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Book Reviews

Swallow Safely

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Swallowing is a four-step process that usually happens without conscious thought or deliberate physical effort, even though most people swallow approximately six hundred times a day. More than ten individual body parts are involved in swallowing, and muscular weakness or poor coordination during its four phases—preparatory, oral, pharyngeal, and esophageal—can ruin mealtime and put certain people at risk of dehydration, malnutrition, oxygen distress, choking, or pneumonia caused by the inadvertent “aspiration” of food or drink into the lungs. Patients, family members, and health care providers must be educated and alert for signals of “dysphagia,” the medical term for “difficulty swallowing.”

Despite its seriousness, too few people know how to identify and treat dysphagia. The authors of this book, a wife and husband team, a speech-language pathologist and neurologist, respectively, have extensive expertise with dysphagic patients, and they have written a well-researched, informative guide for those caring for the elderly or the ill. The book’s straightforward language and clear terminology are accompanied by sixteen well-labeled illustrations of the swallowing process. Each chapter ends with a summary of important terms and information for quick reference or review. The authors’ comprehensive approach to this quality of life issue extends to their thoughtful decision to publish the book in large print that can be read comfortably by both elderly patients and their middle-aged or aging children and spouses.

Swallowing difficulties in the elderly and seriously ill are often overlooked because their symptoms may be relatively subtle and discounted or ignored. Patients who find eating tiring might not mention it to their caregivers, and those who share meals with them might not realize that a runny nose during meals, coughing, or excessively slow swallowing can indicate a potentially life-threatening problem with swallowing. Further, dehydration causes less blood flow to the brain and muscles, causing confusion and dizziness and increasing the chance of falling. Neurological disorders, missing teeth, or poorly fitting dentures are also risk factors.

Patients with respiratory diseases can also be in mortal danger because the normal brief cessation of breath that occurs during drinking can trigger panicky gulping that sets the stage for choking or aspiration. Finally, people without sufficient training can easily mistake choking for a heart attack and fail to respond appropriately.

The authors include a long list of “anticholinergic” medications that can contribute to swallowing problems, as well as many tips for careful eating that may help restore safety and pleasure to mealtimes. A thoughtful, pre-written “Letter for Your Doctor” lists swallowing problems and provides space to list hospitalizations, medical conditions, and medications. This book will save lives.


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