Like many other automatic functions in our body, we don't think about the process of swallowing, unless we choke on a piece of food or have a sore throat. Those are obvious signs we are in trouble. It may be obvious that your carereceiver has problems with swallowing foods, liquids, or saliva. But there may be some "silent" signs that could indicate he or she may be experiencing swallowing difficulties.

It requires coordination of many muscles in the mouth, throat and esophagus (a tube that leads from the throat to the stomach). An efficient swallow allows for all of the material to leave the mouth and head down to the stomach. As we age certain changes can occur. Decreased saliva, taste, smell, elasticity and strength of muscles can affect a swallow. Loss of teeth or new dentures may change the way food is chewed or manipulated in the mouth.

There can be many reasons for swallowing difficulties. Stroke, Parkinson's Disease and other neurological diseases can cause a weakening, decrease in muscle coordination, and/or loss of sensation. Decrease or absence of awareness is also a danger factor. Dysphagia is the term health care professionals use when discussing swallowing difficulties. Dysphagia can result in malnutrition and can interfere with the carereceiver's ability to take medications. If the food or liquid goes down the wind pipe (trachea) and cannot be "coughed" up, it can pass into the lungs (aspiration). This may cause aspiration pneumonia.

If you suspect a swallowing problem, bring it to the attention of your physician or speech-language pathologist. The health care professional may recommend a swallowing study which is performed in a hospital (or as an outpatient) or a "bedside swallowing assessment" which is a clinical observation usually performed by a speech-language pathologist. He or she may be able to recommend a treatment program.

Over the past few years swallowing therapy programs have been developed that may help.

These programs may include changing the consistency or texture of food or liquid, positioning, meal set up, strategies to strengthen the muscles in the mouth and throat and techniques to protect the airway.

Reflux is commonly known as heartburn. Although it is not a swallowing problem it certainly can cause discomfort and possibly aspiration. Reflux occurs when stomach acids back up into the esophagus. Although the causes may vary, if your carereceiver is experiencing this problem frequently it should be addressed with your physician. Here are six precautions:

If you have questions please contact Rachel M. Walden or Bonnie Deach, Speech-Language Pathologists at The Continuum or contact the American Speech, Language and Hearing Association.

November is Family Caregiver Month. Many thanks to all of you wonderful caregivers who give everyday.