How can I help my dad with dysphagia, difficulty swallowing?

Barb, thanks for the compliment. (I am a "she"!)

Abby, I can't find specific previous threads on dysphagia, although I do recall participating and writing a long response recently. So I'll start over.

You're wise to recognize the danger of dysphagia, and puree your father's food. There are different levels of dysphagia, which dictate different preparations. Sometimes food can be pureed, but the foods vary with the different levels, such as "mechanically soft".

Liquids generally need to be thickened, again in accordance with the levels of dysphagia.

Click on the white magnifying glass to the left of your avatar on the blue to green bar at the top of this page, and search for "dysphagia". There are a lot of threads addressing this subject.

I would agree that a swallowing test is mandatory, but it should not be performed by anyone other than a speech therapist knowledgeable of dysphagia. Specific equipment (like a "camera" that reflects the mouth and related areas) is used to provide videoscopic identification of the routes traveled when swallowing and/or aspiration occurs.

Small bits of fluids and solids are given to the patient, and the equipment shows whether they're aspirated directly or go into the stomach. Since I'm not skilled in assessment, I don't know how the speech pathologist determines the level of dysphagia. But it is something that's necessary.

I've watched a few of these; it's hard to follow the route of the consumed liquids and/or foods; hence, a specialist needs to interpret them.

At one rehab facility where my father stayed, a speech pathologist was able to visit, and bring the equipment as well. I don't know whether or not equipment could be brought into a home, but I think it could. Your father's primary might be able to make some arrangements with a referral to a speech pathologist so that the equipment could be brought directly to your father.

To me, given his condition, the state of the pandemic, and safety issues, this would be the better solution than taking him to a hospital. OTOH, the primary might suggest transit via a non-emergency ambulance. This is what we used for several visits. They aren't cheap though, but your father's health is too important to risk.

Was your father's pneumonia diagnosed? I.e., as "aspiration pneumonia"? If so, that's an indication that some portion of foods are going directly into his lungs.

Cite: Aspiration pneumonia Information | Mount Sinai - New York

(I'm having problems getting the actual URLs, as the browser reconfigures them, but search for "aspiration pneumonia", then click on the Mt. Sinai hospital link.)

Also check out the different levels of dysphagia diets, ranging from mechanically soft to pureed food, and including thickened liquids. At one time there were 3 levels, but I believe that's changed.

"dysphagia diets at DuckDuckGo" (again, a truncated URL)"

I suspect though since you seem to be knowledgeable that you may already be aware of these issues.

Another fact concerns me, i.e., his being alone at home. I don't want to stress you unnecessarily, but if he does aspirate and begin choking, it could have disastrous results.

I would raise with his primary the issue of having in home medical care from someone experienced in aspirations to act as an observer. He/she could call for medical help quicker than your father could if he begins choking.

I would also get a medical alert pendant with a very reliable company so that your father could press a button and get medical help ASAP. With the pendant we got through an already existing safety monitoring company, there were 3 choices for notice of an emergency. I was first, EMS was second, and I forgot who was third.

But this company was so alert that it responded even when Dad just bent over. You would (if I remember correctly) provide information on medical conditions, especially aspiration potential, so that this could be provided to EMS.

What a conundrum.

Dysphagia can lead to aspiration, which goes no where good.

Is he having problems with liquids? Those may need to be thickened.

Garden Artist is our dysphagia expert; hopefully s/he will be along shortly!

Ask the primary if the Home Health agency providing care for the after affects of pneumonia can send out a speech language pathologist to do an assessment, or get one via telehealth.

In this case, a diagnosis with a speech therapist familiar with dysphagia is an absolute must.

I was able to get a therapist to come to my home to evaluate my mother, but it was about 20 years ago. Still worth a shot.

It is essential because if he DOES have disrupted swallowing he may indeed aspirate swallowed material into his lungs and risk the reoccurrence of pneumonia, but almost just as serious, if he does NOT have a swallowing disorder, he may unnecessarily be placed on thickened fluids and foods, reject them, and lose his desire to eat and drink.

Please FIND out ASAP if you can arrange the home evaluation. Hopefully you’ll have even better information than taking him to a therapist, since he’ll be in familiar surroundings.

Hoping……

Hello, my father had difficulty swallowing when he was 93. He had a cold sore on his lip and he kept licking it transferring the virus to his esophagus and he couldn’t swallow. After a hospitalization, he was discharged with speech therapy at home. He was given exercises to do and he can now swallow. The herpes simplex left scar tissue on his esophagus so he avoids certain foods now and he’s off all medication because he is afraid the pill will get stuck. Luckily, his meds turned out to be duplicative and he no longer needed them anyway. He’s now 96 and swallowing issues are no longer a problem. He’s moved on to balance issues. Everyone needs to drink water every day to keep our throats supple and moist, and in the elderly, it’s even more important. Lack of water will cause confusion and a host of other problems. Speech therapy was our answer.

Hi Abby.,
My husband has this happen often.
Following a bout with GERD or acid reflux, Tums helps with the heartburn, but his esophagus is inflamed.
Until things calm down in that location, he’s learned to turn his head side to side slowly a few moments to ‘move things along’.

A friend of mine has some swallowing issues, and she has joined a disphagia (maybe dysphagia) support group on Facebook. They share information. I have a different issue : Schatzi's ring, which is basically a fibrous tissue, that gives the sensation of something being stuck in my throat. My friend needs to puree har food, as you do for your dad, but I just have to eat bite-sized pieces of solid food. The point of all this is that there can be different reasons for swallowing issues, so once your dad is able, I'd have him see a specialist, as his Primary Care Physician suggests, perhaps an ENT and/or a gastroenterolgist, to run some tests. Also, sometimes it's a trial and error process, regarding what's the "Goldilocks" sweet spot in terms of what's too thick and what's too thin, regarding the consistency of the food, (judging by what my friend is going through). Best of luck.

When Papa had swallowing difficulties due to Parkinson’s, he was told to tuck his chin to his chest before he swallowed. The Therapist said it was a trick that almost always helped.

I can help😀dysphagia…my mom has been diagnosed with this same issue and through the hospital, NESTLE THICKEN UP
added to whatever liquid he is drinking stops the gagging and choking. I have my mom drink some before she eats and the problem has helped 100%. It is difficult to find and the only place I could find it is st London Drugs or Save On Foods will order it in for you. Hope I have helped
janet

First ask for a referral then try to find a qualified speech language pathologist (SLP - speech therapist). Fox Rehab is a national home therapy company that does speech therapy along with other therapies in the home. Their SLP can do a bedside evaluation and some can even do or bring in another professional to do a FEES study in your home. (Fiberoptic endoscopic evaluation of swallowing). This is not as good as a Barium Swallow Test done outpatient in a hospital, but can give some very good information. The SLP can then do targeted therapy to the muscles that are affected which can be different for each person. Do not start using thickener products without the advice of a SLP even though it is over-the-counter. You need to know what level of thickener is appropriate for your father. Once they identify the reason(s) your father is having difficulty they can then advise you on the best way to address it. I did see where someone also posted to do a chin tuck when he swallows and that is a very helpful tip we have used for years.

My father and I have a genetic issue and had/have to have to get an endoscopy to get stretched. My father had the same issues as your father. Although at his age, I doubt a gastro would do the procedure.