Grandma coughs sometimes when eating, especially if it's candy. Is this normal for the elderly?

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I'm not sure when she started coughing when eating, I'd say within the last six months to a year. It doesn't happen all the time. There doesn't seem to be any pattern to it, although it happens more after breakfast than any other time of day. It happens almost everytime she eats candy and it doesn't matter if it's hard or soft (like a Tootsie Roll or Starburst). I'm not sure if it happens with chocolate bars. I don't usually allow her to eat candy, it's more of a rare treat.


She does have large thyroid nodules that the doctors are keeping an eye on. They said it could cause coughing or possible airway obstruction if it gets bigger. It's unclear if the nodules/thyroid are related to this coughing. I'm kind of thinking it's not related. If anything, I'd guess she had acid reflux.


Does this coughing sound normal for her age? Or should I contact the doctor and ask him?


When I ask Grandma about the coughing, she always blames it on the radiation she received on her throat cancer some 10 years ago. However, this coughing only started in the last six months to a year. She either doesn't realize it's tied to food, especially candy or she doesn't want to admit it.

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Mejjy, you're wise to consider keeping a log of her foods, but I wouldn''t do it for a few weeks before seeing a speech therapist. If she is aspirating, that's just more opportunity for something to happen. And what if she really chokes on something and can't clear it from her throat? Do you wan to be responsible for what might happen in that situation?

I'd be on the phone Monday to get an appointment and have her evaluated by a specialist. Even though I've cared for my father during previous dysphagia episodes, and seen him coughing, I wouldn't be able to watch him eat and swallow and suspect that he's aspirating. That takes a trained professional.
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BTW, this could be aspiration, or reflux, or aspiration of reflux. Trying an acid blocker of some sort may help. Having it with candy though suggests that with more saliva (a thin liquid) more is going down the wrong way and makes aspiration seem a little more likely.
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Straw drinking is sometimes good, sometimes bad - no two cases of dysphagia are exactly alike. Some people get too much per sip with a straw, and there are special straws that limit flow rate.
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Thanks for the advice, I appreciate it. I'll try giving her different foods for a week or two and keeping a journal to see what foods make her cough. Then I'll contact her doctor and ask him what he suggests. I think my 78 y/o uncle just had some sort of special test for dysphagia, so I'll check with his DIL to see what that was all about.

Is it possible that Grandma's lip smacking while eating is related to this coughing? She doesn't actually smack while chewing, it's more when she parts her lips after chewing. It's hard to explain. Sometimes, the smacking sound is really loud. She doesn't always do it. It happens more with sandwiches and Hot Pockets. This smacking thing only started within the last three to four months or so.

Oh! Why is drinking through a straw bad? When Grandma moved into assisted living last year, the staff gave all the residents cups with lids and a straw. So when Grandma moved in with me, we continued using the same type of thing. She also says she worries about knocking over a regular cup and spilling it.
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The coughing with candies makes me suspect she is having difficulty with thin fluids (with the candy she would be choking on the increased saliva), this is similar to the way swallowing problems first began with my mother. As the others have already mentioned she should be evaluated for dysphagia and her diet altered to make eating and drinking easier. If you don't want to go for tests and a formal diagnosis you should at least do some reading on the subject, both here on AgingCare and on the web.
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Forgot to add that there are some exercises that can be done to help strengthen the swallow muscles, and there are techniques (such as the chin tuck) for eating to minimize aspiration.

Some of the exercises are too strenuous for older people, but others can be tolerated.
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It is possible that there is some constriction because of the throat cancer, especially from the radiation. A neighbor had throat cancer, was treated for it, but did have swallowing limitations thereafter.

There's also the possibility of some level of dysphagia, swallowing difficulty, which as FF states, can cause aspiration. This happens to be an issue we're dealing with now, for the second time.

GM should see a speech therapist, who could be recommended if she has an internist or geriatrician. The therapist can give her various foods and observe which might cause coughing. If the therapist suspects aspiration, a videoscopic swallow study can be done. This reveals if foods are getting "stuck" in the throat, and causing choking.

I just watched one being performed last week. It takes a bit to figure out what's actually happening, as I'm not used to seeing active x-rays revealing the path of liquids and foods, but it was interesting (so was wearing a lead apron - yuk).

There are various levels of dysphagia. A good speech therapist and/or videoscopic swallow can determine which one, and an appropriate diet will be recommended.

The type of candy causing the problem might also be a contributory factor, just as some foods are acceptable while others are not.

This can be hard to deal with for seniors as their food choices will be defined for them, but you can be creative once you know if she has dysphagia, and what level.

E.g., brownies and cake are acceptable (they're generally moist) but crackers, toast (especially the crusts) can cause coughing (they're drier). Ground meats and cut up meats might be tolerable, but roasts and thick meats are not unless they're cut up in little pieces.

Liquids can be thickened with Thik-It, which makes them less likely to be aspirated. Using straws is a no-no.

The sooner you can get her evaluated by a speech therapist to either confirm or eliminate dysphagia, the better.
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mejjy11, have your Grandmother checked for "aspiration". That is when food goes into the lungs instead of into the stomach. With aspiration it would happen with anything she eats.

Unless your Grandmother needs to watch her sugar intake, let her have candy, especially dark chocolate. As one ages, their sense of taste isn't the same except for sweet items like candy, pies, cupcakes, cookies. She would be delighted :)
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