Like breathing, swallowing is an essential part of everyday life, and the condition known as dysphagia can occur at any stage in life.
The knowledge of dysphagia and its implications remain largely unknown for most Australians. According to Speech Pathology Australia, the speech pathologists’ peak body, humans swallow between 500-700 times a day, around three times an hour during sleep, once per minute while awake and even more during meals.
“We trust that food, drink, saliva and medicine will pass through our mouth, throat and oesophagus and arrive safely in our stomach.
“Yet, for an average of around eight per cent of the population, this simple act is a problem because food and drink travel into their lungs and causes chest infections like pneumonia. Sometimes this problem is so severe that regular food and drink can become a life-threatening choking risk.”
While Australians are alert to the choking risks for small children, few know the danger of choking on food is seven times greater for people aged over 65 years than those aged 1-4 years.
A significant proportion (16-22%) of Australians over the age of 50 years experience dysphagia (difficulty swallowing, either solids and/or liquids). Dysphagia can be caused by a number of age-related health conditions including stroke, Parkinson’s disease, dementia as well as a consequence of ageing.
That amounts to around one million Australians having swallowing difficulty. Swallowing problems can occur at any stage of life. However, the knowledge of dysphagia and its implications remain largely unknown for most Australians.
Swallowing difficulty (Dysphagia) is any problem with sucking, swallowing, drinking, chewing, eating, controlling saliva, taking medication, or protecting the lungs from food and drink ‘going the wrong way’. It can be a problem with keeping the lips closed so that food, liquid or saliva doesn’t dribble out.
Sometimes, the first sign of a swallowing problem is coughing, gagging or choking when eating and drinking. Swallowing problems can mean food, drinks or saliva gets into the lungs and this can cause lung infections (pneumonia). Reflux is a problem where the valve in the oesophagus causes the contents of the stomach (like food, drink or stomach acid) to come back up, sometimes reaching as far up as the throat and mouth.
According to Speech Pathology Australia, 50 per cent of stroke survivors and 84 per cent of people with dementia experience dysphagia. Sixty-nine per cent of people with Parkinson’s disease will have swallowing difficulties, as will 25 per cent of patients with Multiple Sclerosis. Chewing and swallowing problems affect 30-50 per cent of residents in aged care facilities and those with a disability, with choking being one of the highest causes of preventable death.
The NSW Ombudsman’s Reports into reviewable deaths of people with disability in residential care (2012–2013 and 2014–2017) indicate that improving the identification and management of swallowing risks, and better communication about food textures that are safe for people with dysphagia are some of the keys to preventable choking deaths.
Dr Chichero, Honorary Senior Fellow at Queensland University, said speech pathologists are often the professionals who assess and manage dysphagia.
“To keep Australians with swallowing problems safe, food and drinks are often changed so that they are easier and safer for swallowing,” she added.
“Based on a clinical assessment by a speech pathologist, foods are chopped, minced or pureed and drinks are thickened.”
From 1 May 2019, new guidelines were introduced in Australia to standardise the names and descriptions of food and drink used in medical and community settings to reduce choking risk.
The new guidelines include easily accessible testing methods that allow consumers, health professionals, nursing homes and hospitals to check that the food or drink they are serving is suitable for older Australians with swallowing difficulties.
The guidelines have been developed by The International Dysphagia Diet Standardisation Initiative (IDDSI), which Speech Pathology Australia is actively supporting.
If you would like to find out how to better understand and safely manage Dysphagia, visit https://safeswallowing.com.au
Barbara Braithwaite is one of a limited number of speech pathologists in Australia who has been practising for four decades. She has always maintained a strong passion for disability and aged care, understanding this as an increasingly demanding career choice, with a vulnerable population.
