I am passionate about Eating with Dignity as I work with those who have difficulty swallowing (dysphagia); tasty food and good nutrition for this client group are essential for wellbeing. When it is a struggle to chew and swallow safely motivation to eat is reduced, placing individuals at increased risk of medical and nutritional complications. To be given the choice to enjoy tastes of real food when there is a swallowing difficulty, or at the end of life, offered with support and compassion is the ideal for me.
There are changes in the swallow as we age (60 years+) that occur as primary effects of ageing; it can take longer to chew food; the swallow trigger can be delayed and the muscles responsible for transiting food to the stomach become weaker. There is an increased risk therefore or food going down the wrong way. With this in mind studies have in fact concluded that healthy older adults exhibit a highly safe and efficient swallow.
Clients referred to speech and language therapy with a poor swallow are generally not ‘healthy older adults’ and may require modified food and drinks. In these cases, we alter the texture, consistency or quantity of food and/or drink, allowing a safe transit through the mouth to the stomach. We also consider manoeuvres, positioning and postural techniques along with external factors such as carer support and environmental adaptation.
Where swallowing difficulties are chronic, progressive, a palliative approach is required, or quality of life is the goal, ‘feeding with accepted risk’ may be considered. Feeding decisions can be complex and are best supported by medical professionals. Good communication and team collaboration are essential in achieving successful outcomes. The person with the swallowing difficulty and their family are always considered central in decision making.
You will notice that some of the recipes listed on this site are ‘dysphagia friendly’ and can be adapted to suit modified diets using the IDDSI framework. For more information on IDDSI framework (International Dysphasia Diet Standardisation Initiative) please click here.
Thankfully choking instances that lead to death are rare. In order to protect vulnerable swallows and yourself. I advise the following: If you have a swallowing difficulty, seek a professional SLT assessment or report any concerns to your doctor.
Sue Renyard MSc, RegMRCSLT
Speech and Language Therapist
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