Hardening muscles and swallowing hard

[Timeout]

Mum has had Alzheimer's for many years (must be around about 12 years now) but has been stable for the past 3 years. She's immobile, doubly incontinent, can only speak a few words and is sat on a pressure cushion or a pressure mattress due to risk of sores.

She has a good appetite but is hand fed a soft diet. We often take her in chocolate as she enjoys it, she appears to chew it well but when it comes to swallowing we've noticed she seems to swallow in a hard, exaggerated way as though it won't go down easily, she's the same with liquids ( her liquids are unthickened). Her neck and face muscles seem hard and unmoving although she opens her mouth easily and makes sounds. It's hard to describe. She holds her neck and head back against the headrest of her seat and I'm not sure she can support her head on her own for any length of time.

We asked about whether it was ok she was swallowing in this way and whether she had a sore throats as that what she swallowed like - like you would if you had a sore throat - but the carer couldn't see what the problem was. She swallows fine we were told. I would have expected swallow problems to be more the fact that she can't swallow but this isn't what I was expecting. Is this the start of swallowing issues? How do they present In the early stages? Should she be having thickened drinks? We feel we should be one step ahead of the home as they always seem to react to a crisis rather than preempt them.

Thanks

 

[Beate]

Please ask her GP to refer her for an assessment from the SALT team. Speech and language therapists deal with eating, drinking and swallowing in people with dementia and can advise on what kind of soft or thickened food might be appropriate. You don't want her to develop aspiration pneumonia or something!

 

[Baby Bunty]

Hi timeout..totally agree with beate your mum needs urgent SALT review. As if she aspirates its extremely dangerous and could lead to pneumonia. Xxxx

 

[acorns]

I agree that it sounds like a swallowing issue - look up ‘dysphagia’. My mum was recently seen by speech therapist as she’d been picking through her meals and spitting out lumps. She was put on a texture C thick puree diet with liquids. A month later she is eating a wider and more varied diet but everything turned into purée.

If diagnosed as needing particular diet I suppose it’s the home that would organise this but maybe you could bring in snacks of (eg) custards, soups, fruit purée, milky drinks and rice (rice not texture C as it has lumps in it).

 

[Amy in the US]

I'd get the SALT referral, ASAP. You don't want aspiration pneumonia. I would speak to the manager or nurse manager at the care home today and insist on this happening right away. Surely they are no strangers to swallow and eating issues with PWDs? I hope you can get some help quickly, and best wishes.

 

[Timeout]

Thanks all, I've been to the care home but the carers said they didn't see a problem, she swallows hard because she tends to have her head back against the chair back.
Not happy with this so I spoke to the manager - she will ask the GP for a SALT referral so we'll see how long that takes!