By Kathy Finley, Director of Family Services at Concierge Care Advisors
Let me start by explaining why I am writing about this topic. As I have written before I have an elderly mother, she is 88 and has dementia. A few weeks ago, she developed a cough. Not just any cough, but one where you thought she was drowning or coughing up a lung. Off to the doctor who did an x-ray to rule out pneumonia. The x-ray was negative. What the doctor did say is that it was conceivable that she was aspirating a small amount of food or mucus or saliva into her bronchi or lungs. Aspiration is the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract and is common in older adults with dysphagia and can lead to aspiration pneumonia.
Dysphagia is difficulty anywhere in the swallowing process. Issues in the throat are often caused by a neurological problem that affects the nerves such as Parkinson’s disease, stroke, or dementia. The older adult with one of these conditions is at even greater risk for aspiration because the dysphagia is superimposed on the slowed swallowing rate associated with normal aging. It can also pose the danger of choking, while also increasing the likelihood of dehydration and malnutrition over time.
Signs and symptoms associated with dysphagia may include:
- Having pain while swallowing
- Being unable to swallow for longer than 10 seconds
- Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum)
- Oral leaking or drooling.
- Being hoarse.
- Bringing food back up (regurgitation)
- Having frequent heartburn.
- Choking or gagging
- Pocketing food in the cheeks
- Poor chewing ability that can lead to choking
- Poor motivation to eat
In my mother’s case they prescribed a medication that quieted the lung’s reflex to cough. It still took a good three weeks for her to stop coughing. At a follow up appointment with her primary doctor it was suggested that her diet be modified. Food at her adult family home would need to be cut into small pieces that are easier to chew. No nuts, seeds or anything sticky that could potentially get caught in her throat. Even her favorite clam chowder at Ivar’s is off limits as she cannot sufficiently chew the clam pieces.
When following a dysphagia diet, you should consider the following:
- Eat from a variety of food groups to ensure that the patient’s nutritional needs are being met.
- Be creative – many foods can be put in a blender to provide a nutritious meal.
- Eat small, frequent meals, especially if they are not able to eat large meals.
- Serve both hot and cold foods to provide a variety of temperatures in their diet and to avoid food contamination.
Thankfully my mom did not develop pneumonia. That said, there are some things to think about in the future since she is now at risk for aspiration.
Symptoms of Aspiration:
- Sudden appearance of respiratory symptoms (such as severe coughing and cyanosis- turning bluish) associated with eating, drinking, or regurgitation of gastric contents.
- A voice change (such as hoarseness or a gurgling noise) after swallowing.
- Pocketing of food on one side of the mouth.
- Small-volume aspirations that produce no overt symptoms are common and are often not discovered until the condition progresses to aspiration pneumonia.
I don’t personally have any experience with aspiration pneumonia so I will share with you what I have read on the subject.
What is Aspiration pneumonia?
Aspiration pneumonia is a lung infection that develops after you aspirate (inhale) food, liquid, or vomit into your lungs. You can also aspirate food or liquid from your stomach that backs up into your esophagus. If you are not able to cough up the aspirated material, bacteria can grow in your lungs and cause an infection. It is common to aspirate and not even know it.
Your risk for aspirations pneumonia is highest if you are older than 75 or live in a nursing home or long-term care center. You may become less active as you age, or you may be bedridden. You may not be able to swallow or cough well. The following also increase your risk for aspiration pneumonia:
- The muscles that help you swallow are weakened by stroke, Alzheimer disease, or other diseases
- A weakened immune system caused by diabetes, COPD, heart failure, or other health problems
- Smoking cigarettes
- Use of a feeding tube or ventilator that allows bacteria to travel to your lungs
- Surgery or radiation to treat cancer of the head or neck
- Poor oral hygiene, teeth that are missing, or dentures
- Alcoholism or IV drug use
Some symptoms for this are: Fever, cough, bluish skin around the mouth or fingertips, trouble swallowing, shortness of breath, chest pain, rapid heartbeat, confusion, loss of appetite or weight loss.
If you suspect any of these symptoms in yourself or a loved one, especially the elderly, then you need to get to your doctor or the emergency room. Your doctor may diagnose aspiration pneumonia if you have symptoms and a history of swallowing problems. Your doctor will ask about your symptoms and when they started. He or she will look inside your mouth and down your throat and listen to your heart and lungs. Your doctor will ask you to speak and cough while they listen. Tell the doctor about any health problems you have and any medicines you use.
You may need any of the following tests: blood test for infection, barium swallow with x-ray of throat and lungs, a sputum culture may be tested for bacteria that can cause pneumonia. X-ray or CT pictures may show lung damage or an infection, such as swelling and fluid in your lungs
Finally, the treatment of aspiration pneumonia. You may be prescribed antibiotics, steroids and oxygen through a mask. Depending on the severity you may be hospitalized.
Hopefully you will never have this condition. Listen to your body and that cough that doesn’t go away and consult your physician.