What I can do
Be alert to the signs of dysphagia. These include:
- Coughing or choking while eating or drinking
- Feeling as though food is stuck in the throat and a ‘gargly’ voice
- Drooling or difficulty managing saliva.
Work with the full care team to manage the problem. This may include:
- Discussing together potential treatable causes such as dry mouth, poor oral hygiene, or medications that make swallowing harder
- Referring the person to a speech pathologist for swallowing assessment and a dietitian to ensure adequate nutrition and to develop a mealtime support plan and ongoing review
- Checking with the GP or nurse practitioner if medications should continue to be given orally.
Support the person during eating and drinking by:
- Helping them to sit upright to reduce choking risk and supervising during meals
- Encouraging small, frequent meals rather than large portions and avoid rushing
- Respecting personal choices. Some people may choose to continue eating and drinking normally despite the risks. If so, an acknowledged risk plan should be developed in conjunction with the health team.
What I can learn
The palliAGED Practice Tips give helpful guidance on supporting older people with dysphagia. There is a version for nurses as well as one for careworkers.
Watch the video on Swallowing difficulties for residential providers and staff from the Aged Care Quality and Safety Commission and its associated factsheets for aged care staff.
An introduction to swallowing difficulties for residential aged care providers and workers
Complete the module on Supporting eating and drinking with acknowledged risks from palliBytes (subscription required).
What I can give
If an older person is experiencing dysphagia or the family and carers are distressed by it, these resources may help:
If a resident chooses to continue eating in the same way as before, share with them the poster Food and drink in your aged care home: Your right to choose and take risks from ACQSC.
What I can suggest
Advocate for clear policies and processes, and strong teamwork around dysphagia management. The team should have access to:
- Clear communication pathways between careworkers, nursing staff, speech pathologists, dietitians, and catering teams for a consistent approach
- Care plans and support strategies individualised to each older person’s needs and preferences
- A choking risk and emergency response protocol to ensure everyone can act quickly and appropriately.
Ensure all staff receive dysphagia training to improve safety and confidence in managing swallowing difficulties. This includes kitchen and catering staff who prepare and serve texture-modified meals.
Support families and carers by:
- Helping them understand that swallowing difficulties are often part of the dying process
- Reassuring them that forcing food or fluids is not always appropriate and may cause distress
- Involving them in keeping the person’s mouth moist in the last days and hours of life.
Page updated 25 February 2025