Aging and Life Enhancement
By Kathryn Kilpatrick, M.A.
One of the contributions to a longer, healthy life is good nutrition and a balanced diet. When shopping, cooking or meal planning and preparation become challenging for an older adult, adequate nutrition may be impacted. Further, did you know that swallowing issues may signal an area of concern that may require further assessment by a doctor?
A healthy and balanced diet is important and may require a closer look. There are circumstances when a person may experience swallowing problems (called dysphagia), or has received a new diagnosis that requires the elimination/modification of certain types of foods/ textures because of a stroke, multiple sclerosis or Parkinson’s disease, just to name a few. Poorly-fitting dentures or severely decayed teeth can also contribute to swallowing problems.
“Food is the most primitive form of comfort.” ~Sheila Graham
These are circumstances that may not be obvious, especially if supervision has not previously been a necessity, is sporadic or several people have been offering assistance. Even when there is a mild cognitive impairment, issues such as meal planning and food safety may require more attention and support.
“The first step toward change is awareness. The second step is acceptance.” ~Nathaniel Branden
Perhaps a family or friend may notice some issues when an older adult is eating or handling liquids. There might be a change in food preferences, like hamburgers instead of steak, lots more chewing or an avoidance of crumbly textures. Is there coughing or occasional choking when eating or a wet, gurgling vocal quality, persistent throat clearing, or issues with reflux? These are just a few of the numerous red flags and if there are cognitive and memory issues present, the ability to manage these changes may be challenging or not reported to others.
It is essential to alert the person’s primary care physician and schedule an appointment for a swallowing assessment where, if possible, symptoms noted can be reported in detail. In some cases, a modified barium swallow will be recommended to determine what may be contributing to the concerns reported. Typically, a referral is then made to a speech-language pathologist who will be able to address diet modifications such as foods appropriate to a mechanical soft diet or even pureed textures to reduce the risk of aspiration pneumonia. Another important component may be instruction in an oral exercise program, pertinent swallowing strategies as well as ideas to maximize appeal of the food textures recommended.
Based on my experience, it is important to have a responsible party present for those appointments since there are usually a lot of recommendations given that are specific to the test results involving revised swallowing strategies, diet modifications and sometimes an oral exercise program. It can be overwhelming, and if there are some cognitive issues or just resistance to any recommended changes in a person’s prior diet, compliance may be inconsistent with an increased potential for decreased nutrition or aspiration pneumonia.
Families can become overwhelmed trying to implement appropriate diet modifications and provide guidance for the implementation of the corresponding strategies. There are tips to facilitate the preparation of specialized diets (mechanical soft, pureed, etc.) when regular foods need to be modified, keep in mind the appeal factor, as well. When liquids need to be thickened, care partners often find it tricky to get it to the correct consistency and initial professional input can be invaluable. If the older adult is experiencing even some mild memory challenges, the effectiveness of the plan can be enhanced by support and appropriate supervision.
Educating others is vital, especially if friends or family drop off food or take a person with swallowing issues out to eat. Another issue to put on your radar screen and come up with a plan ahead of time are those special occasions with a buffet and all those food options that are possibly not good choices but compliance is not likely.
Since nutrition is important for healthy aging, one of most rewarding aspects of my career was finding ways to modify foods at the appropriate level so it was appealing. One of my patients had to have all of his food pureed but his intake was poor. His wife was not only an excellent cook, but with some suggestions, she put together a plate of food that was totally appealing. With reminders to slow down and set his spoon down between bites, there were no more coughing episodes and his nutritional needs were being met. The best part was, he was eventually able to enjoy his meal without any of those constant reminders.
For a family gathering, the daughter brought each of the food items (moist, finely chopped texture had been recommended) in small bowls and put them together ahead of the meal so her father could enjoy the socialization experience with others. Since that was a lot of work, others offered next time to prepare some his favorite/appropriate foods but let the daughter create the correct consistencies. Not only did it save her some prep time but it increased the awareness of his support system.
“There is nothing more beautiful than someone who goes out of their way to make life beautiful for others.” ~Mandy Hale
