Coughing while eating is a symptom not to be overlooked as a risk factor for illness and death. Coughing occurs when the swallow mechanism has been challenged. The mechanism related to the swallow is very complex. There are a number of body parts invovled in a safe swallow. In inidividuals with dysphagia, difficulty swallowing, one or more of the systems are no longer functional. This dysfunciton leads to food, fluids and secretions making their way into the lungs and respiratory tree. These substances are either irritating/inflammatory or infectious when they get into the lungs. These inflammatory or bacteria laden materials can lead to pneumonia or pneumonitis.
Speech therapists, or speech language pathologists, are an excellent resource for identifying the scope of the dysphagia problem. They are also the experts at teaching interventions to minimize the risk of foreign materal from entering the lungs. Speech therapists cannot always reverse the cause of the dysphagia because of permanent damage to the brain or swallow mechanism. However, they can provide therapy and meaningful interventions to minimize the impact of the dysphagia.
When you are visiting a nursing home, stop by the dining room at meal time. There should be licensed nursing staff in the dining room when the residents are eating. Often the only staff in the dining room are the dietary or service staff. These individuals are not skilled nor competent to identify the risks for aspiration nor are they appropriate to select interventions or provide referrals.
At a recent visit to a dementia unit at a nursing home, the only individuals in the dining room were wait staff who had English as a second language. While they were friendly and smiled at the residents, they did not have a clue of the risks of aspiration and dysphagia. This was demonstrated by the fact that two residents coughed each time they took a bite of food. Their coughing was so profound that they did not finish their meal. This situation encompassed two risk factors. First, the risk of pneumonia and second, the risk of malnutrtion from inadequate food intake. The wait staff were standing around the corner in the service area after serving the meal and were not even aware of the cough and difficutly eating that two residents demonstrated. They were talking and laughing in their primary language.
Visit nursing homes at meal times and watch for residents who are coughing. Do staff show an awareness of the coughing behavior? Do they respond when this occurs? Also see what staff are in the dining room to assist and monitor residents. Licensed nursing staff should be on site at each meal to recognize and refer residents with swallow issues.