Swallowing difficulties

[marts1711]

Hi All,
My poor dad is in the later stages of vascular dementia and has just spent 5 days in hospital as he become so constipated whilst in the nursing home that it was a danger to him. The sudden deterioration in him over the past 3 weeks is considerable and awful to see. He is now bed ridden, his speech has become very slurred and he has barely eaten for 3 weeks and has lost a lot of weight contributing to his tiredness and muscle fatigue. He is now on a stage 2 diet and was taking lots of fluids whilst in hospital but only drinking Ensure which has to be thickened. My problem is the GP has said that they won't provide Ensure on prescription and the home won't provide it either. Why on earth should we buy it when dad is paying £500 a week for the home???? I am livid and wonder which way to turn now

 

[Beate]

Ask the GP about Fortisip. It might be a better choice and I've seen it prescribed.

 

[stanleypj]

Did the hospital resolve the constipation problem? There's plenty of evidence on TP of the drastic effect constipation can have on some PWD.

Has he seen a Speech and Language therapist about the swallowing? They are the experts on swallowing problems.

What reason has the GP given for not prescribing Ensure? Sorry I've asked questions when you're looking for answers but they might help to clarify things.

 

[jaymor]

Why won't the care home supply it? If your father is no eating then he is paying for food that he is not eating surely they can replace the normal food with ensure. My husband has ensure in the form of a type of pot of yoghurt. He has two pots a day and is also eating his meals.

Has your father been referred to the SALT team? They will observe and make recommendations as to consistency of food from soft or puréed and also how thick a drink should be.

 

[nitram]

"What reason has the GP given for not prescribing Ensure? "

Most likely reason is the relevant CCG guidance on AONS (Adult Oral Nutritional Supplement)

 

[marts1711]

Did the hospital resolve the constipation problem? There's plenty of evidence on TP of the drastic effect constipation can have on some PWD.

Has he seen a Speech and Language therapist about the swallowing? They are the experts on swallowing problems.

What reason has the GP given for not prescribing Ensure? Sorry I've asked questions when you're looking for answers but they might help to clarify things.

Hi Stanlypj
yes the hospital resolved the constipation problem quite quickly. They gave dad an ennama and then started him on strict lactulose and it has seemed to help. Just hope the nursing home are as strict with it or we'll be in the same situation in a couple of weeks.
He saw a speech and language therapist twice in hospital and it was she who said stage 2 diet, yogurt thick fluids and pureed food which incidentally he will not entertain. The GP has given no reason for not prescribing Ensure just that they didn't??? The day before he went into hospital an out of hours GP was called to see dad and he said he'd sort out a prescription for Ensure but never did. I give up. Dad really likes the Ensure and will have about 5 a day. They can't let him survive on fluids alone. BTW my sister was with him this afternoon at the nursing home and an agency nurse gave him lactulose which wasn't thickened enough and he started to choke. My sister had to leave the room as it was so frightening, he went purple. I never envisaged this happening to dad, a month ago he was up and about all night eating others residents food!! Such a change in such a short space of time

 

[marts1711]

Why won't the care home supply it? If your father is no eating then he is paying for food that he is not eating surely they can replace the normal food with ensure. My husband has ensure in the form of a type of pot of yoghurt. He has two pots a day and is also eating his meals.

Has your father been referred to the SALT team? They will observe and make recommendations as to consistency of food from soft or puréed and also how thick a drink should be.

Hi jaymor
I never heard of the SALT team. What is that??

 

[nitram]

"I never heard of the SALT team. What is that??"

Speech and Language Therapist
They also deal with swallowing problems.

 

[Suzanna1969]

Hi jaymor
I never heard of the SALT team. What is that??

Speech and Language Therapy. I have to say the lady they sent to see Mum for her swallowing last year is lovely, I hope we get her again as we've been referred for Mum's loss of communication skills.

 

[marts1711]

Speech and Language Therapy. I have to say the lady they sent to see Mum for her swallowing last year is lovely, I hope we get her again as we've been referred for Mum's loss of communication skills.

Hi Suzanna
yes dad did see a lady from the SALT team whilst in hospital (sorry I didn't put the letters together lol). Im not really sure what she said just that she prescribed the stage 2 diet. Its all very upsetting

 

[stanleypj]

I'd be inclined to ask for a conversation with the SALT. It would be good to know what she has to say and she may also be able to help about the Ensure.