Dysphagia, Eating and Quetiapine

Urchy123

Registered User
Aug 27, 2013
0
0
Bristol
Hi, I just signed-up with this Forum, but have read its posts on and off for a number of months.

For the last four years my father has vascular dementia, and has been detoriating over this period. Last month when our GP visited she said he has severe dementia. I moved back home to live with him a couple of years ago, and gave up work last year to become his full time carer.

My main problem concerns his swallowing problems (dysphagia) which causes trouble when trying to feed him and also to give him his medication, especially Quetiapine to help control his anxiety and aggression.

He finds it very hard to swallow. Often I will give him his medication and he'll suck it and then spit the pills out. To be honest it is easier to give pills to the cats than it is for my father!

I cannot cut up the Quetiapine as it is a slow release pill. Has anyone else had similar problems with administrating pills, and if so, did you come to a workable solution?
The Quetiapine and Zopiclone (sleeping pills) are a godsend as they calm him down, and allow him (and me) to sleep through most of the night. Also to be honest they make caring for him a little more bearable

My second problem is dad is not eating enough. I now add a can or two of Dunn's River Nourishment drink to his diet. This is packed with calories, protein, carbohydrates etc. I was wondering whether anyone else has the same problems and can give me any advice on giving him enough food. I was thinking of adding baby food to his diet.

Sorry for the long winded question, but I am at a loss as to what to do.
 

CeliaW

Registered User
Jan 29, 2009
5,643
0
Hampshire
Hello - that does sound difficult and its important that he gets his medicines as you say. Has he been seen by anyone from the SALT team - Speech and Language Therapists? They may well be able to help with the swallowing issues. Your local councils Adult Care Services should be able to tell you how to get in contact and to get a referral.

Also, do have a chat with your pharmacist about the possibility of different forms of medication or ways to administer it - they may have some good ideas.

I am sure others will be along with helpful suggestions,

Good luck

Celia
 

Urchy123

Registered User
Aug 27, 2013
0
0
Bristol
Thank you

Dear Celia

Thank you for the info regarding SALT.
I have not gone down this route, as dad cannot understand anything people say, words / speech / actions are completely lost on him. Even when I have the pill near the back of his tongue and say swallow, he looks at me in a bemused way. I will though discuss the problem with our GP and see what she can recommend.

We did change his sleeping medication from pills to liquid. Unfortunately the taste was disgusting and he'd spit it out. I tried the liquid medication and it was the most foul tasting medicine ever, with an after taste which lasted nearly an hour. Surely you'd think they'd try and make it palatable! So we reverted back to the pills.

If pills are the only option then I'll ask to see if they can be administered rectally. I don't mind this (as dad is both urinary and faecal incontinent so I'm used to cleaning up down there). Just not sure how dad will react with pills shoved up his bum!

Thanks again

Nick

Hello - that does sound difficult and its important that he gets his medicines as you say. Has he been seen by anyone from the SALT team - Speech and Language Therapists? They may well be able to help with the swallowing issues. Your local councils Adult Care Services should be able to tell you how to get in contact and to get a referral.

Also, do have a chat with your pharmacist about the possibility of different forms of medication or ways to administer it - they may have some good ideas.

I am sure others will be along with helpful suggestions,

Good luck

Celia
 

BeckyJan

Registered User
Nov 28, 2005
18,971
0
Derbyshire
Hello and welcome to TP - I hope you are finding it helpful.

My husband had difficulties with swallowing and we did get a SaLT in to help (Speech and Language Therapists are specialists in swallowing). He was put onto liquidised foods and thickened drinks, all at a yoghurt style consistency. Medication was a problem but it is worth you asking if any can be prescribed in liquid form - makes such a difference as it can be syringed into the mouth if necessary. My husband was in a NH so this was allowed there.

My husband also was on Quetianpine and Zopiclone for some time, so I understand your need for a solution.

I hope your GP or Mental Health Consultant can help.
Best wishes
 

Urchy123

Registered User
Aug 27, 2013
0
0
Bristol
Thank you

Dear Jan

Thank you for your info.

After your and Celia's advice I shall now definately discuss SaLT with our GP. The liquidised foods / thickening agents may be the way to go. The syringed medication is also useful so I'll mention this to the GP.
We did try the liquid form of Zopiclone but it was the most disgusting tasting liquid ever - even when mixed with squash etc.

Best wishes

Nick

Hello and welcome to TP - I hope you are finding it helpful.

My husband had difficulties with swallowing and we did get a SaLT in to help (Speech and Language Therapists are specialists in swallowing). He was put onto liquidised foods and thickened drinks, all at a yoghurt style consistency. Medication was a problem but it is worth you asking if any can be prescribed in liquid form - makes such a difference as it can be syringed into the mouth if necessary. My husband was in a NH so this was allowed there.

My husband also was on Quetianpine and Zopiclone for some time, so I understand your need for a solution.

I hope your GP or Mental Health Consultant can help.
Best wishes
 

CeliaW

Registered User
Jan 29, 2009
5,643
0
Hampshire
Hi Nick - I hear what you are saying about your Dad not understanding but its not really about the speech and language side of it - despite the name - but how they can help with swallowing and various tips and techniques they can share with you.

I am not sure from your reply if you have had contact with them or not but it could be useful and worth asking if not.

I have just been googling about it but the information seems to get buried in so much detail - there are some information sheets on this site if you search - this is one:

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=149

Celia

Edit to say - I see we have all been posting at the same time - but hopefully the information is still useful!
 

FifiMo

Registered User
Feb 10, 2010
4,703
0
Wiltshire
The SALT can be a saviour! They start by checking the swallowing reflex using a stethoscope at the throat and asking the person to have a drink or something to eat and they can tell how good or bad the swallowing is. There is another test but that involves attending a clinic where they give different thicknesses of drinks and take X-rays to check where the fluids are going eg if the person is aspirating or not. Chances are they they will just advise to give puréed food and thickened drinks for your dad.

They will also show you the right sitting position for your dad when eating. For example a lot of elderly people tilt their head back to eat and drink and this causes everything to go straight to the back of the throat which makes swallowing more difficult and might cause them to start coughing as though they are choking. The optimum position is to sit upright with the head down towards the chest. It can sometimes help to stroke the throat in a downwards motion to stimulate the swallowing reflex. This might be something you could try to see if you can help with the swallowing of his tablets.

One tip from me, if they prescribe thickening powder for drinks, make sure you order the next tin in plenty of time as it can be like gold dust! We have driven round the midlands on numerous occasions trying to find a chemist who had it in stock. We have even resorted to going to hospital and begging to be given some to tide us over.

Fiona
 

Urchy123

Registered User
Aug 27, 2013
0
0
Bristol
Hi Celia

Thanks very much for the link, I downloaded the PDF and emailed a copy to my sister. So many of the problems encountered are included in this leaflet.
I am definitely going to see the GP to see about a referral to the SALT people.
Shame they cannot do home visits as dad can become very agitated, even aggressive at the doctors or hospital.

Best wishes

Nick
 

Urchy123

Registered User
Aug 27, 2013
0
0
Bristol
Hi Fiona

Thank you for your help and advice.

I shall definitely see the GP to see about a referral to the SALT people. I do have hesitations as if they try to do medical things to him will become agitated and maybe aggresive.

Also if they recommend thickening agents I'll be sure to stock up!

Best wishes

Nick
 

FifiMo

Registered User
Feb 10, 2010
4,703
0
Wiltshire
The SALT that my sister in law saw came out to the house without any problem, on many occasions too, so I would certainly ask them if it is possible given your dad's condition! If you don't ask, you don't get and if you still don't get then shout a bit louder! It is the ones that shout the loudest these days that get the attention.

Fiona