Sometimes as we get older we can have difficulty swallowing food and drink and can be at risk of choking.  There are signs to watch for that a person has problems swallowing and these may include:

  • Taking a long time to chew and swallow food
  • Choking or coughing (which can be dangerous, frightening, painful and tiring)
  • Wet, gurgly voice after swallowing
  • Aspiration (food or fluids entering the airways) which can result in pneumonia
  • Drooling
  • Dehydration
  • Weight loss which can lead to malnutrition, muscle wasting, dehydration and low energy levels
  • Frequent chest infections
Coughing and choking

Have you noticed coughing or choking when eating and drinking?

Food, drink and saliva maybe ‘going the wrong way’.

Does the person have difficulties with chewing? 

Are they rushing or cramming food in? 

Are they talking whilst eating and are easily distracted?

Encourage the person to slow down and help them to concentrate by sitting with them to keep them focussed on the meal.

Ensure they are sitting upright in a comfortable and well-supported position. Encourage small mouthfuls and sips.

Follow any Speech and Language Therapist advice carefully to ensure that they are given the correct food consistency and texture to minimise the risk of choking.

Not able to clear their mouth

Sometimes food residue can get left in the cheeks after eating? This is called ‘pocketing’ or ‘pouching’ food.

This could be because the person is unable to chew effectively and so food stays in large pieces and gets trapped in the cheeks.

They may also have reduced tongue movements so they may be unable to clear the residue with their tongue.

It could also be due to reduced sensation in the mouth and so the person may not even know the food is there.

This can be a choking risk.

Always offer good, thorough mouth care after eating to clear away any residue.

Consider if trying easier to eat, softer foods may be safer and more enjoyable for the person.

Frequent chest infections

Is the person having recurrent chest infections?

This may be because of aspiration. Aspiration is where food, drink and saliva ‘goes the wrong way’ and ends up in the lungs.  

Aspiration can cause recurrent chest infections and pneumonia. Usually, aspiration will cause some coughing or choking, but not always. 

Sometimes aspiration can also happen without any coughing or choking.  This is called ‘silent aspiration’ as there may not be any obvious signs.

Consider if someone who is having recurrent chest infections may have a swallowing difficulty.

Good oral hygiene is really important, so always offer regular and thorough mouth care. This reduces the bacteria in the mouth.


Consider referral to Speech and Language Therapist if you have concerns that someone has a swallowing problem.

Changes to Dysphagia guidelines - further information can be found here