Solve the Medical Riddle: Her 75-year-old Mother Has Trouble Swallowing, Fourth Week

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient and her daughter reported the patient’s symptoms. The doctor proceeded with the examination using the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendation

The doctor then referred Mildred to a radiologist. The second week, the radiologist performed a modified barium swallow test. Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following mont

The Doctor Reveals the Diagnosis

I commend everyone for some excellent guesses! However, Mildred is fortunate in that she doesn’t have any of the serious conditions that were suggested.  Ginny L. is the one who hit on the diagnosis when she said that maybe Mildred is “just getting older”. As an internist who often cares for the elderly, I quickly suspected that the aging esophagus issue would turn out to be the cause of Mildred’s trouble with swallowing. The medical term for the problem is presbyphagia from the Greek “presby” meaning old and “phagia” meaning to swallow or ingest. Another term for this is “senescent swallowing”. Presbyphaiga is one form of dysphagia, or difficulty swallowing.


Treatment for dysphagia typically includes referral to both a speech therapist and a registered dietitian. Speech therapists know how to read the results of the modified barium swallow test so they can identify the specific problem. They make recommendations that may include changes in positioning or posture when eating or drinking, exercises to strengthen or improve swallowing muscles, techniques to aid in swallowing more safely, or changes in consistency of foods such as puréeing or mashing them, and the possibility of adding thickeners to fluids to improve ease of swallowing and to ensure that the patient does not aspirate.

A dietician can outline the appropriate consistency of foods in order to minimize the difficulties of eating and swallowing. Other considerations include catering to patients’ food preferences as much as possible; providing time for a leisurely, relaxed mealtime without distractions such as TV; and eating with family or friends. The elderly simply need more time to eat. No gulping down the food as we do when we are young! The goal of treatment should be to offer the most permissive yet safe diet for a patient.