

Dad had speech treatment in the hospital and rehab, and after being intubated for months, eventually was able to have the tube removed and gradually eat normally again. He was 85 then, and lived to 99.5 years.

As people age, sometimes they develop difficulty swallowing. My mother stopped chewing at a point when she had dementia. She was living in a memory care unit and the staff told me she was "pocketing" her food (stuffing it in her cheeks) rather than chewing and swallowing. They switched her to soft foods that didn't need chewing (scrambled eggs, other foods mashed or pureed, starchy foods like farina. If he's still good mentally, perhaps in-home aides to help him prepare his foods would be sufficient. If he has dementia, it may be better for him to move to a memory care unit where there are professional staff to care for him. All the best to you both!

When Papa had swallowing difficulties due to Parkinson’s, he was told to tuck his chin to his chest before he swallowed. The Therapist said it was a trick that almost always helped.

My father and I have a genetic issue and had/have to have to get an endoscopy to get stretched. My father had the same issues as your father. Although at his age, I doubt a gastro would do the procedure.

I can help😀dysphagia…my mom has been diagnosed with this same issue and through the hospital, NESTLE THICKEN UP
added to whatever liquid he is drinking stops the gagging and choking. I have my mom drink some before she eats and the problem has helped 100%. It is difficult to find and the only place I could find it is st London Drugs or Save On Foods will order it in for you. Hope I have helped
janet

NESTLE THICKENER added to liquids

I havent read everybody but heres my opinion … ask doc if he can have a thyroid ultrasound.

First ask for a referral then try to find a qualified speech language pathologist (SLP - speech therapist). Fox Rehab is a national home therapy company that does speech therapy along with other therapies in the home. Their SLP can do a bedside evaluation and some can even do or bring in another professional to do a FEES study in your home. (Fiberoptic endoscopic evaluation of swallowing). This is not as good as a Barium Swallow Test done outpatient in a hospital, but can give some very good information. The SLP can then do targeted therapy to the muscles that are affected which can be different for each person. Do not start using thickener products without the advice of a SLP even though it is over-the-counter. You need to know what level of thickener is appropriate for your father. Once they identify the reason(s) your father is having difficulty they can then advise you on the best way to address it. I did see where someone also posted to do a chin tuck when he swallows and that is a very helpful tip we have used for years.

Abby2018: Perhaps he requires a swallow study.

My Dad was evaluated by a speech therapist and then went through several weeks of therapy with a device that was some electrodes placed on his neck when he swallowed. I was told that he improved and it seemed to be true. We have to make sure he slows down when eating and does not speak while eating. He absolutely hated the thickeners so we abandoned them after he completed the therapy. We do not give him anything he can easily choke on. Nothing with pits or that is super hard to chew. Applesauce helps with pills.

i say its worth taking that trip to the doctor to check on his thyroid. its vital. yes, keep puree all his food until u see what the problem is. make sure he's drinking lots of veggies, fiber (beans) of different kinds puree he can warm it and spoon it. make sure everything is healthy. Check the meds to see if there are interactions. please drink lots and lots of water. that's an wonderful age to be. do thorough labs, stool, uti every test u can think of. please keep us posted ur all in our prayers. its age and just yrs of living. things don't work the way they use to.

please let him drink lots of water. when i say that meaning sipping throughout the day everyday.

He really needs to be evaluated by a speech therapist to evaluate his swallowing. The therapist will test his ability to swallow various textures of food and fluids. Then, you will be given recommendations of the best texture and thickness of food and fluids for his abilities.

Until then, make sure he always sits upright when eating, Try feeding/eating with a spoon. Take 1 bite at a time and make sure he swallows it thoroughly before taking another bite. If he can swallow water without choking, coughing, or sputtering... try adding more liquids to his foods.