Chewing difficulty and swallowing difficulty are asked about when there is a reason to — after a stroke, in advanced dementia, when weight has dropped. They are worth asking in everyone over 65, because they identify risk before anything visible has happened.
Two questions, answered by the patient, take under a minute: do you find it harder than before to eat tough foods, and do you ever choke on your tea or on your food. Neither needs an examination, an instrument or a referral to ask.
Dry mouth, notably, did not carry the same signal. It is common, it is usually drug-related, and it is worth addressing on its own terms — but it does not mark the same risk, so it should not be what a brief screen spends its time on.
When either answer is yes, the follow-through is practical rather than diagnostic: look at what they are actually managing to eat, check dentition, review the drug list for anything impairing swallow or salivation, and weigh them.
- Ask about chewing tough foods and about choking in every review over 65
- A yes to either is a reason to check weight, dentition and the drug list
- Dry mouth alone did not carry the same risk signal — treat it, but do not screen on it
- The questions take under a minute and need no equipment
Why it matters
A risk marker that needs no test or referral is currently only asked about when something has already gone wrong.
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