How aging affects swallowing

As we age, our bodies change in ways we might not expect — and one of the most overlooked changes is how aging affects swallowing. Known medically as presbyphagia, this condition can be subtle, but it plays a major role in maintaining health, dignity, and quality of life in older adults.

Swallowing difficulties are not always just about getting older — they can also be one of the early warning signs of dementia or other neurological conditions. In this blog, we’ll explore what happens to swallowing with age, how to spot red flags, and how to help older loved ones stay safely hydrated and nourished.

What Is Presbyphagia?

Presbyphagia refers to age-related changes in the swallowing mechanism. It’s not a disease, but a gradual weakening of the muscles and reflexes involved in swallowing. The tongue may move more slowly, the throat muscles may not contract as strongly, and the coordination between mouth and throat can become less precise. This can lead to:

• Choking or coughing while eating

• A feeling of food “sticking” in the throat

• Avoidance of certain textures, like dry or crumbly foods

• Longer mealtimes or fatigue while eating

These subtle signs can be dismissed as “just old age,” but they deserve attention, especially when they begin to impact nutrition, hydration, or safety.

Swallowing Problems and Early Dementia

Swallowing difficulty can be one of the first signs of cognitive decline. This is because swallowing is not just physical — it’s a complex neurological process that involves multiple brain regions. In conditions like Alzheimer’s disease, vascular dementia, or Parkinson’s related dementia, the brain may begin to lose coordination over this reflex.

Some clues that point toward a cognitive connection include:

• Forgetting how to chew or swallow

• Holding food in the mouth without swallowing

• Lack of interest in food or drinks

• Panic or confusion at mealtimes
  

  When memory and motor control are affected, meals can become overwhelming. This isn’t simply forgetfulness — it’s a loss of the brain’s ability to sequence motor patterns and respond to the body’s needs.

If you notice any of these symptoms in a loved one, it’s worth discussing with a GP or a dementia specialist. Early intervention can help slow progression and improve quality of life.

A recent conversation with a friend, where she was frustrated with her elderly mother not swallowing medication or liquids, led to me introducing her to jellydrops - I explained to her that it could be a sign of cognitive decline and she told me that she does get confused more often. I asked her to get in touch with her GP and ask them to call her in for health checks and to get a memory and cognition test. Confusion and brain fog can happen to the best of us, but this kind of behaviour is a red flag.

Why Older Adults Struggle to Stay Hydrated

Dehydration is a common and serious issue in older adults, often made worse by swallowing issues. But even without clear dysphagia, older people are more prone to dehydration for several reasons:

• Reduced thirst response: The body’s natural signal to drink gets weaker with age.

• Mobility limitations: Getting up for drinks may feel like too much effort.

• Medication side effects: Diuretics, antidepressants, and antihistamines can increase fluid loss or dry the mouth.

• Fear of incontinence: Some older adults purposely limit fluids to avoid frequent urination or accidents.

Add to this the challenge of swallowing thin liquids — which are the hardest to control — and it’s easy to see why water often gets neglected. Filling up a large bottle of water and sipping it throughout the day is helpful, but with cognitive decline, the person may struggle to remember what the water bottle is or represents. My sister and I used to have to remind my mother every 30 minutes to take some sips of water, otherwise she'd suffer UTI's and that made the dementia worse.

Health Risks of Dehydration and Malnutrition

When swallowing difficulties lead to dehydration or malnutrition, the health risks can escalate quickly. Common complications include:

• Urinary tract infections

• Constipation and impaction

• Confusion or delirium

• Falls and fractures

• Kidney damage

• Increased hospitalisations

Urinary tract infections (UTIs) are very common in the elderly and can cause hallucinations. Sometimes this can be missed by medical professionals and can lead to patients being placed into dementia wards. This happened to my mother. She went into the hospital and was put into the dementia ward, and when we questioned it, we told them that she had regular UTIs, and it was probably that. Once given antibiotics to clear it up, she became rational again.

In dementia, dehydration can mimic or worsen symptoms of confusion. Likewise, not eating enough can cause rapid weight loss and frailty, further reducing the ability to swallow.

Being proactive is essential — and hydration is often the first and easiest thing to improve.

How to Encourage Older People to Drink More

Here are some practical and compassionate ways to help elderly people drink more:

1. Offer small sips frequently

Instead of large glasses, try offering drinks little and often. Keep a small cup within arm’s reach and offer sips every 30–60 minutes.

2. Use cups with handles or straws

Adaptive drinking aids can make it easier to hold a cup or sip safely. Some people may prefer a straw or even a lidded cup for more control.

3. Make drinks more appealing

Experiment with warm drinks (like herbal teas or warm milk), lightly flavoured water, or even hydrating foods like soup, jelly, or juicy fruits. Variety matters.

4. Thicken fluids if needed

For those with diagnosed dysphagia, thickened fluids may be recommended by a speech therapist. These are easier to control and reduce the risk of aspiration.

5. Make it social

People are more likely to drink during conversations or mealtimes with others. Sharing a cuppa can be a subtle and effective reminder to drink.

When to Get a Swallowing Assessment

If you're concerned about an older adult’s swallowing, ask their GP for a referral to a Speech and Language Therapist (SLT). An SLT can:

• Assess the safety and efficiency of swallowing

• Recommend texture modifications for food and drink

• Provide exercises to improve muscle strength and coordination

• Offer advice for carers to support safe mealtimes

Getting this assessment early can prevent complications and provide peace of mind.

Supporting Dignity and Quality of Life

Swallowing is something we often take for granted — until it becomes difficult. For older adults, especially those living with dementia, the act of eating and drinking can become a source of frustration, embarrassment, or even fear.

By understanding the changes that come with ageing, recognising early signs of cognitive issues, and taking small steps to promote hydration, we can help our loved ones feel safer, stronger, and more supported.

Final Thoughts

Swallowing difficulties aren’t just a nuisance — they can be a red flag for deeper health concerns. Whether it’s due to normal ageing, neurological changes, or early dementia, it’s vital to spot the signs early and seek help.

Hydration is one of the simplest yet most powerful ways to protect health in older age. By adapting how we support older people — with kindness, patience, and understanding — we can make a big difference.