In daily life, we often encounter elderly or children coughing while eating, and in severe cases, food may accidentally enter the airway, causing aspiration. Elderly people are a high-risk group for aspiration. Once aspiration occurs, even repeated aspiration, it can easily lead to aspiration pneumonia, worsening the condition, weakened immunity, and even seriously threatening life and health. Unlike obvious reactions such as sudden coughing, blushing, and wheezing while eating or drinking, the unfamiliar medical term "invisible aspiration" is becoming a "hidden killer" that threatens the health of the elderly. The most prominent feature of "difficult to detect" is invisible aspiration, medically known as "silent aspiration", which refers to the phenomenon where food, liquid, or oral secretions do not completely enter the esophagus during swallowing, but partially or completely infiltrate the trachea and bronchi without causing typical reactions such as severe coughing or wheezing. According to Lu Wei from the Department of Geriatrics at Taiyuan Second People's Hospital, under normal circumstances, the airway automatically closes when swallowing, allowing food to enter the esophagus smoothly. But as people age, their swallowing function naturally declines, their swallowing muscle strength weakens, coordination decreases, and the "switch" for airway closure becomes less sensitive, making it easy for "fish to slip through the net". Especially for elderly people with conditions such as cerebral infarction, Parkinson's disease, cognitive impairment, etc., their swallowing function is more severely impaired, and the risk of hidden aspiration increases significantly. The terrifying aspect of invisible aspiration lies in its' silent 'nature. A small amount of aspiration may not immediately cause symptoms, but long-term accumulation can lead to recurrent lung infections, chronic bronchitis, and in severe cases, respiratory failure, suffocation, and even life-threatening conditions. According to research data published in the Chinese Journal of Geriatrics in 2023, the incidence of hidden aspiration in healthy elderly people aged 65-79 is about 35% -40%; And over the age of 80, this proportion will soar to 50% -65%. This means that even for elderly people without underlying diseases, one in every two individuals may have a hidden risk of aspiration. It is worth noting that the "concealment" of invisible aspiration may lead to a higher actual incidence rate than the data shows. In the geriatric and rehabilitation departments of the hospital, doctors found through "swallowing contrast examination" (gold standard) that about 70% of elderly people with hidden aspiration have no obvious symptoms during daily eating - neither coughing nor wheezing, which is difficult for family members and caregivers to detect through naked eye observation. This' asymptomatic invisible aspiration 'is often the most dangerous, with risks accumulating over months or even years, ultimately leading to outbreaks of' recurrent pneumonia 'and' respiratory failure '. Intervention at this time will greatly increase the difficulty of treatment. There is a high-risk population and some external factors. Mr. Wang, who lives in an old residential area, is 85 years old and in good health. However, after suffering from a cerebral infarction three years ago, he spoke vaguely and swallowed slower. The children think that the elderly can eat and drink, but they only occasionally clear their throats and don't take it seriously. In the past six months, Mr. Wang has frequently had fever and cough, and has been hospitalized three times for pneumonia treatment. Each time, he relapsed within half a month of discharge, and the doctor could not find a clear source of infection. Until his third hospitalization, Mr. Wang underwent a swallowing function assessment on the advice of a respiratory specialist. Only then did the family know that when he swallowed, food could not completely enter the esophagus, and a small amount of Congee and water would "sneak" into the airway. However, due to the slow cough reflex caused by cerebral infarction, he did not cough significantly. It is these accumulated "invisible aspiration" that make the airway a breeding ground for bacteria, leading to repeated lung infections. It wasn't a cold, it was caused by eating! ”Mr. Wang's son regretted deeply after learning the truth. I used to think that it was a good thing for the elderly to be able to eat on their own, but I never thought that there was such a big risk behind slow swallowing. Lu Wei introduced that there is a certain high-risk group for invisible aspiration. For example, elderly people over 80 years old are the main group of invisible aspiration due to natural decline in swallowing function and decreased airway protection ability; Elderly people with cerebrovascular diseases (cerebral infarction, cerebral hemorrhage), Parkinson's disease, cognitive impairment, Alzheimer's disease and other diseases have impaired swallowing muscle coordination and slow cough reflex; Elderly people who are bedridden for a long time, rely on nasal feeding, have a recovery period after surgery, and have oral dysfunction (such as missing teeth and oral ulcers) have increased difficulty swallowing. In addition, some elderly people with poor lifestyle habits may also experience hidden aspiration, such as eating too quickly, lack of concentration (such as eating while watching TV), and elderly people who eat after drinking alcohol are prone to aspiration due to uncoordinated swallowing movements. In addition to factors such as age, improper food texture, oral problems, and the influence of certain medications may also cause hidden aspiration. "Too thin liquids (such as water, rice soup, and clear soup) have strong fluidity and are easy to slide into the airway quickly; too thick foods (such as rice cakes, rice dumpling) or blocky foods (such as uncut meat and vegetables) are not chewed adequately by the elderly, and are easy to block the airway or remain in the throat when swallowing, leading to aspiration," Lu Wei said. Inadequate oral hygiene can lead to increased secretions and bacterial growth, which not only increases the risk of infection after aspiration, but may also cause hidden aspiration due to residual secretions; Some elderly people may experience drowsiness and weakened swallowing reflex after taking sedatives and antihistamines, which can easily lead to aspiration when eating; Eating too quickly, taking too much food per bite, improper posture during eating (such as lying flat or bending down), and lying flat immediately after a meal can all increase the risk of aspiration. Through some "clues", it is actually possible to identify invisible aspiration. "It is not easy to detect, is it impossible to prevent it? ”We can't always ask ourselves every time we eat: Have you swallowed? Are you feeling uncomfortable? "Regarding these concerns, Lu Wei said," Although there are no obvious symptoms of coughing due to invisible aspiration, it is not without traces. Family members can detect these 'danger signals' as long as they observe carefully. "She further explained that these signals include frequent clearing of the throat, coughing (not severe coughing) after eating, or hoarseness and a feeling of foreign objects in the throat; Unexplained low-grade fever, fatigue, especially a slight increase in body temperature after eating; Repeated pulmonary infections, multiple hospitalizations for pneumonia in the short term, and the infection sites are mostly in the lower lobes of both lungs; Symptoms during eating include slow chewing, hesitant swallowing, food residue in the corners of the mouth or mouth, or shortness of breath and chest tightness after eating; Unexplained weight loss and decreased appetite may result in reduced food intake due to discomfort swallowing or concerns about coughing; Snoring worsens and breathing becomes irregular during nighttime sleep, or coughing and expectoration occur in the morning. Lu Wei reminds that if an elderly person at home experiences one or more of the above conditions, they should be promptly taken to the rehabilitation department, otolaryngology department, or geriatrics department of the hospital for swallowing function assessment. Common assessment methods include drinking water test, swallowing imaging, endoscopic examination, etc., which can accurately determine whether the elderly person has hidden aspiration and risk level. Family prevention can start with diet, posture, etc., to make the elderly's swallowing safer. Mr. Chen, who is 70 years old this year, suffers from Parkinson's disease. His daughter Xiao Chen found that her father has been chewing for a long time during meals recently, occasionally clearing his throat, and sometimes his voice becomes hoarse after drinking saliva. Thinking about the elderly neighbor who accidentally sucked into the hospital, Xiao Chen quickly took his father to the hospital for a swallowing function assessment, which showed that Mr. Chen had a mild hidden risk of aspiration. Later, under the guidance of the doctor, Xiao Chen began to adjust his father's diet and nursing methods: boiled rice into soft Congee, chopped vegetables into mud, and stewed meat until crisp; When drinking water for my father, use a small spoon with a scale to feed only one small sip at a time, and wait for my father to swallow it completely before feeding another sip; When eating, ask the father to maintain a sitting position with a straight back and a slightly forward leaning head. After the meal, sit for half an hour before lying flat; I clean my father's mouth with physiological saline every day and regularly take him for swallowing rehabilitation training. After a period of time, Mr. Chen has never experienced clearing his throat, hoarseness, or lung infection again. It turns out that as long as we observe carefully and take scientific care, we can avoid danger, "Xiao Chen sighed. Many elderly people's hidden aspiration can actually be prevented through early recognition and correct care. Indeed, prevention is the most crucial. ”Lu Wei said that this needs to start from all aspects of daily life. Firstly, adjusting eating posture and techniques is the most direct and effective method. It is recommended that elderly people sit upright in the correct position when eating, with their heads slightly tilted forward, and never eat while lying down or half lying down. The movement of "chin retraction" can narrow the airway entrance, close the throat, and make it easier for food to enter the esophagus instead of the trachea. At the same time, avoid chatting while eating and remind the elderly to chew every bite of food thoroughly, swallow it thoroughly before taking the next bite, and do not rush. You can also take a sip of saliva after every few bites of food or liquid drinks to ensure that there is no residue in your mouth. In terms of food selection, it is recommended to choose foods that are soft, easy to shape, not easy to loosen, and have a moderate viscosity. Avoid foods that are too dry and broken (such as cookies, nuts, cake crumbs, etc.), and do not choose liquids that are too thin (such as water, clear soup, milk, etc.), as they have a fast flow rate and are most likely to cause aspiration. It is recommended to prepare paste like foods such as vegetable puree, meat puree, rice paste, mashed potatoes, etc., or mix water, juice, soup, etc. into a consistency similar to honey or pudding, which has been clinically proven to significantly reduce the risk of aspiration. You can also choose some soft foods, such as steamed eggs, tofu, rotten noodles, etc. At the same time, it is recommended to strengthen the oral hygiene of the elderly. A clean mouth can ensure that even if there is a small amount of aspiration, the bacteria entering the lungs are greatly reduced. So it is recommended to rinse your mouth and brush your teeth immediately after meals to remove food residue from your mouth. For bedridden individuals, family members should assist with oral care by using a soft bristled toothbrush or oral cleaning cotton swab to carefully clean teeth, gums, tongue, and upper jaw. Regular dental check ups are also necessary to ensure that dentures are suitable, not loose, and to avoid increased risk due to insufficient chewing. In addition, managing gastroesophageal reflux is also important. Gastric acid reflux is an important source of hidden aspiration, especially when lying flat at night. It is recommended to not eat for 2 to 3 hours before bedtime to give the stomach enough time to empty; If the elderly have reflux problems, raise the head of the bed 15-30 degrees while sleeping to prevent acid reflux using gravity. If the elderly's swallowing function significantly declines, they should seek the help of a speech therapist or rehabilitation therapist for professional swallowing function training. (New Society)