Stage : Age Associated Memory Impairment
This stage features occasional lapses of memory most frequently seen in:
- Forgetting where one has placed an object
- Forgetting names that were once very familiar
Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.
Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
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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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.
What Are The Signs Of End
It is important for caregivers to know when an individual with dementia is close to the end of their life, because it helps ensure they receive the right amount of care at the right time. It can be difficult to know exactly when this time is due to the variable nature of dementias progression, but understanding common end-of-life symptoms of seniors with dementia can help. Below is a timeline of signs of dying in elderly people with dementia:
Final Six Months
- A diagnosis of another condition such as cancer, congestive heart failure or COPD
- An increase in hospital visits or admissions
Final Two-to-Three Months
- Speech limited to six words or less per day
- Difficulty in swallowing or choking on liquids or food
- Unable to walk or sit upright without assistance
- Incontinence
- Hands, feet, arms and legs may be increasingly cold to the touch
- Inability to swallow
- Terminal agitation or restlessness
- An increasing amount of time asleep or drifting into unconsciousness
- Changes in breathing, including shallow breaths or periods without breathing for several seconds or up to a minute
Patients with dementia are eligible to receive hospice care if they have a diagnosis of six months or less to live if the disease progresses in a typical fashion. Once a patient begins experiencing any of the above symptoms, it is time to speak with a hospice professional about how they can help provide added care and support.
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What Causes Trouble Swallowing
Ryba explains that difficulty swallowing can occur for a variety of reasons, including multiple sclerosis , amyotrophic lateral sclerosis , Parkinsons disease , stroke, and various forms of dementia. These conditions can affect the muscles and/or nerves involved in the process of swallowing. Other conditions can contribute to swallowing difficulties, such as gastroesophageal reflux disease and growths in and around the esophagus.
How To Deal With Loss Of The Ability To Swallow Among The Elderly
If you are asking yourself how long will my dad live because he cant swallow anymore, remember that there are treatment options for those who can no longer swallow. It will not necessarily even require surgery or other invasive measures as those with issues swallowing or chewing can begin by taking small steps to make it safer and easier to swallow.
1. Position Correctly
- Always sit completely upright while eating, preferable at a 90° angle.
- Tilt the head forward slightly.
- Stay standing or sitting upright for between 15 and 20 minutes following every meal.
2. Eat in the Right Place
- Eat in an area with minimal distractions.
- Concentrate on eating and drinking as opposed to other tasks.
- Dont talk when there is food in the mouth.
3. Mind Quantity and Speed
- Always eat your food slowly.
- Either cut your food into smaller pieces or have someone do it for you. Be sure to take the time to chew it thoroughly, waiting until it is liquid in the mouth before you swallow.
- Avoid eating more than a half teaspoon of food in one bite.
4. Swallow Carefully
- Dont be afraid to swallow several times for every bite or sip, perhaps even 2 to 3 times.
- If you notice liquid or food catching in your throat, gently clear your throat or cough. Then swallow one more time before breathing. Repeat this process if necessary.
- Make a conscious effort to swallow frequently.
5. Manage Saliva
6. Know the Consistency of Food
7. Take Your Medications
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Signs And Symptoms Of Dysphagia
Knowing what to look for is imperative since swallowing problems are common in seniors with Alzheimers disease and other types of dementia. Patients may not be capable of communicating discomfort or difficulties to their caregivers.
There are recognizable, yet often subtle, signs and symptoms that indicate dysphagia. When these signs occur, it is important for caregivers to address them as soon as possible, Ryba urges. Treatment and management will depend on an official assessment called a swallowing study, which is commonly performed by a speech-language pathologist .
What To Do About Incontinence
Incontinence means a person can’t control his or her bladder and/or bowels. This may happen at any stage of Alzheimer’s disease, but it is more often a problem in the later stages. Signs of this problem are leaking urine, problems emptying the bladder, and soiled underwear and bed sheets. Be sure to let the doctor know if this happens. He or she may be able to treat the cause of the problem.
Accidents happen. Try to be understanding when they occur. Stay calm and reassure the person if he or she is upset. Incontinence supplies, such as adult disposable briefs or underwear, bed protectors, and waterproof mattress covers, may be helpful. Learn more about dealing with incontinence.
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The Seven Stages Of Dementia
One of the most difficult things to hear about dementia is that, in most cases, dementia is irreversible and incurable. However, with an early diagnosis and proper care, the progression of some forms of dementia can be managed and slowed down. The cognitive decline that accompanies dementia conditions does not happen all at once – the progression of dementia can be divided into seven distinct, identifiable stages.
Learning about the stages of dementia can help with identifying signs and symptoms early on, as well as assisting sufferers and caretakers in knowing what to expect in further stages. The earlier dementia is diagnosed, the sooner treatment can start.
Additional Resources For Dementia And Eating Issues
Read and download the NHS helpful Dementia Care Guide Support with eating and drinking . This guide talks about the common problems those living with dementia can have at meal time, and offers some tips to resolve them.
Another great tool that carers can use is The DMAT . The DMAT enables carers to assess, select interventions and generate a person centred care plan to support mealtime eating abilities and meal behaviours in people with advancing dementia. You can learn more about the DMAT and its benefits on their website.
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Try Some Of These Best Foods For Dementia Patients To Eat
There are lots of fads and daily news on the latest food to help slow down dementia. Advice from the Alzheimers Society and other expert dementia organisations is clear: there are foods that can help reduce some of the symptoms, but mostly its common sense. A healthy balanced diet with treats in moderation of course. Some suggestions include:
Make Sure You Are Giving The Right Medicine
People often keep medicines they were supposed to stop. Or, maybe one provider prescribed a medicine, and another prescribed the same medicine, without knowing what the first one was doing. So, it is best to bring a bag or list of all medications, including those bought over-the-counter, to each medical visit. The provider should create a single list of medications that includes medicine names, doses, times taken, and who prescribed it. Once you know the correct medicines, keep an updated list with you at all times.
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How To Help If A Person Forgets To Swallow
A person with a dementia may forget to swallow. Things that can help include:
- alternating temperature and taste within a meal, for example, sweet and savoury food or hot and very cold foods or fluids
- offering sips of ice cold drink before a meal or in between mouthfuls
- giving verbal prompts to swallow
- trying placing an empty spoon in the mouth between mouthfuls to help stimulate a swallow
Pay Attention To Posture
Posture can be a major player when it comes to safety and swallowing. Caregivers should ensure that their loved ones with dementia and dysphagia are in a comfortable and upright position during meals, Desai wrote, and keeping them upright for 30 minutes after eating can help with digestion.
Meanwhile, a speech-language pathologist may recommend adjustments to a patients postures. According to Nicole Rogus-Pulia, a speech-language pathologist and an assistant professor of medicine at the University of Wisconsin-Madison, one adjustment includes the chin tuck, which moves the base of tongue further back to the throat and narrows the entrance to the airway to reduce the risk of aspiration. Another is the head rotation, which involves turning the head to the side while swallowing. It can be helpful for people with weakness on one side of the throat, redirecting material to the stronger side.
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Lewy Body Dementia Canada
Learn to live best with LBD
Menu
Careful Eating Habits Limit Aspiration Risks with Dementias, and particularly with Lewy Body Other Dementia.
Summary points:
Read the full story below.
Reduce Dementia-related Swallowing ProblemsSwallowing Can Be A Killer. Be Vigilant.
Choking is always a risk, even when healthy. However, a slow, silent threat exists which needs to be actively avoided, aspiration: accidentally having food or fluids go into the lungs instead of the stomach.
Aspiration frequently leads to pneumonia by having fluid buildup in the lungs, which is a leading cause of death in the frail.
Dementia with Lewy Bodies affects the autonomic nervous system, which renders simple, otherwise automatic reflexes ineffective. This is why swallowing problems, blood pressure and heart rate fluctuations, incontinence, and sleep disturbances commonly become problems. The unconscious mind essentially becomes unable to tell the body what to do.
Eat When Awake and Alert.
Concentrate on Eating. Avoid Distractions.
Our Story
Why Do People With Dementia Stop Eating And Drinking
One of the most distressing phases during the span of time caring for someone with dementia can be when the person has stopped eating or drinking. As hard as it is to see this is often a natural part of the disease. As a caregiver, it is important to understand some of the causes of this stage of the disease, what it means for the person you care for and some ideas that may help.
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Before Eating And Drinking
- Respect their food and drink preferences, may need assistance with choosing their meals.
- If you are concerned about their nutrition you can ask the nurse about what extra snacks are available and if a dietitian is required.
- Sit at their eye level if they require assistance with feeding. Try experimenting with strong/different tasting foods explore what they really enjoy.
- You may need to offer little amounts of food, often .
- Provide high calorie foods.
How To Get People With Dementia To Take Pills
Dementia care demands incredible creativity. The ever changing needs of the person who has dementia challenges family caregivers and professionals alike. One particular frustration is getting important medications into their loved ones who either can’t or won’t cooperate when it comes to taking pills.
As Alzheimer’s spreads throughout the brain, logic departs. The ability to understand one’s world disappears, understandably being replaced by fear and suspicion. These emotions are often blamed by caregivers when the person that they love refuses to take needed medications.
To complicate issues, loss of appetite is common. Disliking once favored food is also common. Swallowing can be a problem, as well as sheer stubbornness about taking the pills. Therefore tricks become the norm in the quest to sneak pills into a loved one’s food, often with limited success. Sweet treats are often the chosen method since people with dementia seem to like sweets, but this method often fails when medication is added. Why?
Teepa Snow, an acclaimed dementia-care education specialist, reminds us that the sense of taste changes with the progress of the disease. Unfortunately, the ability to detect bitterness remains strong. This is one reason why it becomes more difficult to sneak medications into food. The other reason is that people with the disease can still detect texture.
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How You Can Help Your Loved One Eat And Drink
There are several ways that you can try and increase your loved ones appetite and interest in food and drink.
You know your loved one, their preferences, and their routines best, and that puts you at an automatic advantage. You also know their likes and dislikes and what they can physically manage when it comes to eating and drinking.
Here are some ideas to help encourage your loved ones appetite:
Image courtesy of WessexAHSN
- Make food look and smell appealing. I find that using different tastes, colors, smells, and textures really help my Grandpa want to eat, especially if hes in the kitchen and can see and smell the food being prepared.
- Look for opportunities to encourage your loved one to eat. My Grandpa is most alert and willing to engage in the mornings, so I take advantage of this by making him a big breakfast with a high-calorie count.
I still encourage him to eat throughout the day, but I find that the morning boost helps him quite a bit.
- Give them the food they like. Even if it seems like its much of the same thing, giving my Grandpa small, regular portions of food that he enjoys works far better than a heaping plate of food that hes indifferent towards.
- Keep trying different types of food and drinks: Sometimes, the foods your loved one used to love most now become the ones they cant stand and vice versa.
While not ideal, only eating dessert is better than eating absolutely nothing at all.
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.
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Consult With A Speech
A feeding tube is a medical device designed to provides nutrition to people who cannot eat or swallow safely, or who need supplemental nutrition. For caregivers to people in advanced stages of dementia, its a complex decision. Some physicians may recommend tube feeding when peoples dementia progresses to advanced stages and dysphagia becomes severe. However, studies have shown that the tube-feeding does not improve the quality of life for people with advanced dementia nor prolong duration of life.
According to Desai, tube-feeding may also increase a patients risk for additional health problems. In advanced stages, we have overwhelming evidence to show that its not going to prevent aspiration pneumonia, she said. Its not going to prolong their survival rate. And its actually another source of infection when you have a feeding tube in the stomach. The burden of having it doesnt outweigh the benefits.
Rogus-Pulia added: Sometimes, a speech-language pathologist isnt included in the end-of-life feeding discussion. And we really should be, because theres so much we can do to recommend safe swallowing that also aligns with the patient and goals of care. There are ways that we can modify what youre swallowing that still are enjoyable. She said it is critical for people with a dementia diagnosis and their caregivers to discuss feeding options with their clinicians early, to make an informed decision.