Signs which could indicate potential swallowing difficulties include1,2:
- History of choking
- Recurrent chest infections (due to food or liquid entering the respiratory tract)
- Coughing before, during or after swallowing
- Changing of breathing pattern of shortness of breath when eating/drinking
- A rattling or gurgling voice (after liquids in particular). The voice may sound hoarse or ‘wet’
- Difficulty controlling food or liquid while in the mouth
- Regurgitating food or liquid
- Aspiration of food or liquid
- Unexplained weight loss
- Prolonged meal times
- Refusal to eat or drink
- Dehydration
- Patient complains of a feeling of “obstruction” when swallowing
- Patient has a dry mouth (xerostomia)
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Some patients might not acknowledge their symptoms, perhaps through embarrassment or because of difficulties in communication, for instance following a stroke. Asking open questions may be useful in helping to identify patients with swallowing difficulties such as:
- ‘Do you cough after drinking or eating?’
- ‘Do you feel that tablets / capsules stick in your throat or chest?’
- ‘How long does it take you to eat?’
- ‘Does your mouth feel particularly dry’
The carer could be asked whether the patient:
- Appears to have difficulty swallowing the tablet or capsule
- Misses taking medication because of swallowing difficulties
- Sometimes hides medication instead of taking it
- Needs to suck or chew tablets to make them easier to swallow
Guidelines for healthcare professionals state that you should always ask a patient about swallowing difficulties before prescribing a medicine and assess the reasons for this. This should be taken into consideration when prescribing medication.3
1. https://www.medicalnewstoday.com/articles/177473 (accessed 15th March 2020) | 2. Wright et al. 2011. Prescribing Medicines for Patients with Dysphagia. A handbook for healthcare professionals | 3. Wright D, Chapman N, Foundling-Miah M et al. Consensus guideline on the medication management of adults with swallowing difficulties. In: Foord-Kelcey G, editor. Guidelines – summarising clinical guidelines for primary care. 30th ed. Berkhamsted: Medendium Group Publishing Ltd; October 2006.