Swallow Safely Roya Sayadi and Joel Herskowitz, Inside/Outside Press Page 4 of 4

Ongoing Evaluation and Treatment
Treatment of swallowing problems is an ongoing process. Several sessions over several months may be required to meet treatment goals.

The initial plan may not be the final plan. The swallowing specialist will follow the patient over time, monitoring progress at the bedside or in the office. She will arrange for further testing as needed and make necessary adjustments to the diet.

Be sure to keep the doctor, nurse, and swallowing specialist informed as to advance directives and changes in your loved one’s condition. If you think the treatment plan is no longer suitable, let them know in what way as soon as possible.

In the next chapter, we will show you how to put your questions, observations, and concerns to use in getting help for your loved one.

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Appendix B: Suggestions for Swallowing Safely

Mental and Physical State

• Don’t eat if drowsy, confused, or agitated.
• Don’t eat if unusually weak or out of breath.

Setting

• Reduce distractions: Turn off TV, radio, cell phone.
• Relaxing music is OK.
• Close doors to reduce traffic.
• Don’t overdo conversation or promote laughter while eating.

Positioning

• Sit upright, not tilted back or slumped to the side.
• Provide firm support for legs.

Food Preparation

• Involve the person with a swallowing problem in preparing food to promote saliva flow and overall enthusiasm for eating.
• Check temperature of food and liquids to make sure they are not excessively hot or annoyingly cold.
• Avoid difficult-to-swallow foods such as crusty bread, toast, popcorn, raw vegetables (celery, lettuce, etc.), whole nuts, and peanut butter.
• Avoid crumbly, flaky foods and pastries dusted with sugar.
• Be careful with (or avoid altogether) carbonated beverages.
• Watch out for foods of mixed consistency such as some fruit and cereal with milk.
• Be careful with foods (like ice cream or Jello) that melt.
• Avoid foods or liquids that have caused prior difficulty.
• Provide tasty foods of suitable consistency.
• Thicken liquids as directed.

Mealtime Strategies

• Don’t rush.
• Eat a small amount at a time.
• Chew thoroughly.
• Don’t talk and eat at the same time.
• Use the chin tuck maneuver, as directed.
• Swallow, clear throat with a gentle cough, and swallow again before taking in more food.
• Finish the swallow before reloading spoon or fork.
• After the swallow, check mouth for left-over food or pill.
• Clear the mouth, if needed, by tongue, hand, or mechanical suction.
• Alternate solids and liquids to facilitate passage of the bolus and wash away residue.
• Watch for fatigue; finish meal another time, if necessary.
• Arrange for smaller, more frequent meals.
• Note cough, sputter, choke, gag, tearing, runny nose, nasal regurgitation, or other problems.
• If someone coughs or chokes, do not slap on the back.
• Be prepared to carry out the Heimlich maneuver.
• If a choking person leaves the room, follow him or her. Do not leave alone until the incident is resolved.

Taking Medication

• Stay calm.
• Sit upright.
• Take one pill at a time.
• Swallow pills with plenty of liquid to make swallowing easier and to protect the esophagus.
• Don’t exceed daily fluid requirements.
• Use applesauce to facilitate pill-taking.
• Replace difficult-to-swallow pills with more suitable preparations, as approved by a pharmacist.
• Use a specialized cup, if allowed.
• Take medications as early in the day as possible.
• Remain upright for 30 minutes after taking pills.
• In general, use the same strategies that work for swallowing solids and liquids (e.g., effortful swallow, chin tuck).

After Meals

• Do not lie down for 30-45 minutes after eating.
• Walk for several minutes if permitted.
• Clean teeth, gums, and dentures several times per day.
• Use an antibacterial mouth rinse as prescribed.
• Swab lips, tongue, and cheeks to moisturize and lubricate the mouth.
• Suction pooled saliva to reduce the bacterial load.
• Arrange for regular dental care.

Between Meals

• Watch for respiratory difficulty (such as cough, rapid breathing, or wheezing), chest pain, or voice change.
• Carry out approved swallowing-related exercises that involve breathing, coughing, and chewing.
• Work on overall fitness, muscle strength, balance, and posture.
• Keep mind and body active with reading, playing bridge and Scrabble, doing word puzzles and Sudoku, mentoring, and other activities.
• At bedtime, elevate the head of bed to 30 degrees to help prevent aspiration or reflux during sleep.

From “SWALLOW SAFELY: How Swallowing Problems Threaten the Elderly and Others. A Caregiver’s Guide to Recognition, Treatment, and Prevention” by Roya Sayadi and Joel Herskowitz © 2010. Reprinted with permission of the publisher, Inside/Outside Press, www.SwallowSafely.com.

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