Speech pathology week ends FridayBy Cathy StovellWe all know that if we cannot breathe we will die, but did you know that if you cannot swallow you will meet the same end without medical intervention?“If you cannot swallow you cannot live,” said Sandra Cook-Anderson, clinical supervisor for speech pathology at King Edward VII Memorial Hospital.Most of her work with patients is centred on swallowing.“In the hospital swallowing disorders or dysphagia are very commonly the result of stroke, dementia or other neurological conditions,” she said.The problem is not only with adults.“Even children can suffer, especially premature babies,” Mrs Cook-Anderson said.This article will focus on the problem many elderly patients face in swallowing. According to Mrs Cook-Anderson, it’s a serious concern.“Sometimes people cannot swallow due to dementia,” she said.Dementia happens as the brain is shutting down. As a result, the person loses control of their body, their bodily functions and their mind.Speech is one of the last areas where control is lost and in tandem with that, comes swallowing.“They lose the ability to swallow and forget how to swallow,” said Mrs Cook-Anderson.Persons with dementia often put food in their mouths and forget what to do with it, mostly because they’ve forgotten how to trigger their swallowing reflex, she explained.“Some elderly hold food in their mouth for a couple hours, some even a whole day,” she said.She said it’s also common for them to chew when they don’t need to, some will chew things like water.The problems occur in what speech language pathologists call the oral phase of swallowing. It’s when chewing and moving food or liquids from the mouth to the throat takes place.Those caring for someone with dementia can easily see when the person has food in their mouth.According to Mrs Cook-Anderson swallowing poses a greater medical concern in the pharyngeal phase when food and liquids are squeezed down the throat.We’re not accustomed to consciously thinking about how to do this but it’s a complex process.Choking is the main danger in this phase.What actually happens is that at the back of the throat there are two tubes the trachea leads to the lungs; the oesophagus, leads to the stomach.When we swallow food we first hold our breath, a flap covers the trachea, the voice box moves up and tucks into the jaw and the tongue moves to the back of the mouth and pushes food down the oesophagus.“The pharyngeal phase is the most medically significant. Food could end up in the lungs and you could choke,” said Mrs Cook-Anderson.Dementia patients who have lost the ability to swallow risk getting food into the lungs, thus causing infection. It also means that the person will not be able to eat and won’t get the required nutrients to be able to live.“We see this very often as an end-of-life issue,” said Mrs Cook-Anderson. “If you cannot swallow you cannot live.A feeding tube is an alternative however it’s often a very difficult decision for a family member to make, she added.“A lot of the time the patient at this stage has a cognitive deficit. That’s why advance directives are important.“It’s important to share your beliefs with your family and your healthcare provider but it’s best to put it in writing.“If you don’t, people you may not know, may get to make the decision.”Dementia research shows that it does not improve the patient’s quality of health to simply put a feeding tube in place.“That’s because when they have a tube, lots of times we have to put their arms in restraints,” she said.The feeding tube goes directly in the stomach and poses the additional problem of wound care and possible infection.“It also doesn’t guarantee the food doesn’t come back up and it can cause diarrhoea because the body is absorbing less,” she said. “Research shows the best course of action is hand feeding.”