3 Ways Dysphagia Can Shorten Your Life, and What to Do About It
For most of us, ketchup is just a condiment, and chocolate sauce is a treat. But for Kate Proctor, ketchup and chocolate sauce are tools of her trade. That’s because her job is to help people eat.
Kate is a speech-language pathologist at Heritage Health Care Center in Globe. Part of her job is to help people learn to speak again after a head injury, stroke or severe illness. She also works to improve patients’ ability to communicate when conditions like dementia hamper speech. But Kate’s favorite area is a condition called dysphagia.
Dysphagia – pronounced dis-FAY-gee-ah – refers to problems with swallowing. The ability to swallow is important because it affects the ability to eat. And it’s fairly common, affecting about 15 out of 100 elderly people. That number, however, is much higher in nursing homes, where about 7 out of 10 have swallow problems. Swallow problems tend to get worse as we age, Kate says.
According to Kate, there are three ways swallow problems can shorten a person’s life:
1. “First, you can choke and die from lack of oxygen, or the event can cause stroke or heart attack,” Kate says. “This is what most people worry about.” But she adds, “It’s the least of my worries.” That’s because other problems are more common and can have just as severe effects.
2. “Second, you can starve to death. Sometimes it’s obvious. Sometimes folks just start being able to eat less and less,” Kate says. She once treated an elderly woman whose son had been told there was nothing to do for her. The doctor had told him to “take her home to die.” Instead her son brought her to Kate’s hospital, where Kate evaluated her. She had the woman do a “chin tuck” – looking down and swallowing. The woman was able to swallow when she did this. She ate lunch that day, got better, and went home.
Sometimes, patients with severe dementia lose the desire to eat and do not realize that they need to eat. This is where the ketchup and chocolate sauce come in. Kate’s job is to experiment and find foods that will encourage the person to eat. “Will they only eat hamburgers dipped in ketchup? Should we cover everything in chocolate syrup?” Sometimes, Kate says, it’s a matter of finding a way to make the swallow “work” – as with the chin tuck. Once Kate finds a solution, she works with Heritage’s staff to help them do what’s best for the patient.
3. “The third way is the sneakiest,” Kate says: “Aspiration and aspiration pneumonia.” She says this can happen without any obvious signs or symptoms. When someone has a swallow problem, food, liquid and bacteria from the person’s mouth can get into their lungs. If the person also has a weakened immune system – which is common in hospitals and nursing homes – the body isn’t able to fight off infections. The bacteria grow in the lungs, causing pneumonia. Kate says aspiration pneumonia is particularly lethal, because as long as the person continues to have the swallow problem, the pneumonia will come back.
This is why Kate is passionate about dental care. “Tell everyone you know to take care of their teeth!” she says. “I read a study that estimated that in the year 2000, if we brushed our teeth and everyone in hospitals and nursing homes had good oral care, we could save 10,000 people a year, because brushing teeth reduces oral bacteria and reduces the risk of aspiration pneumonia in the elderly or chronically ill.”
So enjoy that ketchup and chocolate sauce – but be sure to brush your teeth afterward!
Patricia Sanders lived in Globe from 2004 to 2008 and at Reevis Mountain School, in the Tonto National Forest, from 2008 to 2014. She has been a writer and editor for GMT since 2015. She currently lives on Santa Maria island in the Azores.
Hello Patricia – thanks for sharing such a great summary of dysphagia. Many people miss mentioning the danger of aspiration. I work in the food services department for a group of nursing homes so this is a topic I stay on top of. Pneumonia from aspiration is deadly. Steps must be taken to prevent these folks from getting choked while eating. So, we take the consistency of any pureed foods very seriously so that the patient gets a nice smooth bolus of food that simply slides down without much work at all.