As older adults age, swallowing easily and without choking or aspiration can increasingly become a challenge. This difficulty can arise from any one or a combination of the following factors:

• Dry mouth and reduced salivation, often a side effect of medications used by older adults
• Poor dentition, including missing teeth or ill-fitting dentures
• Weakened swallowing muscles as older adults become more frail
• Impaired neurological control of swallowing due to conditions such as stroke, dementia, or Parkinson’s disease
• Gastroesophageal reflux disease (GERD) and acid reflux

 
Problems with swallowing can cause older adults to eat less, leading to weight loss and nutritional deficiencies, which often worsen the cycle due to weakened swallowing muscles. The impaired swallowing process can also result in aspiration or choking on food entering the airway or lungs. Sometimes, these events can be 'silent' or 'mini' aspirations, leading to chronic sputum production, or they can result in significant aspiration pneumonia, which may lead to hospitalization or even death.
 
Older adults who are beginning to experience swallowing difficulties may exhibit some of the following symptoms:

• Frequent throat clearing
• A voice that sounds ‘wet’ rather than clear
• Coughing or chest congestion, particularly noticeable after eating
• A feeling of something ‘stuck’ in the throat or difficulty swallowing
• Food accumulating in the cheeks while eating
• Drooling or difficulty managing saliva

 
If you suspect that you may have any of the above symptoms, consult your physician. Addressing some of the causes, such as improving dentition, reducing medications that cause dry mouth, or treating acid reflux, may help. Your physician may also refer you for a swallowing assessment and therapy with an occupational therapist, who can provide proper advice on techniques to reduce the risk of choking, as well as exercises to strengthen and stimulate the swallowing muscles.
 
When an older person is at risk of aspirating food, the easiest thing to choke on is water or thin liquids. Therefore, it is advisable to thicken all fluids consumed, whether using a commercial thickening agent or alternatives such as rice or barley water. Food consistencies may also need to be adjusted according to swallowing abilities, often requiring modifications to minced or pureed consistencies. An occupational therapist can provide guidance on this, working with the geriatrician and dietitian to ensure that appropriate energy and nutritional requirements are met.
 
The following tips can help reduce the risk of aspiration for those experiencing swallowing difficulties:

• Eliminate distractions, such as television or conversations, while eating.
• Sit upright at a 90-degree angle, with the head bent slightly downwards.
• Use a smaller spoon for portion control, taking smaller, teaspoon-sized mouthfuls.
• Chew thoroughly and slowly before swallowing.
• Use the ‘double swallowing’ technique, i.e., swallow, then swallow again 2-3 more times to ensure all food is cleared from the mouth before taking the next mouthful.
• Use a spoon for thickened liquids. Drinking through a straw is generally not advised, but if used, opt for a thin straw and keep a small volume in the cup at a time.
• Large tablets and capsules may become harder for older adults to swallow. Consult your physician or pharmacist about whether they can be crushed and mixed with foods or thickened fluids, or if a liquid form of the medication is available.