Solve the Medical Riddle: Her 75-year-old Mother Has Trouble Swallowing, Fourth Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient and her daughter reported the patient’s symptoms. The doctor proceeded with the examination using the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendation

The doctor then referred Mildred to a radiologist. The second week, the radiologist performed a modified barium swallow test. Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following mont

The Doctor Reveals the Diagnosis

I commend everyone for some excellent guesses! However, Mildred is fortunate in that she doesn’t have any of the serious conditions that were suggested.  Ginny L. is the one who hit on the diagnosis when she said that maybe Mildred is “just getting older”. As an internist who often cares for the elderly, I quickly suspected that the aging esophagus issue would turn out to be the cause of Mildred’s trouble with swallowing. The medical term for the problem is presbyphagia from the Greek “presby” meaning old and “phagia” meaning to swallow or ingest. Another term for this is “senescent swallowing”. Presbyphaiga is one form of dysphagia, or difficulty swallowing.

Treatment/Plan

Treatment for dysphagia typically includes referral to both a speech therapist and a registered dietitian. Speech therapists know how to read the results of the modified barium swallow test so they can identify the specific problem. They make recommendations that may include changes in positioning or posture when eating or drinking, exercises to strengthen or improve swallowing muscles, techniques to aid in swallowing more safely, or changes in consistency of foods such as puréeing or mashing them, and the possibility of adding thickeners to fluids to improve ease of swallowing and to ensure that the patient does not aspirate.

A dietician can outline the appropriate consistency of foods in order to minimize the difficulties of eating and swallowing. Other considerations include catering to patients’ food preferences as much as possible; providing time for a leisurely, relaxed mealtime without distractions such as TV; and eating with family or friends. The elderly simply need more time to eat. No gulping down the food as we do when we are young! The goal of treatment should be to offer the most permissive yet safe diet for a patient.

Too many healthcare professionals rush to put older patients on a puréed diet as a cure-all, which it isn’t! Patients who require soft or puréed foods are rarely happy with the food choices they are offered. Even if the foods taste like the foods they have eaten all of their lives, the altered texture makes the food unappetizing to them. As a result, they tend to eat less or rely primarily on sweets such as ice cream, puddings, and milkshakes for nutrition. No surprise there! This can result in a dangerously inadequate and imbalanced diet that may compromise a patient’s ability to heal, hasten disease processes, and/or cause undesirable weight loss, which can become life threatening in older patients. Malnutrition is a huge health risk.

On another note, Ginny L. pointed out that Mildred’s need to push herself up out of a chair by using her arms on the armrests is probably a sign of muscle loss due to aging. The medical term for that is sarcopenia from the Greek “sarco” that means flesh and “penia” that means deficiency. Everybody experiences this to some degree but those with a sedentary lifestyle are the most prone to it. Mildred no doubt needed to exercise more in order to avoid the frailty that often comes with old age. Her daughter, Lucy, agreed. Mildred laughed and said that Lucy could stand to be more active herself!

As Mildred put it, “We had pretty much turned into a couch potato family. Even my teenage grandsons were glued to their phones and tablets and the TV way too much. So all of us, including my son-in-law, decided we needed to get moving! We joined a running group and we get out at least twice a week with the gang. I’m the pokiest one, but I’m actually not all that slow. The boys get a huge kick out of Grandma lacing up those running shoes! They’ll probably run a marathon eventually and while I won’t bet on that for me, I can tell you that I feel a whole lot better now that I’m not sitting around all the time. As for my swallowing, the problem isn’t any worse and I actually think my active lifestyle may be making my throat muscles stronger. I do still follow the speech therapist’s advise about throat exercises and the dietician’s advice about food and beverages, but I’m enjoying my meals and my daughter is no longer worried about me. I’m so glad I listened to her and went to the doctor. Who knew that aging could affect the way you swallow? I hope people who have this problem and read my story will realize they’re not alone and go get help the way I did!”

Come back to ThirdAge.com next Thursday when we’ll introduce a new medical riddle!

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.