Have you noticed that a common theme in aging is the fact that we now have to pay close attention to bodily functions that we never paid close attention to before? Well, swallowing is no exception. So many of my patients are on altered texture diets simply because they cannot effectively swallow any longer. Such a simple everyday requirement that we used to do with ease and without thinking about. BANG. Now we have to think about it. No one realizes how important the esophagus is until it doesn’t work very well anymore….Like every other organ as we age, it goes through its own set of unique changes that may require some extra consideration and care.
So let’s start with the basics. What is the primary role of the esophagus? Transportation. It is responsible for getting food from its entrance into the body where digestion begins, to the stomach where the body really gets down to the business of processing what we have ingested. The esophagus relies on sensation, saliva, smooth muscle contraction and a clear pathway to move the food along. So the issues with swallowing that occur as we age often are related to one of these factors.
Changes to the Aging Esophagus:
Muscle Weakness: With age, there is a natural decline in muscle mass and strength, a phenomenon known as sarcopenia. The muscles of the esophagus are not immune to this process. As a result, the smooth muscle fibers in the walls of the esophagus may weaken, leading to reduced contractility and potentially slower movement of food through the esophagus.
Decreased Elasticity: The elasticity of the esophageal tissues tends to diminish over time. This reduced elasticity can impact the ability of the esophagus to expand and contract efficiently during the swallowing process. As a consequence, individuals may experience a decreased ability to accommodate larger food boluses, potentially contributing to difficulties in swallowing.
Impaired Peristalsis: Peristalsis is the coordinated, rhythmic contraction of muscles that propels food downward through the esophagus. Aging can result in disruptions to this coordinated process, leading to less effective peristalsis. This impairment may contribute to a feeling of food sticking in the throat or chest during swallowing.
Reduced Saliva Production: Saliva plays a crucial role in the initial stages of digestion, helping to moisten food and facilitate its smooth passage through the esophagus. Aging is associated with a decline in saliva production, which can contribute to a drier and less lubricated esophagus, potentially exacerbating swallowing difficulties.
Increased Risk of Gastroesophageal Reflux Disease (GERD): Aging is a risk factor for GERD, a condition where stomach acid flows back into the esophagus, causing irritation. Chronic GERD can lead to inflammation, narrowing of the esophagus (strictures), and an increased risk of developing Barrett’s esophagus, a precancerous condition.
Hiatal Hernia: A hiatal hernia occurs when part of the stomach protrudes through the diaphragm into the chest cavity. The prevalence of hiatal hernias tends to increase with age. While not everyone with a hiatal hernia experiences symptoms, it can contribute to acid reflux and swallowing difficulties.
Changes in Sensation: Aging may affect the sensory receptors in the esophagus, leading to altered perceptions of taste and difficulty sensing the presence of food in the throat. This can contribute to a delayed or impaired swallowing reflex.
Common Swallowing Issues in the Elderly
Dysphagia: Dysphagia is a term used to describe difficulty in swallowing. It can manifest as pain or discomfort while swallowing, the sensation of food sticking in the throat, or coughing and choking during meals. Dysphagia can result from the age-related changes in the esophagus, as well as other factors such as neurological conditions or muscle disorders. In the facility where I work, this is the number one reason for a speech therapy consult–inevitably, a staff member witnesses a resident struggling with their
Gastroesophageal Reflux Disease (GERD): Aging is a risk factor for GERD, a condition where stomach acid flows back into the esophagus, causing irritation and inflammation. Persistent GERD can lead to complications such as narrowing of the esophagus (strictures), making it harder for food to pass through.
Aspiration: Aspiration occurs when food or liquid enters the airways instead of the esophagus. This can lead to respiratory issues, including pneumonia. Aging may contribute to a weakened cough reflex and a diminished ability to protect the airways during swallowing.
Effective Treatments:
Dietary Modifications: Adjusting the texture of foods can make swallowing easier for individuals with dysphagia. Soft or pureed foods, as well as thickened liquids, may be recommended to minimize the risk of aspiration. I would also encourage seniors to be very cognizant of how big their bites are and how fast they are consuming their food. I know that this is a huge challenge for me, even in my 40s. I cannot simply settle into a meal and enjoy the food. I eat fast and take big bites because I, of course, am very busy and don’t have time to sit and chew. (At least that’s what my brain tells me at every meal).
Positional Changes: Changing body positions during meals, such as sitting upright (don’t slouch), can assist in the smooth passage of food through the esophagus. This can reduce the likelihood of reflux and aspiration.
Speech Therapy: Speech therapists play a crucial role in helping individuals improve their swallowing function. They can provide exercises to strengthen the muscles involved in swallowing and teach techniques to enhance coordination during the process. Below are some links to various Johns Hopkins webpages that provide more specific information about swallowing exams and exercises you can do at home that may improve your swallow:
Medications: Medications such as proton pump inhibitors (PPIs) may be prescribed to manage GERD and reduce stomach acid, alleviating irritation in the esophagus. And here is the slippery slope, so to speak. We have to find a balance between using these medications to assist with a problem and ending up on these medications unnecessarily for the long term.
Surgical Interventions: In severe cases, surgical interventions may be considered. Procedures like dilation can help widen strictures in the esophagus, improving the passage of food. Results with these procedures are variable and individuals often find that the stricture slowly recurs within 6 months. The risks and benefits of endoscopic or surgical intervention should always be discussed with your primary care provider and surgical specialist.
When do I really worry about someone’s swallowing? Well here are some red flag symptoms you should never ignore–weight loss, vomiting, hoarseness, pain with swallowing, chest pain, shortness of breath. If you are experiencing any of these symptoms, seek medical attention.
So there you have it. A breakdown of why swallowing is no longer something you don’t have to think about. And one last thing that should be obvious–I would encourage you to remember that ANY swallowing difficulty should prompt consultation with a medical professional (not a blog!). Good luck! Stay healthy, stay home, and CHEW your food!!
