Recognising and managing swallowing difficulties for people with dementia

Experiencing any issues with swallowing is known as dysphagia.  The condition can be caused by several factors, including damage to parts of the brain that control swallowing.  It can be an acute onset (from a stroke, for example) or progressive, as is the case for those with dementia.

 

9 out of 10 people with dementia will experience dysphagia at some point so if you’re caring for someone with the condition, it’s important to remember just how powerful nutrition is in enriching their quality of life.  If overlooked, dysphagia can lead to a range of complications from weight loss and malnutrition to choking and aspiration pneumonia, which is a severe chest infection.

 

If you’re caring for someone with dementia, you can help to maintain their health and wellbeing by looking out for the following signs of dysphagia.

 

Symptoms of dysphagia

  • Drooling saliva, food or fluid
  • Effortful or prolonged chewing
  • Pocketing of food in cheeks
  • Pooling of fluid in mouth
  • Spitting out food
  • Nasal regurgitation
  • Fatigue
  • Coughing when drinking or eating
  • Wet or gurgly voice
  • Food getting stuck in the throat or neck region
  • Pain or discomfort with swallowing
  • Unexplained weight loss
  • Chest infections or aspiration pneumonias.

 

Managing swallowing difficulties in people with dementia

Consider the following strategies when helping someone with dysphagia:  

 

Environment

Eat meals in a familiar dining environment at regular times each day.  Food should be the kind that the person enjoys and it should be presented using familiar, everyday cups, plates and bowls.

 

Use pleasant decor such as tablecloths and napkins, and remove any other non-food items from the table. Gentle music can also be relaxing in the background.

 

Meal preparation

Make food visually appealing - vibrant in colour and separated on the plate so that textures and flavours are distinct.

 

Cut up and prepare food that can easily be picked up with fingers and encourage self-feeding for as long as possible.

 

Prompting

Be patient, giving people enough time to eat, whilst minimising any distractions.  Offer reminders about what to eat and why – and help to orientate them to the meal by discussing the food, aromas and the cooking process.

 

Encourage small sips or bites of food, remind the person to swallow with each mouthful they take and if needed, stroke their throat gently in a downward motion, without applying any pressure.

 

Modifying diet

If problems with eating and drinking worsen, the texture of food and fluids may need to be changed so that they’re soft, minced or pureed.  A speech pathologist can recommend softer food or thicker fluids, if necessary – more details about contacting a speech pathologist are below.

 

Feeding assistance and positioning

Approximately 50% of people with dementia will need full feeding assistance eventually.

 

If you’re feeding someone, ensure you’re sitting opposite them at eye level and that they’re sitting upright in a chair.  Their head should be facing forward, with their hips, knees and ankles at a 90-degree angle.

 

If someone cannot sit in a chair, then help them to sit as comfortably upright as possible in a bed or wheelchair, making sure they’re both alert and responsive.  Never feed someone when they’re lying down or in a sleeping position as this can increase the chances of choking. 

 

Care should be taken to feed the person slowly, placing food in the middle of the tongue and allowing them enough time to swallow each bite before offering the next.

 

Watch their “Adam’s apple” to make sure they’ve swallowed, alternate between mouthfuls of food and fluid to help clear any residue in their mouth and always let them know when you’re about to offer the next mouthful.

 

Referral to a speech pathologist

Speech pathologists offer expert advice on diet modification, positioning and strategies to help with safe swallowing.  They also make sure that that eating and drinking is as pleasurable as possible for their patients.

 

If you’re caring for someone with dementia who has swallowing issues, contact Alzheimer’s Queensland to access our speech pathology services.  Typically, we facilitate swallowing assessments for people with the following symptoms:

 

  • Drooling (of food/saliva)
  • Frequent throat clearing while eating
  • Difficulty biting or chewing
  • Coughing or choking while eating or drinking
  • Feeling pain when swallowing or the sensation that food is stuck in the throat
  • Recurrent chest infections
  • Unexplained weight loss.

 

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If you’d like further information or support, please take a look at our Eating, Drinking and Swallowing Difficulties in Dementia fact sheet or call our 24-hour Advice Line, on 1800 639 331.

 

Speech pathology services

Alzheimer’s Queensland has an allied health service called AQ Rehab, through which people can access services for speech pathology.  You can do this via private health insurance, Medicare Chronic Disease Management or through home care packages.

 

We also have allied health funding in Brisbane North and Ipswich for people to access speech pathology.

 

For further information, please call Alzheimer’s Queensland Rehab on 1800 180 023.

 

Words: Ash Anand