Practical measures and advice
Sometimes simple advice may be all that is required to enable the patient to take their medicine as prescribed. Pharmacists may initially advise patients to try medication formulated as a capsule or elongated "torpedo" shaped tablet, which are easier to swallow. This simple advice may be sufficient to enable the patient to take their medication as prescribed.
Alternatively patients may simply require advice on how to swallow medication. This advice can include initially moistening their mouth with saliva or water, place the tablet in the centre of the tongue lengthways where the tablet is oval and then immediately take a sip of water to wash the tablet into the throat. Alternatively, patients can be advised to hold water in the mouth before inserting the tablet, and to put their chin onto their chest when swallowing; this opens up the oesophagus facilitating swallowing.
Where dry mouth is causing swallowing difficulties, symptoms can often be relieved by frequently sipping cool drinks, sucking small pieces of ice or frozen fruit, sucking sugar free fruit pastilles, chewing sugar free gum and preventing dry or chapped lips by applying petroleum jelly. If these are ineffective, patients can be recommended artificial saliva products such as Biotene, Xerotin, Glandosane or Saliveze, or saliva stimulants such as Salivix pastilles or SST tablets.
Patients with dentures may benefit from referral to a dentist as a reduction in masticatory strength and co-ordination is more common in patients with partial or complete dentures. This can result in a tendency to swallow larger pieces of food with an increased risk of choking.
Practical management options for patients with dysphagia may include:
- Adjusting position or posture when eating or drinking.
- Managing the size of the food bolus by offering small quantities of food.
- Adapting the texture or temperature of the food.
- Restricting the speed of eating or drinking.
- Encouraging exercises of the oral muscles.
- Teaching specific swallowing techniques.
- Provision of specialist equipment.
These options require the patient to be referred to a speech and language therapist with specific experience in the treatment of dysphagia.
Patients who have a high risk of aspirating food, such as a patient who has suffered a stroke, will find foods of a thicker consistency easier to swallow whilst thin liquids such as water should be avoided. In comparison, with patients where there is a significant risk of choking, such as those who find chewing foods into small pieces difficult, will find thinner liquids in small volumes easier to swallow. Thickening agents such as Thick and Easy®, Instant Carobel® or Nutilis® can be used to modify the consistency of food and drink to one that the patient can swallow.
Generally a speech and language therapist will advise on the use of thickening agents and modifications in food or drink consistency.