Author Archives: mfleegle

Food Access and Dysphagia

Swallowing difficulties, also known as dysphagia, are common among older adults. To keep eating safe, healthcare providers often recommend diet changes, such as softer foods or thickened liquids. While these modifications reduce choking risk, they can also make eating less enjoyable and decrease how much a person eats and drinks. Over time, this can lead to dehydration, malnutrition, and faster health decline, especially for older adults.

Many older adults also face food insecurity, meaning they don’t always have enough nutritious food due to financial limitations, mobility challenges, or living in areas with limited grocery options (“food deserts”). When swallowing problems and food insecurity overlap, it creates significant risks for both health and quality of life.

One major concern is dehydration. Thickened drinks are often recommended to prevent aspiration (liquid entering the lungs), but many people dislike them and drink less. Inadequate hydration can trigger urinary tract infections, confusion, kidney issues, and general weakness. Lack of fluids and poor nutrition can also worsen swallowing difficulties, creating a cycle that’s hard to break.

For caregivers, these challenges can be overwhelming. Preparing safe meals often involves extra steps—blending, chopping, or thickening liquids—which takes time and energy. This can add stress, reduce opportunities for social meals, and contribute to caregiver burnout. Caregivers often find themselves juggling food preparation, healthcare appointments, and navigating assistance programs, all while supporting their loved one’s day-to-day needs.

Social and financial barriers can make things harder. Older adults from marginalized communities are more likely to face food insecurity and severe swallowing problems. Programs like the Supplemental Nutrition Assistance Program (SNAP) can help, but their complex application processes may be difficult for older adults or their caregivers to manage. Many also feel stigma around using food assistance, which can prevent them from seeking help.

What can caregivers do?

Prioritize hydration. Offer sips of preferred drinks throughout the day, use high-water foods (like melon or soups), or try commercial thickened beverages if recommended.
Simplify meals. Prepare soft, easy-to-swallow foods in advance and freeze them into single portions to save time.
Seek professional guidance. Speech-language pathologists (SLPs) can teach safe swallowing strategies and recommend appropriate food textures. Dietitians can help plan meals that are both nutritious and safe.
Ask about support programs. Local senior centers, Meals on Wheels, and social workers can help with meal delivery, shopping assistance, or SNAP enrollment.
Include yourself. Caregiving is demanding. Reach out to support groups or respite services to maintain your own health and wellbeing.

Reference

Beltrán, J., & Shune, S. (2025). Environmental Considerations in Dysphagia Care: Exploring the Relationship Between Dysphagia and Food Security. Perspectives of the ASHA Special Interest Groups. https://doi.org/10.1044/2025_PERSP-24-00276

New Research on Swallowing Difficulties in Older Adults

Swallowing difficulties, or dysphagia, are more common in older adults than many realize. While occasional coughing or trouble swallowing pills might seem minor, these can signal underlying changes in swallowing function that require attention. A recent study by Namasivayam-MacDonald, Werbeloff, and Shune used data from over 11 years of interviews with thousands of older adults to better understand the prevalence and risk factors of swallowing problems in the U.S.

The study found that 8.7–10.2% of older adults reported swallowing difficulties at any given time. Interestingly, these problems were often transient, meaning they came and went rather than staying constant. This suggests that dysphagia in older adults can be linked to episodic health changes—such as illness, injury, or medication side effects—rather than always being permanent.

Several important risk factors emerged, including:

Poor overall health and multiple medical conditions
Lower physical activity and reduced muscle strength
Difficulty eating independently (needing help at meals)
Low income and less education, highlighting the role of social determinants of health
Hispanic ethnicity, which the authors linked to disparities in healthcare access and support

These findings underscore that swallowing is not just a medical issue—it’s deeply connected to overall health, nutrition, mobility, and social support.

For caregivers, understanding these risks is crucial. Swallowing problems can lead to serious complications, including pneumonia, malnutrition, dehydration, and reduced quality of life. Because dysphagia is often under diagnosed, caregivers are often the first to notice red flags such as frequent coughing during meals, needing to swallow multiple times per bite, or avoiding certain foods.

What can caregivers do?

Watch for early signs. Keep track of changes like coughing or throat clearing during meals, unexplained weight loss, or prolonged meal times.
Encourage regular check-ups. Ask healthcare providers about swallowing screenings, especially if your loved one has dementia, lung disease, or recent hospitalizations.
Promote safe eating environments. Reduce distractions at meals, ensure good posture (upright position), and allow plenty of time for eating.
Seek professional help early. Speech-language pathologists (SLPs) can assess swallowing and recommend safe strategies or food textures.
Support overall health. Physical activity, adequate hydration, and good nutrition can help maintain muscle strength—including swallowing muscles.
Address barriers. If cost, transportation, or language are obstacles, reach out to social workers or local aging agencies for support.

The research also suggests that periodic re-screening is essential, as swallowing problems can develop or resolve over time. By staying vigilant and advocating for care, caregivers can help prevent complications and maintain their loved one’s safety and dignity.

Understanding dysphagia and its risk factors empowers caregivers to act early and effectively. With proper support, many older adults with swallowing problems can continue to enjoy meals safely and comfortably.

Reference

Namasivayam-MacDonald, A., Werbeloff, M., & Shune, S. (2025). Prevalence and predictors of self-reported swallowing difficulties in community-dwelling older adults: A population-based study from the National Health and Aging Trends Study (NHATS). Dysphagia. Advance online publication. https://doi.org/10.1007/s00455-025-10860-0

Dysphagia and Dementia FAQ

Many of our survey participants expressed interest in learning more about dysphagia and ways to support their family member with dementia who may be dealing with dysphagia now or in the future. Here we are sharing the short answers to some common questions about dysphagia and dementia and where to go to learn more.

What is dysphagia?

Dysphagia is the medical term for swallowing difficulty. It is categorized according to where along the way the difficulties arise. For example, oral dysphagia refers to issues moving the food/liquid within the mouth, oropharyngeal dysphagia refers to issues moving the food/liquid into the back of the throat or pharynx, and esophageal dysphagia refers to issues moving the food/liquid down the esophagus to the stomach. Licensed medical professionals known as speech-language pathologists or speech therapists are specially trained to assess and treat swallowing disorders.

What causes dysphagia for someone with dementia?

Dysphagia can be caused by changes that occur in the brain as well as environmental factors, such as background noise, distractions, etc. While dysphagia tends to be more apparent in the later stages of dementia, it may be present to one degree or another at any stage of dementia.

What are signs that someone with dementia has dysphagia?

Potential signs or symptoms may include difficulty chewing, food left in the mouth, coughing during eating/drinking, reduced intake, taking longer to eat, avoiding certain foods, and weight loss. This brief questionnaire can help identify a possible swallowing disorder.

What are the risks of dysphagia?

Perhaps the most well-known risk is choking, which happens when food goes “down the wrong pipe” and obstructs breathing. Making a vocal sound like coughing is a good indicator that a person is not choking since airflow is needed for making sounds like coughing, talking, etc. Refer to the American Red Cross website for more information on how to recognize and respond to a choking event.

Lesser-known risks associated with dysphagia include malnutrition and dehydration as well as a serious condition called aspiration pneumonia, when aspirated material (i.e., food/liquid that enters the airway) becomes infected in the lungs.

How can I prevent aspiration pneumonia?

Routine oral care limits the bacterial load in the mouth and, therefore, limits the bacteria in any consumed food/liquid that may take a wrong turn and enter the lungs. So, proper oral hygiene is one way to help prevent this type of pneumonia.

Another way is to try to prevent aspiration (material entering the airway) in the first place. If you are noticing signs and symptoms of dysphagia, talk to your doctor about seeing a speech-language pathologist who can assess and come up with an individualized treatment plan. Part of the plan may include mealtime modifications, such as head posturing. Such modifications can be more effective at preventing aspiration and aspiration pneumonia than thickened liquids, a dietary modification that is also associated with an increased risk for dehydration. While feeding tubes are an option, research suggests that they do not prevent aspiration/aspiration pneumonia (what is being fed through the tube can come up and enter the airway), nor do they prolong life.

How do I help someone with dementia get the nutrition they need?

Maximizing sensory cues associated with eating (e.g., flavors, temperatures, textures) can improve meal engagement and nutritional intake among individuals with dementia. People with dementia may also prefer to eat multiple small meals and/or “finger foods” that can easily be eaten using hands instead of utensils. Setting up meals to suit these preferences, and any others you’ve identified, such as softer foods, familiar foods, etc., can lead to greater intake throughout the day.

To learn more about dysphagia and access dysphagia-related caregiver resources, visit the National Foundation of Swallowing Disorder website.

Holiday Conversation Tips for Friends and Family of People with Dementia

If you are a friend or family member of someone with dementia, you may be thinking about ways to enjoy the upcoming holidays with them. Below are a few strategic adjustments you can make to the environment and your own communication to help promote meaningful connections this holiday season.

Setting the Scene

If you are the care partner, consider hosting or attending the festive event in the morning or whenever cognition is at its best for the person with dementia (PWD). Additionally, putting out pleasing sights, sounds, or smells associated with the holiday can help trigger fond memories and bring to mind what the day is about. For example, setting out a familiar decoration, playing a song you commonly sing around the holidays, baking fresh rolls so the smell wafts from the oven. These elements offer not only a positive atmosphere; but also, they have the potential to leverage the PWD’s intact long-term memory and can be a jumping off point for conversation. Keep in mind, you do not have to do it all. Whatever ideas you come up with, pick what seems the most simple and pleasant to put into practice.

Supporting Conversation and Connection

If you have noticed a change in the PWD’s conversation abilities, adjusting how you express yourself can help to meet them where they are. That may mean simplifying and slowing how you speak (e.g., using short sentences, asking yes/no questions, waiting patiently for a response). It may also mean enhancing your message with sensory-rich language (e.g., the spice of the hot cider, warmth of the fireplace) and/or supporting it with visual cues (e.g., gestures, written words). Noticing and acknowledging nonverbal forms of expression, such as sounds and facial expressions that convey feelings, is another valuable way to create a sense of shared connection. In the end, engaging in a conversation topic that is familiar and meaningful to the PWD, such as reminiscing about a past, personal event, can help encourage meaningful discussion and social participation. As mentioned, if you have concrete elements in the environment (e.g., a photo album) to help introduce and facilitate the recall, even better.

We hope everyone has a happy holiday season!

If you try (or have tried) any of these tips or others, please feel free to share your experiences in the comments below.