Frailty, muscle and swallowing

An old swallow can be a healthy swallow

Dr. Humbert and a colleague wrote in 2008 that a healthy older adult's swallow is not inherently impaired. It just changes a little.

It may start a bit later and take a bit longer. That alone is not a swallowing problem.

Frailty and less in reserve

Frailty means the body has less strength and less spare capacity. Muscle loss with age, called sarcopenia, is part of it.

The tongue and throat are muscles too. When they weaken, there is less room for things to go wrong.

What can tip the balance

A swallow that managed well can struggle after:

• An illness, like pneumonia or a bad infection.
• A hospital stay, surgery or a fall.
• A new medicine, especially one that makes you sleepy.
• Eating less for a while, and losing weight.

What you might notice

• Meals taking much longer, or being left unfinished.
• Coughing or throat clearing at meals.
• A wet or gurgly voice after drinking.
• Avoiding meat, bread or other foods that need chewing.
• Clothes getting looser.
• Getting tired partway through a meal.

What can help

• Sit fully upright for meals.
• Small, frequent meals can be easier when you tire quickly.
• Eat when you are most alert, and rest before meals.
• Keep mouths, teeth and dentures clean and well fitted.
• Ask about a dietitian if weight is dropping.
• Swallowing exercises may help some older adults build strength. An SLP can show the technique and check if it helps.
• Before changing foods or drinks, ask what a swallow assessment showed. Then decide what to try.

Questions to ask your care team

• Is this a normal age change, or worth checking?
• What are the pros and cons of changing what I eat?
• Could an SLP assess my swallowing?
• Are any of my medicines making me sleepy or dry?
• How can I keep my strength up?

When to get help

Get checked soon if you notice any of these. A doctor or SLP can look at what is going on.

You know your own body best. Bring what you notice to your care team, and decide together.

• Coughing or choking when you eat or drink.
• Food or pills that feel stuck.
• Losing weight without trying.
• Pneumonia or chest infections, especially if they come back.