Eating and drinking difficulties (dysphagia) - Newcastle Hospitals NHS Foundation Trust

What is dysphagia?

Dysphagia is when someone has difficulty eating, chewing, drinking or swallowing following a stroke.

Up to 65% of people have difficulty swallowing after a stroke.

Many people with dysphagia can be at risk of aspiration (food and/or drink entering the lung).

If dysphagia is severe, you may need to be tube fed. This can be short or long-term. Suitability for tube feeding depends on many factors, and will be discussed by the medical team and you/your family.

What are the risks of dysphagia

People suffering from dysphagia can be at a higher risk of:

Choking
Dehydration and/or malnutrition
Weight loss
Aspiration pneumonia/chest infections
Psychological and social distress
Reduced quality of life
Longer hospital stay
Death

Signs and symptoms of dysphagia

Coughing before or after eating/drinking
Choking on food/drinks
Wet/gurgly voice when eating or drinking
Pocketing i.e. food left on the tongue and/or mouth
Pain e.g. feeling of food sticking in the throat
Drooling with drinks/saliva
Food spilling out of the mouth

How to help with dysphagia

If you have difficulty swallowing tablets, a pharmacist can advise you on alternatives (e.g. liquids or crushable tablets)
Not all tablets are suitable to be crushed/mixed with water/food and it’s always best to check with a pharmacist first
Altering the texture of drinks and food helps reduce risks
Thickened fluids and/or altered diet texture (e.g. pureed, mashed or soft and tender food) can make swallowing easier and safer for some people
Thickener does not change the taste and smell of food/drink
There are a range of thickened oral supplements if you need these to help with your nutrition
Supplements need to be requested via referral to a dietitian or by a GP
Foods which are crumbly, crispy, stringy or crunchy may be more difficult for some people
Your speech and language therapist will advise on the safest food/drink options
Your speech and language therapist may provide you with specific exercises to improve the effectiveness and safety of your swallow

Sit upright for all eating/drinking and for 20 minutes afterwards
Reduce distractions (e.g. TV/radio) and avoid talking when eating/drinking
Ensure the mouth (tongue, cheeks, roof of mouth) is clean and clear, using a toothbrush if needed
If wearing dentures, ensure they are secure before and after eating/drinking
Feed yourself if possible
If help is needed, the person helping should wait and watch to check you have swallowed each mouthful and sit close whilst helping
Monitor for tiredness and change in position (e.g. slipping down the bed or chair/leaning to one side) and reposition yourself if necessary
If assisting with feeding, be positive about modified diet/fluids which have been recommended for safety

Nutrition and hydration: things to consider

Weakness and visual changes can affect your ability to feed yourself
Taste changes can make eating less enjoyable
Post-stroke pain, bowel changes, tiredness or low mood can affect your appetite
You may feel scared or embarrassed to eat in public due to your swallowing difficulties
Changes to concentration, attention and memory may impact on how you eat and drink
Loss of independence (e.g. needing assistance with eating/drinking) might feel undignified

Malnutrition (unbalanced amount of nutrients or food to stay healthy)

Malnutrition is common after stroke and can affect rehabilitation potential.

People with dysphagia may be more likely to be malnourished.

Poor nutrition is associated with poor recovery and reduced independence at 6 months after stroke

Poor nutrition can lead to infections and skin damage and, sometimes, an increased risk of dying

More resources

Visit the following pages on the Stroke Association website:

You can also contact your local community stroke team.

Further Information

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