Swallowing difficulties (dysphagia) in older adults: signs, safe eating and choking risk

Swallowing difficulties are common after a stroke and with Parkinson’s, dementia, some cancers and age-related muscle weakness. Food or drink going down the wrong way into the windpipe (aspiration) can lead to pneumonia, malnutrition and dehydration. Spotting it early and getting a specialist assessment is very important.

Signs to watch for

• Coughing or a choking sensation while eating or drinking, or just afterwards
• A “wet”, gurgly change in the voice after swallowing
• Pocketing food in the mouth, meals that take a very long time
• A feeling of food “sticking in the throat”, food coming back through the nose
• Unexplained weight loss, frequent chest infections or fever
• Avoiding certain foods or avoiding swallowing tablets

If you notice these signs, tell the doctor and ask for a swallowing assessment by a speech and language therapist.

A safe mealtime routine

• Sit fully upright to eat (in a chair if possible); in bed, the head and upper body should be well raised.
• Small mouthfuls and small sips; do not offer the next mouthful until the last has been swallowed.
• Turn off the television and do not ask questions during the meal; attention should be on eating.
• Do not rush them; risk rises with tiredness, so if needed make meals smaller and more frequent.
• Stay upright for about 30 minutes after eating.
• Dentures should fit well, and mouth care should be done regularly.

Textures: do not change them yourself

After an assessment, specific textures such as soft, puréed food or thickened fluids may be recommended. These recommendations are individual; do not change the texture yourself because “it will be safer”, and do not relax the recommended texture. Share the recipe for the recommended texture with the caregiver in writing.

When giving medicines

If swallowing tablets is difficult, always ask a pharmacist or doctor before crushing tablets or opening capsules; some medicines work differently or can be harmful when crushed. Alternatives such as liquids or dissolvable tablets may be available.

Mouth care reduces the risk of pneumonia

Bacteria in the mouth can cause pneumonia when they go down into the windpipe. Cleaning the teeth and tongue twice a day, cleaning dentures every day and taking them out at night are especially important for people with swallowing difficulties.

Choking: an emergency

If the person can cough, encourage them to keep coughing. If they cannot speak, breathe or cough, or are turning blue, call your local emergency number (112 in Türkiye and across the EU) immediately; if you have had first aid training, use the technique you were taught. This is why basic first aid training is so valuable for carers.