Dysphagia: Caring for someone with swallowing difficulties

It is the difficulty or inability to swallow solid and/or liquid foods. The causes of dysphagia can be varied, ranging from diseases that affect the muscles to frailty in very elderly patients, reduced saliva production, or lesions of the tongue and gums.

Patients with dysphagia are at risk of dehydration and may develop respiratory problems. To prevent this, specific care is required, especially by modifying the consistency of foods.

General recommendations if the patient is hospitalized:

• Confirm with the nursing team that the patient’s level of consciousness is adequate for oral intake.
• Moisturize the mouth before eating using cotton swabs or artificial saliva.
• Position the person sitting upright in bed with the head fully elevated, or seated in a chair during meals and for up to one hour after finishing.
• Instruct the person to keep their chin down while swallowing.
• Always use a spoon and give food and liquids in small amounts.
• Due to the high risk of choking, the patient should not drink water or other liquids normally; it is recommended to replace liquids with thickened drinks.

How are thickened liquids prepared?

To thicken liquids, you will need:

A glass, a spoon, a thickening agent, and the drink you want to serve (water, juice, milk, infusion, etc.)

The amount of thickener varies depending on the base liquid.

If you are preparing water, coffee with milk, milk, or an infusion:

• Nectar consistency:

In a 150 ml glass (like those used in hospitals), add 2 level tablespoons of thickener.

• Honey consistency:

In a 150 ml glass, add 3 level tablespoons of thickener.

• Pudding consistency:

In a 150 ml glass, add 4 level tablespoons of thickener.

If you are preparing juice (pineapple, peach, orange, flavored smoothies):

• Nectar consistency:

In a 150 ml glass (like those used in hospitals), add 1 level tablespoon of thickener.

• Honey consistency:

In a 150 ml glass, add 2 level tablespoons of thickener.

• Pudding consistency:

In a 150 ml glass, add 3 level tablespoons of thickener.

The thickened drink should not be left standing for more than one hour. Once prepared, it should be consumed immediately.

Nutritional recommendations for following a healthy diet at home

Patients with dysphagia, depending on the severity, may need a homogeneous pureed diet, or if the condition is milder, they can eat foods that are easy to chew while avoiding certain high-risk foods.

• It is important to have a varied and balanced diet.
• Maintain regular meal times and try not to skip any.
• Eat slowly, using a small spoon, taking small bites or spoonfuls.

For patients who require a homogeneous pureed diet, it is recommended that the puree contains no bones, spines, skins, etc., and should include:

• 1 portion of protein foods: meat, fish, or eggs
• 1 portion of starchy foods: rice, potato, pasta, or legumes
• 1 portion of vegetables
• 1 portion of oil

At the end, complement the meal with a dessert such as custard, yogurt, compote, etc.

Remember to thicken liquids to the appropriate texture. For patients who only require an easy-to-chew diet, foods should be well-cooked and moist enough to be swallowed without difficulty (for example, meatballs with thick sauce, cannelloni, lasagna, potato omelets, meat or fish pies, etc.).

In both diets, high-risk foods should be avoided.

High-risk foods

• Very hot, acidic, or spicy foods (pepper, vinegar, etc.)
• Fibrous or stringy foods that may cause choking (pineapple, fibrous meat, celery stalks, white stems of lettuce, chard stems, asparagus, etc.)
• Juicy fruits that release juice when chewed, ice cream, sorbets, etc.
• Skins of legumes, bones of meat, fish spines, pits, seeds, etc.
• Dry foods such as chips, toasted bread, nuts, etc.
• Sticky foods such as toffee candies, dry rice, etc.
• Foods with mixed textures: broth with pasta, lentils with juice, juicy fruit, milk with solid cereals, etc.

Recommended beverage texture during meals

At main meals (breakfast, lunch, and dinner): a glass of gelatinized water. Mid-morning and for snacks: a glass of thickened water.