The ability to chew and swallow a slice of bread or take a drink from a cup is easy to take for granted. Problems with these basic activities suggest, and often lead to, a constellation of other problems for older adults, as the ability to drink or eat for oneself can provide a vital connection to others.

University of Iowa Ph. D. candidate Samantha Shune researches a little-studied aspect of dysphagia — the term for problems people have with eating and swallowing.

Dysphagia affects between 20 to 40 percent of people over the age of 60. Eating and swallowing problems for older people with various health conditions, such as stroke and dementia, are closer to 80 percent. Problems with eating and swallowing often lead to malnutrition and unhealthy weight loss, and swallowing problems may also be a contributing factor in a large number of the set-backs patients experience soon after being discharged from the hospital. Such set-backs can lead to a move back into a more intensive health care setting, which can be both disheartening and more expensive for patients.

Because meal times are social events, says Shune, eating and swallowing problems have psycho-social ramifications, such as decreased social participation and increased anxiety. Social isolation and depression often follow—all amounting to a diminished quality of life.

Other researchers in the field have examined possible links between depression and the psycho-social ramifications of isolation in the elderly population. Shune’s research takes it a step further, focusing specifically on eating, which is one possible factor affecting isolation.

“Eating is very social, and taking away that ability leads to further isolation,” says Shune. “Having a meal is a big cultural event beyond getting nutrition. It’s striking to see people at meal time sitting side-by-side in wheelchairs, but there’s no interaction—whether it’s because they’ve lost the ability or they don’t know how anymore. Of additional concern, we are not clear what impact these and other environmental aspects of the mealtime process may play on the act of eating itself.”

Shune is studying the interplay between the social and physiologic aspects of eating in order to find ways for caregivers to improve the quality of life of older people with diminishing abilities. In order to make scientifically-supported recommendations for how caregivers can improve mealtime processes for the elderly, Shune must first construct studies to gather data about eating habits. Currently, few studies of this type exist.

“Eating and swallowing research that takes into account the other external factors impacting eating that occur prior to food entering the mouth—such as caregiver involvement, visual or auditory cues from the environment, and knowledge of what is about to be eaten—is not that developed,” Shune says. “We’re starting at the beginning.”

One of Shune’s mentors, Jerald Moon, professor of communication sciences and disorders, says speech-language pathologists are often asked to evaluate and offer a treatment plan for people with swallowing disorders associated with either a medical condition or the normal aging process. But he says Shune’s research may break new ground.

Working with Moon on motor control and healthy aging, Shune is examining the mechanical specifics of eating and swallowing. Using infrared sensors attached to the study participant’s face and hand, a 3-D motion tracking device traces the particulars of the patient’s efforts to bring a cup to his/her mouth—marking the start, stop, and any changes in motion.

“While a significant amount of research is conducted relative to both normal and abnormal swallowing physiology and clinical approaches to dysphagia,” says Moon, “Samantha’s approach to considering non-oral motor and sensory components is unique.”

After earning her master’s degree, Shune’s first job was in stroke rehabilitation. Working as a speech-language pathologist, Shune has spent a lot of time in hospitals and nursing homes. That’s when her attention was first drawn to eating and swallowing problems and the social dimension of eating. It was clear that breaking bread meant more than consuming carbohydrates.

Shune is examining how frequently hospital and nursing home staff recommend that caregivers provide eating assistance for older patients. She wants to find out whether too much “help” might have detrimental effects.

“With little kids, it’s accepted that eating and drinking isn’t always a clean, smooth process,” Shune says. “We understand that there’s a developmental reason for letting kids get a little messy sometimes.”

The reason caregivers may assist with eating can be emotionally complicated. Caregivers may be uncomfortable witnessing attempts to eat and drink that seem less than dignified, and sometimes messy. In nursing home settings, efficiency is sometimes the rationale for moving away from self-directed eating and drinking.

Shune acknowledges that sometimes caregivers should intervene, but she hopes to make the process as natural as possible. Among people suffering from dementia, especially, there are inevitable losses in ability, but Shune says allowing for more agency in this area could help with safety.

Globally, more and more people are living longer. Shune says this demographic explosion makes research into improving quality of life—throughout the life cycle—especially important, and understanding the problems of aging holds a special fascination for her.

“It’s not just about development, but dealing with the loss,” she says. “You have an ability one day, and the next day it’s gone.”

Regardless of what their abilities will allow them to do, Shune wants patients to have every possible advantage, and that only comes with research.

“There are still lots of unanswered questions and a need for research in this field.”