Loss Of The Ability To Swallow: Why And What To Do
Those with swallowing disorders may notice pain while swallowing and others may not be able to swallow at all. Still others may not be able to swallow saliva, foods, or liquids in a safe manner. If you are wondering what happens if you cant swallow, the quick answer is that eating becomes a serious challenge. This means that the loss of the ability to swallow may lead to serious medical conditions, including malnutrition.
Swallowing And Chewing Difficulties
Dysphagia is reported in 13-57% people living with different types of dementia and is most common in later stages of AD and frontotemporal dementia.14 People in this situation may hold food in their mouth, fail to form a bolus and have a delay in swallow initiation. Other signs include choking, coughing or wet voice whilst eating and drinking. Dysphagia may develop as a result of the inability to recognise food, oral-tactile agnosia and swallowing and feeding apraxia. Dysphagia of the pharyngeal phase leads to aspiration before, during and after swallowing. People living with dementia and dysphagia have double the risk of dying with aspiration pneumonia than those without aspiration.15 Furthermore, chewing problems may develop as a result of fatigue from prolonged mastication, forgetting to chew, mouth pain, dental caries, or ill-fitting dentures.
Signs And Symptoms Of Alzheimer’s Disease
Alzheimer’s disease is a progressive condition, which means the symptoms develop gradually over many years and eventually become more severe. It affects multiple brain functions.
The first sign of Alzheimer’s disease is usually minor memory problems.
For example, this could be forgetting about recent conversations or events, and forgetting the names of places and objects.
As the condition develops, memory problems become more severe and further symptoms can develop, such as:
- confusion, disorientation and getting lost in familiar places
- difficulty planning or making decisions
- problems with speech and language
- problems moving around without assistance or performing self-care tasks
- personality changes, such as becoming aggressive, demanding and suspicious of others
- hallucinations and delusions
- low mood or anxiety
Read more about the symptoms of Alzheimer’s disease.
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What To Do If Food Stays In The Mouth
A person with a dementia may begin to keep food in their mouth at the end of a meal.
Things that can help include:
- checking their mouth after each meal and encouraging or providing regular teeth brushing or denture cleaning, as food left in the mouth can cause mouth infections and bad breath
- keeping the person upright for a short time
- if food remains in the mouth despite these attempts to encourage a swallow, you should safely try to remove it
If the person you are caring for is persistently coughing or choking when eating and/ or drinking, contact their GP for advice as a speech and language therapy assessment may be needed.
If they’re having difficulty with swallowing tablets, talk to their GP or local pharmacist who will be able to advise you.
Caregivers Guide To Dysphagia In Dementia
Byline: Rinki Varindani Desai is an ASHA-certified medical speech-language pathologist and BIAA-certified brain injury specialist, specializing in the rehabilitation of cognitive-linguistic and swallowing disorders in adults. She is the founder and admin of the Medical SLP Forum, co-author of the mobile app Dysphagia Therapy and co-founder of Dysphagia Grand Rounds. Rinki currently serves on ASHAs SIG 13 Editorial Committee as Associate Editor of Perspectives, on the Dysphagia Research Societys Website, Communications, and PublicRelations Committee and has been selected to participate in ASHAs Leadership Development Program 2017-2018. She has presented at national and international conferences on topics related to adult dysphagia and written numerous articles for leading SLP blogs and magazines. Originally from Mumbai, India Rinki currently practices in Rochester, New York as Healthpro Rehabilitations SLP Team Leader for the Western NY region. You can follow her Medical SLP updates on and or reach out to her at .
Dementia and Dysphagia
Dementia is not one specific disease. It is a broad term that describes a wide range of symptoms associated with a decline in memory, communication, and other thinking skills severe enough to reduce a persons ability to perform everyday activities .
Dysphagia Signs and Symptoms
Common Causes of Dysphagia in Dementia
Consequences of Dysphagia
Mealtime enhancement tips for caregivers
Adaptive Equipment and Finger Foods
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How To Find Help For Caregiving
As the person moves through the stages of Alzheimer’s, he or she will need more care. You may not be able to meet all his or her needs at home anymore. It’s important to know your limits, take care of yourself, and to seek help whenever you need it. Learn more about getting help with Alzheimer’s caregiving and finding ways to care for yourself. If caring for the person has become too much for you, you can also learn more about finding long-term care for a person with Alzheimer’s.
During Eating And Drinking
- Staying with the person throughout the meal and assist by gradually supporting them, with the ultimate aim to encourage complete independence e.g. consider starting the person off then phasing out assistance.
- Try offering an empty cup/spoon to prompt a swallow.
- Prompt or model eating behaviours as well as giving verbal prompts .
- Talk about the smell/taste of the food use a gentle tone of voice.
- Try not to rush them.
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Dealing With Challenging Behaviour
Dietitians may experience people living with dementia reacting aggressively either verbally or physically. They may make threats, scream, shout, hit, pinch, pull hair, and bite. We may feel frightened and rejected. It is noteworthy that such behaviour is unlikely to be a deliberate act of aggression but more likely to suggest fear or desperation due to misunderstanding. They may be unable to communicate in a way that is heard. Understanding their behaviour is crucial. It may be helpful to ask carers or family members if the person demonstrates any challenging behaviour and any potential triggers to be aware of.
Tips for responding to challenging behaviour:
- Stay calm, take a deep breath and step back to give the person space and time
- Prioritise your own safety, consider whether it is appropriate to continue dietetic review and leave the place if you do not feel safe
- Communicate with a calm tone of voice to find out the triggers and maintain eye contact
- Consider offering a beverage of the persons choice
- Try not to blame the person as the challenging behaviour can be triggered by memories or previous trauma and may not necessarily be a reflection or directed at you
- Communicate your experience with the multidisciplinary team for advice and consider a need for a medication review
Forget To Eat And Drink
People living with dementia may forget to eat and drink or forget that they have already eaten and drunk, leading to skipping meals or overeating. They may lose the cognitive ability to initiate or continue effective eating strategies. Impaired decision-making ability may slow food choice and reduce intake. Those living with dementia may also have problems in communicating hunger or thirst and likes or dislikes.
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Choking On Water: Why Do Elderly Adults Have Difficulty Swallowing
Have you noticed your senior loved one choking on water? Learn why elderly adults have difficulty swallowing sometimes and what you can do to help here.
Difficulty swallowing also known as dysphagia is a common condition among senior citizens. It affects approximately 15 percent of all elderly adults.
Is your elderly parent or loved one choking on water or having trouble swallowing? If so, you know how scary it can be trying to help them. You might even feel helpless.
If youre tired of feeling this way, or if you just want to be prepared for potential problems in the future, keep reading.
Everything you need to know about swallowing difficulties is explained below, along with information on you can prevent and treat them.
How Can Dementia Affect A Person’s Appetite
A person with dementia may lose interest in food. They may refuse to eat it or may spit it out. The person may become angry or agitated, or behave in a challenging way during mealtimes.
If a person isnt eating enough, it can lead to weight loss and less muscle strength. They may also feel tired and weak. This can make them frailer and less able to recover from infections or viruses.
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Why Do People With Dementia Develop Dysphagia
Dysphagia can be caused by several different factors. These include damage to the parts of the brain responsible for controlling swallowing. In the case of a person with dementia, dysphagia usually occurs progressively over time, unlike the acute dysphagia that can occur suddenly in other elderly care situations, such as if a person has a stroke.
Help Your Loved One Eat Safely
Problems with chewing and swallowing can happen for several reasons:
- They donât like the food offered.
- Theyâre in pain.
- They eat very slowly. As Alzheimerâs disease goes on, your loved one may take longer and longer to eat.
- They forget to swallow. Itâs common for people whoâve had the disease for a long time to keep food in their mouth and not swallow it.
- They have trouble using the muscles that let them swallow. This can make them cough and choke because food or drink has gone into their lungs.
No single solution works well for everyone, so itâs important that your loved one see their doctor. But you can do a few things to help make them comfortable and feel safe when they eat:
You also might talk with their doctor about having them work with a speech therapist to strengthen the muscles used in swallowing and recommend tips and guidance.
To keep both yourself and your loved one safe during meals, donât put your fingers in their mouth while you feed them, while you clean their teeth, or if theyâre choking. If they get agitated or upset at meals, use plastic or dull utensils.
Archives of Gerontology and Geriatrics: âEvaluation and Management of Oropharyngeal Dysphagia in Different Types of Dementia: A Systematic Review.â
American Journal of Nursing: âPreventing aspiration in older adults with dysphagia.â
Clinical Interventions in Aging: âDysphagia in the Elderly: Management and Nutritional Considerations.â
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What To Do About Body Jerking
Sudden twitching or jerking, known as myoclonus, is another condition that sometimes happens with Alzheimer’s. The person’s arms, legs, or whole body may jerk. This can look like a seizure, but the person doesn’t pass out. Tell the doctor right away if you see these signs. The doctor may prescribe one or more medicines to help reduce symptoms.
Home Care For Late Stage Dementia Part : Eating/ Swallowing Problems
Persons in late-stage dementia are almost totally dependent, confined to a wheel chair or a bed, and have serious memory problems and physical complications. In India, care for persons in this stage is usually done by family caregivers, and can be very challenging.Dr. Soumya Hegde is a Bangalore-based Consultant Geriatric Psychiatrist. She has extensive experience in supporting people with dementia and their families through all stages for persons living in full-time facilities as well as for persons being cared for at home by their families. Dr. Hegde completed her training in Geriatric Psychiatry in the UK. Her work experience includes seven years as Associate Director of the highly reputed full-time facility, Nightingales Centre for Ageing and Alzheimers . In this series of posts, Dr. Hegde discusses various aspects of home care for advanced dementia, and provides useful information and several practical suggestions.In this part we start looking at a very common area of concern: when someone with dementia starts having eating/ swallowing problems.
Questions/ Comments by Dementia Care Notes: One very common and extremely worrying situation in late-stage dementia is when the person reduces or stops eating and drinking. Can you share why eating problems happen?
DCN: Why would someone not want to eat?
DCN: Thats a lot of possible reasons. But first, how can we know if a person doesnt want to eat or if she cant eat?
Slowly growing dehydration is often missed.
Swallowing Difficulties: What To Look Out For
If a person with dementia has difficulties swallowing they may not be able to tell you, however you may notice some of the following:
- repeated coughing and/or throat clearing after swallowing food or drinks
- choking when eating and drinking
- a wet sounding voice after swallowing
- a reluctance to eat and drink
- food and drinks are not swallowed but are held in the mouth.
How To Connect With The Person
Communicating with a person with late-stage Alzheimers disease can take effort and patience. Though that persons ability to respond may be limited, it is important to continue to interact:
- Continue to visit with the person even if responses are limited.
- Try to speak calmly and slowly be aware of the tone and volume of your voice.
- Consider sharing familiar stories with the person.
- Make eye contact, say the persons name and smile.
- Use other methods of communication besides speaking, such as gentle touching or massage.
- Have the person listen to music or calming nature sounds.
Learn more about how to communicate with a person who has Alzheimer’s disease.
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Eating And Drinking Difficulties In Dementia
- Forgetting to put the food into their mouth, forgetting to chew or swallow it and talking with mouth full.
- May repeatedly chew and not swallow the food.
- Leave most of their meals.
- Physical difficulties chewing certain foods.
- Overfilling their mouth and eating quickly.
- Poor coordination of swallow food may go down the wrong way.
- Worry that they have not paid for their food.
- Believe that the food is poisoned.
- Not recognising the food as something edible.
- Getting tired and giving up eating.
- Spitting out lumps.
Why Are There Swallowing Problems
As dementia progresses it affects the area of the brain that controls swallowing. In advanced dementia the person may have a weak swallow or lose the ability to swallow safely. For example, they may cough or choke after swallowing food or drinks. See the Chewing and swallowing problems feature in the Eating well section.
Swallowing problems can also be caused by general weakness and frailty of the person, that is, their swallowing muscles become very weak. In addition, changes in sensation and sensory awareness means that some people will find the experience of eating feels very different and may, at times, feel unpleasant to them.
Other problems such as having a sore mouth or sensitive teeth can cause a person to take in less food or develop swallowing problems. You should bring these difficulties to the attention of a doctor, nurse or dentist as soon as possible to review.
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Eating And Drinking For A Person With Dementia
Dementia often has an impact on peoples appetite and ability to eat and drink. Read our advice on some of the changes you might notice and how to support the person you care for.
People with dementia may experience problems with eating and drinking, and its quite common for their appetite to change as their condition progresses.
- forget to eat or drink
- not recognise when they are hungry, thirsty or full
- have trouble preparing food or drinks
- struggle to recognise food items
- have a change in appetite or taste
- find certain colours, textures or smells of food off-putting
- struggle to follow particular diets, for example for diabetes, coeliac disease, or religious or cultural diets
- have difficulty handling cutlery and feeding themselves
- find it difficult to swallow
- develop a sweet tooth
Helping a person with dementia to maintain a healthy diet can be difficult, but its important to encourage them to eat well. You could try:
A person with dementia may not always be able to recognise when they are thirsty, or communicate their thirst. This means it can be difficult for them to drink the recommended eight to 10 glasses or mugs of fluid per day. You could try:
- making sure the person always has a drink beside them
- offering squash if they dislike water
- offering a choice of hot and cold drinks
- helping if they are struggling to pick up or hold a cup
- offering different shapes and sizes of cup
- using a favourite mug, glass or cup, if they have one
Ways To Make Eating Easier
1. Offer soft food that requires minimal chewing.
2. Use smaller utensils and specially designed cups which allow drinking whilst keeping the chin down .
3. Choose strong flavours rather than bland ones, as these can stimulate the brain to swallow, and also try to offer a variety of hot and cold food in one meal.
4. If the person youre caring for is extremely slow to swallow, try putting an empty spoon to their mouth, as if offering more food. This can act as a reminder to swallow.
5. Make sure theyre sitting upright and are as calm and comfortable as possible before you begin.
6. Consider thickening fluids to make the food easier to control, you can get advice about how to use them from your GP or a dietician.
7. Avoid small hard textures such as sweetcorn, peanuts and peas, and stringy textures such as cabbage, or bacon.
8. Cook food longer, mash it with a fork, or puree it in a blender or liquidiser.
9. Try not to offer mixed textures of liquids and solids, such as milk and cereal or minestrone soup as they can make choking more likely.
10. Be patient. Accept that meal times are probably going to take much longer than they used to, but try to prioritise them. If you can help the person you care for to eat more than they normally would, its probably worth the extra time and effort.
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