A health concern that leads to tens of thousands of deaths each year in America often hides behind other problems, leaving the elderly the most at risk.
"Many people know that falling problems account for thousands of deaths in the elderly. There are a comparable number of deaths because of swallowing problems," said Dr. Joel Herskowitz, a St. Louis native who is a pediatric neurologist and faculty member at the Boston University School of Medicine.
Herskowitz and wife Roya Sayadi wrote the book "Swallow Safely: How Swallowing Problems Threaten the Elderly and Others. A Caregiver's Guide to Recognition, Treatment, and Prevention" because of their personal experience as caregivers and Sayadi's professional experience as a speech language pathologist.
Sayadi, who works with the Visiting Nurse Association in Natick, Mass., said she sees patients with swallowing problems daily, but patients don't recognize the symptoms.
A Washington University School of Medicine assistant professor of neurology agreed.
"I don't think it's on our radar because patients might have a lot more issues that they think are more pressing than that," Dr. Thy Nguyen Huskey said. "But if you can't swallow, you can't eat."
Parkinson's disease, multiple sclerosis and strokes cause chewing and swallowing difficulties, and Alzheimer's patients can forget they're chewing.
Medicines such as Benadryl and Spiriva can produce a dry mouth as a side effect, which can lead people to believe they have swallowed when they really haven't. And then they could choke.
"Medicines can dry up saliva," Herskowitz said. "Saliva is important. It helps each food particle stick together, so it helps food from the front to back and helps it slip into the esophagus."
Sayadi and Herskowitz suggest taking these medications in liquid form or crushed and mixed into food, if the medicine is as effective when cut.
If food isn't swallowed, it can slide down the trachea instead of the esophagus. This process, called aspiration, can carry bacteria to the lungs and cause pneumonia.
"People know about pneumonia coming through contact with air," Sayadi said. "Rarely are people aware of getting pneumonia through food going down into the respiratory tract. Nothing other than air should go to lungs."
Even poor dental habits contribute to aspiration. Both the authors and Huskey warned that oral bacteria can enter the lungs and cause pneumonia.
Caregivers can be on the lookout for frequent throat clearing during meals, drooling, a change in voice because food is trapped at the back of the mouth, and a runny nose or tearing eyes while eating because food is being aspirated.
Huskey's advice for patients and caregivers is to simply ask their physicians about their symptoms.
"Ask not in a casual way, but in a really probing way," she said.
Although anyone can have swallowing problems, Huskey said the elderly are at a considerable risk.
"The older you get, there's an increased likelihood of other illnesses, which all can lead to swallowing problems."