Fae Boczko, M.S.,CCC-SLP,BCS-S

Swallowing difficulty — dysphagia — in the elderly is a growing healthcare concern. It can be a result of many different diseases, including acute neurological events and progressive neurological diseases, such as dementia. 

It can create havoc for your residents, and their direct caregivers. Luckily, there is a relatively new focus for saving your residents and staff from a lot of frustration, and potentially dangerous circumstances: tongue exercises.

Oropharyngeal dysphagia (difficulties in the oral and/or pharyngeal phases of swallowing) can be observed in reduced tongue movements causing difficulty starting the swallow, as well as protecting the airway.

It has been reported that individuals over the age of 65, on average, swallow more slowly than people under the age of 45. Age-related changes in the head and neck musculature are partly responsible and place the elderly person at risk for developing swallowing difficulties.

The signs and conditions associated with dysphagia include dehydration, malnutrition, and in particular aspiration pneumonia (the invasion of foreign material into the airway).

To improve swallowing safety and efficiency, alternative methods of nutritional intake (such as a feeding tube) or texture modification (such as pureed food) may be recommended — but they would come with possible negative effects on quality of life.

An alternative, successful approach to treating dysphagia has emerged over the past few years: targeting tongue muscles through strengthening exercises that are based on maximal isometric pressure tasks.

During swallowing, tongue motion changes the pressure applied to food and liquid by rising toward the palate and generating an anterior-to-posterior pressure wave that squeezes food and liquids backwards towards the pharynx.

As a result, decreased tongue strength and pressure may result in disruption of food or liquid moving from the oral cavity to the pharynx, causing a lot of coughing during meals. It also can put individuals at risk for choking and aspiration.

Tongue pressure exercises can restore muscle mass and strength, just like when you exercise the rest of your body and build muscle mass. Simply put: The tongue is made up of muscles and needs exercise too.

The older person, especially, needs a strong tongue and the pressure to swallow. Pressing the tongue against the roof of the mouth and applying pressure can help build muscle mass in the tongue. Pressing the tongue on the palate and holding it for about 10 seconds can help. Squeeze and hold and do it about 30 times.

Building tongue pressure will help a person swallow more safely, help decrease coughing during meals and help protect the airway.

Think of it as barbells for the tongue!

Faerella Boczko, MS, CCC-SLP, BCS-S, is Director of Speech-Language and Swallowing Disorders at The New Jewish Home, in New York. She is a board-certified specialist in swallowing and swallowing disorders and has served as principal investigator to two research grants, written book chapters, published research articles, and presented at professional society meetings. She has more than 35 years experience working with the geriatric population.