Visit from Dentist - Cracked Teeth and now not chewing well and diet problems

[CraigC]

Hi All,

Well a bit wiser after today. Thanks so much.
I had a long chat with nurse and carer today and cleared the air.

It was really helpful having notes based on your replies and although it is still upsetting at least I have clarity.

The reason for the change of diet is that dad has been observed while eating and the nurse feels that he is not chewing food enough before swallowing. This is due to the bad state of his teeth particularly his molars. I watched him carefully again and he does not seem to be in any pain but his teeth are just not functioning well enough. The dentist was completely wrong when he said that there would be no problem with his eating and not to worry. Hopefully I can speak to him again so at least he does not give misleading advice to anyone else.

Just to be clear, there seems to be no issue with swallowing, purely dad ability to chew food properly. Being fair to the home, if he can't chew properly there is a risk of choking. The choking was observed by us last week but not happened again.

So moving on, the preparation of food.

Dad's food will not now be pureed. It is liquidised slightly - they did not really grasp the concept of mincing. Food like pies is mashed as far as I can tell, but will keep an eye on what turns up for dinner. The nurse said some residents have fully pureed if they have swallowing problems.

We still have a referral with SALT lady and Ill be there with list of questions and watching her observe dad.

The good news is we can still take in food for dad, just need to give it a shot/pulse on liquidiser (e.g. the mince with shepherds pie). Can still take in nice flavoured food and have made a list from your suggestions, thanks.

Feel a lot better getting clarity and so glad I asked today before speaking to home.

He has never had any problems with constipation etc nor loss of flavour. I always tried a spoonful first of anything that I was putting into his mouth,

Thanks Connie x, that has put my mind at rest. Will try tasting too. If it is not good enough for me then dad should not eat the food.

How would the home mince food, probably using a blender for a shorter time

Spot on lin, that was my confusion but a lot clearer now thanks.

http://www.cuh.org.uk/resources/pdf...aflets/PIN1473_eating_well_on_pureed_diet.pdf

Ella, that was a great link have printed it off for meeting with SALT. thanks.

* important to try and retain textures

I think that was my biggest concern pw. It is quality of life and food is one of the few things that gives dad pleasure now. All these problems have reminded me not just to cook for dad but to pick up the odd treat from cheese shops etc. His smell and taste are still working so want him to enjoy his food and stimulate the olfactory.

thanks again for everyone's advice and bon appetite!
Kindest Regards
Craig

 

[CraigC]

Have and appointment with SaLT on Friday so will let you know how it goes. Shame the dentist won't be there

 

[CraigC]

Hi All,

The SaLT spent about an hour, watching dad eat and answering questions. She felt his throat as he swallowed and watched us feed him very carefully. She also carefully observed him drinking five gulps, holding his throat. He had fish and chips solid but cut up and ate well, chewed well and both his main carer and the floor nurse were there.

The long and short of it is that the SaLT felt dad could carry on eating solids mostly if the food was cut up carefully. He will be on a fork mashable diet. She gave a list of things to avoid and some really good handouts on How to Reduce the Risk of Aspiration, Diet Advice Sheet on Soft for mashable diet. Really positive and helpful. A good thorough list of unsuitable food (e.g. Tough Meat, Dry Biscuits, Fruit Skins, Sweetcorn etc)..

Interesting information on Reducing the Risk of Aspiration, but these are going to take up more of the homes time, feeding slowly not rushed - small mouthfuls and sips, avoiding noise and distractions, keeping dad upright during feeding, watch head position. Most importantly use verbal and visual prompt to encourage swallow. You can see it is big ask of home so need to focus on advantages and maintaining his quality of life.

I've asked if I can copy and put a PDF of both factsheets on TP site as they would help others on forum, will let you know. The SaLT is typing a report and sending it on to me, the home and GP.

However, I went in to feed dad on Sunday. All the food was liquidized, so a few challenges there and just some communication issues. A lot seems to be down to interpretation so trying to keep my cool and not get upset.

As always, appreciate the support and ideas, it helped me prepare and focus for meeting. If anyone has similar problems please feel free to ask any questions, and as I say hopefully can add attachments to these factsheets at a later date. BTW anyone with swallowing or eating problems is entitled to see a SaLT specialist, don't let anyone tell you that someone with dementia is not as entitled to this service from NHS.

Thanks again
Craig

 

[CraigC]

Hi All,

Dad has been a bit unwell and got dehydrated a few days back. He was unresponsive but improved with fluid intake. We had GP out and he is on the mend and on antibiotics just in case it is a UTI.

Just a question; I went to see dad today and fed him. When I gave him a drink, I noticed that although he was sipping and it seemed like he was gulping and swallowing he was actually storing it all in his mouth. Suddenly the flood gates opened and about half a cup of tea came out. Not see him do this before. With the help of the staff we made him very alter and got plenty of fluid down, eventually, but it is taking a lot of time and patience. I can see now how he possibly became dehydrated.

Anyone else experienced this storing up of fluid when feeding?
I'm obviously going to have to be a lot more careful and make sure he is very alert when drinking as there is a risk of choking.

Kind Regards
Craig

 

[Canadian Joanne]

Craig, I've heard of people "pouching" food mostly but also occasionally liquid. It's almost as if they forget to swallow. One of the ladies I feed does this now and then, usually when she's having an off day.

You'll have to go slowly and remind your dad to swallow. I've read that gently rubbing the throat encourages swallowing also.

It sounds more like a disease progression to me but more about the remembering, rather than the mechanics at this point. But I could be mistaken.

 

[CraigC]

Thanks Joanne.
I'd heard of pouching food but not liquid. He had his mouth practically full of liquid it could have been quite scary.

You'll have to go slowly and remind your dad to swallow. I've read that gently rubbing the throat encourages swallowing also.

He is not responding to any command or prompting sometimes. Getting dad alert enough to swallow involves a lot of talking (well shouting) and encouraging. I usually rub his neck, cheek or arm but will try the throat, thanks. Hopefully it was an off day but it does remind me what a difficult job the staff have at the home. Nearly all the residents in the nursing home need a lot of TLC when it comes to feeding. They all have their own little quirks and feeding issues.

Will definitely be a lot more careful.
Dad just seemed tired with it all today. He has every right to get fed up with it all and it is difficult to get him out of the home regularly during the winter months.

thanks again
Craig

 

[CraigC]

Interesting reading through an old thread. Nice to have a record as it helps me work out where we are at. And Joanne it looks like you were spot on.

We have more problems again with dad eating. He is holding food in his mouth more often, particularly liquid. This increases the risk of choking and chest infections.

Had the SaLT specialist out again last week and we can't really get to the bottom of it as he slept through the whole visit.

She is kindly coming again this week to do another assessment (at breakfast) as dad was so sleepy. One thing that came out of the initial meeting was the odd feeding times at home. They give breakfast up to 9:30 an it can be quite a formidable meal. Porridge (big plate) and then bread with jam. Then lunch at 12:30. Not much of a break at all. It may explain why dad is so sleepy in mornings when I visit.

The SaLT specialist also felt that the sleeping and lack of activity is due to the stage of Alzheimer's. Dad is late stage now and sleeps a lot more. Unless we take him out the stuffy home he never seems to be fully awake but that could just be bad luck and timing of visits.

I was thinking about the gap between breakfast and lunch and thinking about it, this has been similar in all the homes dad has been in. Appreciate it is convenient for home but that is a pretty short break between meals and then they have 11:00 tea and cake biscuit throw in.

For now we have asked for dad to be first for breakfast and last for lunch. It turns out that they often have to reheat his meals anyway as he is too sleepy to feed. Which make explain holding the food in mouth. But best to get it checked again as it could be an issue with swallowing reflex.

The SaLT was very honest about dad's progression which you need from an outsider once in a while. Bit of straight talking. We discussed PEG feeding again and what is likely to happen over the coming years. I look at dad now and just feel for him that enough is enough. He should be put to bed at some points of the day rather than left in a wheelchair - even in his new chair he looks uncomfortable. He needs more one to one care at this stage. But I know it just isn't practical with the level of staffing in home.

Off to visit now and check out when he was fed and what time lunch is given. Hopefully some of the advice sunk in. And it is a sunny day so we get to go out for a walk in the fresh air

Kind Regards
Craig

 

[Helen33]

Your post is heart-rending Craig. I do wish that dementia care could be at Hospice standard as a base line rather than something exceptional. One day maybe. I think you are right to long for the best and to try to assess just what can be done at this particular time. I do hope the altered feeding times makes a difference and that it enables your father to be more comfortable in this aspect of his life. Also being taken to bed during the day to give comfort to his dear body seems such a reasonable thing. I do hope so. My wish is that Hospice standard care could be given to the living rather than the dying. It would make your father's last part of 'living' the best it could be.

It is so good to hear an update from you and I imagine you as that guardian angel over your father.

Love

 

[Canadian Joanne]

That's not much time between breakfast and lunch. Wouldn't it make more sense to have lunch at 1:00 or 1:30?

But nursing homes are like that. My mother's schedule is 8:00 am for breakfast, snack around 10:00 am, lunch at noon, snack at 2:30, dinner at 5:00 (this is way too early in my opinion) and another snack at 7:00. It's very regimented. I suppose that's how they manage to get through.

Asking him to be fed first at breakfast & last at lunch makes sense and I hope they can work with that.

But it does sounds like progression, Craig, and I'm so sorry there is nothing we can do about it. Just enjoy him.

 

[germain]

Hi Craig - long time no speak !

I have a total dental phobia and have to be put out even for a clean & polish. When I actually broke a tooth my dentist filed the sharp edges down for me while I was waiting for a crown.

Now I know that AZ people may not take kindly to an anaesthetic but don't think dental sedation is quite the same. One little prick in my hand & I count down in gin & tonics as I go woozy. My dentist assures me that I am responsive all the time but all I can ever remember is the occasional dream of " open your mouth wider please"
Would this be an option for your Dad ? Have to pay privately but don't think the cost for a one- off would be exorbitant.

regards
Germain

 

[Sox]

Hello Craig - I am having similar dental problems with my husband. I have difficulty getting him to the dentist and usually he won't open his mouth when he gets there!Fortunately he has not cracked any teeth yet, but he will only allow me to clean his teeth once a day and his gums do bleed a little. I use an electric toothbrush and just have to do the best I can but he won't let me look in his mouth at all. At the moment I can get him to rinse his mouth out with a mouthwash. The dentist says I am doing all I can, so will have to leave it at that for the moment. Good luck with the electric toothbrush - I am sure my husband's mouth is better since I started using one. Take care. Sox

 

[CraigC]

Thanks for all the replies, advice and support.

Unfortunately dental surgery is out for dad at moment. Local anaesthetic would not allow dentist to work on dad and general anaesthetic is just not practical - hospital visit. I hope to speak to dentist who is visiting dad today but would not commit to a time As long as dad is not in pain we will hold off I think. The SaLT (Speach and Language Therapist) visited this morning at breakfast and we spent a lot of time feeding and observing dad. The SaLT specialist was outstanding and had a very detailed knowledge of dementia. She felt his throat (around the adams apple) as he swallowed food of different consistencies and checked the reflex and time it took to chew swallow. To cut a long story short we observed the following.

1. Dad is taking a long time to chew his food, even soft bread and porridge. He is swallowing solids OK so that is not a concern. However he does need to be given more time between mouthfuls.

Advice: Take more time over meals, feed more slowly. Make sure carer is seated and relaxed when feeding. Feeding when standing up makes people rush the feeding process. This is not practical in a care home setting at very busy feeding times but I will discuss with all staff when I visit at mealtimes.

2. Dad gets more tired during the meal so may hold a mouthful of food. You need to carefully watch to see if he swallows before presenting more food.

Advice: If dad does not swallow, offer a dry spoon/fork and the let him open his mouth. This may encourage more chewing and swallowing. Stroke face etc and keep as awake as possible at mealtimes.

3. Fluid. Dad is definitely holding fluid and this is the main concern. He may not swallow a mouthful of tea for example but will accept another. The risk here is that the remaining liquid trickles down when the epiglottis is not closed and dad is breathing. It's the food or liquid that gets into the lung causing danger of chocking or infection.

Advice: As above. Taking time and observe swallowing. Also try giving fluid at the beginning of mealtime when dad is more awake. Fluid seems to be the main concern. As dad has not had lung infections we are just going to keep a close eye on him. If it does not improve we will need to add thickeners to his drinks.

We are also getting some nosey cups on her recommendation. These allow the cup to be tilted without having to tilt the head and minimise the risk of choking when drinking. Great idea and very cheap £3 from HomeCare. See Nosey Cup.
She also recommended clear nosey cups so the carer can easily see how much is left in the cup.

We are also looking at timing of meals and will still try and give dad liquidised or mashed up consistency rather than puréed for now. Just keeping an eye on things.​

Through the whole process dad looked very tired. This is one of those severe dips in his decline which has been very gradual generally.

However, it is just so refreshing to deal with someone who takes care over their job and knows how to deal with dementia, it made all the difference today. Hard to be 'happy' with the situation but a lot more informed and comfortable than I was a few weeks ago.

Again, thanks for all the advice and support.
Hope this helps someone is same boat over the years and please contact a SaLT if you have any concerns for someone you care for. Anyone with dementia is entitled to help from a SaLT.
Kind Regards
Craig

 

[Grannie G]

Feeding when standing up makes people rush the feeding process.

Oh my goodness Craig. The thought of this is dreadful.


I`m relieved at least you had a therapist worth her salt. [no pun intended]

 

[CraigC]

Hi Sylvia,

The reason that the carer fed dad standing is that his new wheel chair is quite high. It is not practical to hoist dad from armchair to wheelchair then to dinning room chair, so he is fed in chair. I'm going to keep an eye on mealtimes to see if this is causing a problem in dinning room. The wheelchair is godsend, we can adjust the tilt but not the height. My main concern in that the staff just don't have the time to feed dad slowly. Meal times are pretty busy. I'm sure they will try but it is all down to the practicalities and down to staff ratio, unfortunately. All I can do is make everyone aware.

The wheelchair has made it so much easier to take do out of the home and a lot safer taking dad to local high st.

She was definitely worth her salt a wealth of information.

Kind Regards
Craig

 

[piedwarbler]

Good to hear from you Craig. My mum has two nosey cups but I paid a tenner each for them, just shows it's good to shop around! I agree too, Mum's SALT therapist is a diamond.

 

[CraigC]

When the cups arrived they are a bit small.
My mistake, it did say 4oz on website so should have realised.

But great idea and work very well. Do not recommend them for catching spiders

 

[Contrary Mary]

Thanks for the link, Craig. I shall definitely be ordering some for Mum for the bad days when she can't keep her head up.