The average person swallows about 600 times a day without giving it a second thought. However, for some, the simple act of swallowing can be difficult, painful—or even life-threatening.

At least 15% of adults age 65 and older have an occasional or chronic swallowing disorder called dysphagia. It’s a main cause of aspiration, in which saliva, food or liquids go into the lungs instead of down the esophagus—a problem that can lead to fatal pneumonia.

Dysphagia can be caused by a variety of conditions. For example, it may be due to structural damage (such as chronic irritation of the esophagus caused by acid reflux)… medication… neurological disorders (such as Parkinson’s disease or dementia)… cancer of the head, neck or esophagus… or throat muscles that have been weakened by age or conditions such as stroke.

Important new finding: When researchers reviewed data from more than 77 million hospital admissions, patients with dysphagia typically spent about twice as long in the hospital and were more likely to die of all causes than those without the condition.

WHAT GOES WRONG

Swallowing is a complicated process that involves precise coordination of the mouth, lips, tongue and various muscles/structures in the throat. A problem in any one of these areas can make it difficult or painful to swallow.

What most people don’t know: Dozens of prescription and over-the-counter drugs cause mouth dryness as a side effect—and a lack of saliva can make it harder to swallow. Medications that interfere with the senses of smell and taste also can interfere with the supply of saliva, thus causing swallowing problems.

If you’re having trouble swallowing: Write down every drug that you take. Review this list with your doctor or pharmacist. A commonly used group of medications that are likely to interfere with saliva and swallowing are known as anti-cholinergics. They are used to treat such conditions as allergies, depression and overactive bladder.

Other red flags for dysphagia: Repeated throat-clearing when eating or taking pills… drooling… a sensation of food getting stuck in the chest or throat… or coughing during meals.

Dysphagia is usually diagnosed by a speech-language pathologist or physician. This diagnosis is typically confirmed with a test called a modified barium swallow, a video X-ray of each phase of the swallowing process.

SAFER SWALLOWING

Because dysphagia can be caused by so many different conditions, treatment varies from patient to patient. If the cause of dysphagia is something as simple as medication, the condition can be cured by stopping the drug. In other cases, dysphagia usually can be improved with modification of the diet and exercises that help coordinate swallowing muscles. Regardless of the cause, most people benefit from these approaches…

  • Stimulate the senses. It helps to get involved in the cooking and preparation of meals, if possible. That’s because smelling food and/or taking small tastes stimulates the sensory receptors that increase saliva as well as appetite.

    • Important: Dehydration can be both a cause and a result of a swallowing disorder. People who have trouble swallowing may not get enough liquids, increasing their mouth dryness. That’s why it is important to drink adequate amounts of water, juice and other liquids. Caution: If you have congestive heart failure or kidney disease, your doctor may advise you to drink less to avoid fluid retention, so speak to him/her about your optimal daily fluid intake.

  • Chew your food well. As obvious as it sounds, many people take bites that are too large and don’t chew their food enough. Good rule of thumb: Chew food until it is reduced to a mass of pasty consistency.
  • Be wary of mixed-consistency foods. Many foods, such as cereal with milk, contain both liquid and solid elements. This makes swallowing tricky. For example, someone might do fine with solid, crunchy cornflakes, but the rapid flow of milk to the back of the throat can result in coughing, choking or aspiration.

    • This also can occur when you eat fruit with skin, which requires more chewing than the flesh.

    Helpful: Prepare foods so that the textures are more consistent—for example, give breakfast cereal time to soften before eating it. You also can blend or puree foods to achieve a uniform consistency.

  • Thicken thin liquids. Watery beverages and foods move more quickly through the throat than thicker foods. The muscles involved in swallowing might not be able to keep up, which can lead to choking and/or aspiration.

    • If you or a loved one has trouble with liquids, consider drinking somewhat thicker fluids, such as tomato juice or fruit nectar, or ask your doctor if you should use a thickening agent. Thickening agents are available in pharmacies and can be used to thicken water, soup, juice, etc.

  • Take smaller pills. It may be easier for some people to swallow a small tablet than a large capsule or pill. Sometimes the reverse is true—ask your doctor which type and size are best for you.

    • A pill that stays in the esophagus for longer than the usual eight to 20 seconds is more likely to damage the lining. Recurrent damage from stuck-in-the-throat pills can cause a buildup of scar tissue that worsens swallowing problems.

    Other options: If you’re having problems swallowing pills, crush the pill and mix it with applesauce. Or ask your pharmacist or doctor about liquid medication.

  • Effortful swallowing. This simply means swallowing hard—as though you’re trying to swallow a golf ball. People usually find that it’s easier to manage foods and liquids, as well as pills, when they consciously make each swallow more forceful.
  • Chin tuck. When eating or drinking, lower your chin slightly toward the chest. This often makes it easier to swallow by preventing foods and liquids—or pills—from going down too quickly.