I am Karen, a speech therapist from the Swallowing Research Laboratory of The University of Hong Kong. Today, I will talk to you about what normal swallowing is, what abnormal swallowing is, and finally, how we can use food to help patients eat more safely.
First, let’s look at how many people have swallowing problems, especially the elderly. In our previous research, we found that in nursing homes, about 60% of the elderly have swallowing problems of different degrees. 60% is actually not a small number. We estimate that in the whole of Hong Kong, there are probably 46,000 elderly people living in nursing homes who have swallowing problems of different degrees. So, if you can help prepare some delicious and safe food, it will be of great help to these elderly people.
So why is a speech therapist also concerned with matters related to eating? In fact, a large part of a speech therapist’s job involves this. The very important part when we eat is the soft palate. There is also an epiglottis which acts like a door. Everyone, please note: when eating, the tongue helps to hold the food in the mouth. When we swallow, the uvula at the top will close so the food can’t go up to the nose; the epiglottis below also closes. Then the food goes down the passage behind, which is our esophagus. This large space in front is our trachea. So this is normal swallowing.
Let’s look at abnormal swallowing. Abnormal swallowing is when any problems that appeared in the previous video occur. Let’s take a look at this one. Similarly, when eating, if the food goes down the first time without any problems but the epiglottis opens too early, and you see the food has gone into the esophagus—this is abnormal swallowing.
The second example: similarly, if you are eating something but that food is too sticky, then the food has a chance of getting stuck in the throat. You can’t cough it out; then the patient might suffocate.
Finally, we are also worried that the food might be too slippery. When we are not ready, the food has already slid down the throat. It would be like in this clip: the food may go into the trachea.
If any patient has the conditions that we just mentioned, in fact, we can change the food we eat a little bit. For example, the simplest way is to turn it into a shui chan. If you can make the rice softer, it is called yuan chan. If you can cut the meat and vegetables into small pieces, it is called shui chan. The most powerful thing we see a lot in society is a wu chan. The meaning of wu chan is to make everything smooth—it is like a baby eating baby food. For example, vegetables, meat, and rice all have to be turned into a soft meal.
Everyone, look at this picture. For soft diets, many times if we just blend the vegetables, meat, and rice together in a bowl, the food looks very unappealing and doesn’t taste good. Many times we hear that elderly people with cognitive impairment refuse to eat this kind of food. It’s very obvious because they can’t even tell that this is food. So now we really want to promote making soft meals look more appealing. The photos you see are actually from many places in foreign countries, especially Japan and Australia. They also make their soft meals look more appealing. It is still safe to eat because it is very soft and easy to swallow; they will eat faster and safer.
At a minimum, we hope to achieve this. For example, in one of the photos you can see that there are four bowls of different colors: the rice is in a bowl, the vegetables are in a bowl, the soup is in a bowl, and the meat is in a bowl. There are at least four colors for the elderly to see, so they will be happier when they eat.
In addition to improving the food, we also need to improve the water. So if you want to prepare some sauce to put in the meal, you also need to pay attention to the consistency of the sauce. We usually recommend that if it’s liquid, most people who have swallowing problems can’t just drink a glass of water or a bowl of soup. We need to add some thickener to make the liquid thicker. It can go from slightly thick to very, very thick—as thick as sesame paste. So when making the sauce, we usually recommend that it is at least from slightly thick to medium thick. It will make the sauce thicker. When people with swallowing problems eat these foods, they will be able to eat more safely.
This is a simple explanation of what swallowing problems are and how we can use food to help them eat more safely. But how to make the food fragrant and flavorful—that will depend on everyone’s own consideration.