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What would you do? Swallowing

Discussion in 'I care for a person with dementia' started by SerenaS, Sep 30, 2015.

  1. SerenaS

    SerenaS Administrator
    Staff Member

    Apr 7, 2011
    13,269
    London
    .
    Do you have any tips to help someone who is having difficulties when swallowing?

    Swallowing can be difficult for people with dementia - do you have any knowledge you'd like to share with someone who is having this problem?

    We're planning to include more real life experiences of dementia in our Living with Dementia magazine and we'd love to hear from you.

    Please do add your comments below, and we may feature it in the next issue of the magazine.

    Thanks,

    Serena :)
     
  2. jaymor

    jaymor Volunteer Moderator

    Jul 14, 2006
    12,553
    Female
    England
    My husband was seen by the SALT well over twelve months ago following a chest infection that took his mobility and his ability to eat a normal meal. At first his food was of a soft consistency and later became puréed food. His drinks are thickened.

    He is still eating well but very slowly and it can take an hour to feed him. There is nothing he can't eat. Desserts we had to be careful with but lots of food can be mashed and adding custard or cream makes it perfect. On days where the dessert can't be mashed then he has a mousse. Drinking is a little more complex. He sometimes stores it in his mouth and can take ages to swallow it. It is wise to give it him in sips,less chance of choking. Other times it goes down normally.
     
  3. LYN T

    LYN T Registered User

    Aug 30, 2012
    6,962
    Brixham Devon
    My late Husband started to lose his swallow about April 2013. He had a sort of gurgle in his throat and I had to make sure that everything was slightly mashed and served up lots of fish and casseroled chicken-red meat was off the menu especially mince!

    Pete went into a CH June 2013 and the food was generally what I had given him. By April/May 2014 Petes food was much more mashed up with gravy/parsley sauce with fish and lots of mashed potatoes. He also had trouble with 'hamstering' his food; we had to lightly run our fingers down his throat to stimulate his swallowing reflex. I gave him jellies to help with his liquid intake. Unfortunately, Pete then had to have his drinks thickened and everything pureed.

    Unlike many people Pete retained his desire for food-it seemed to be his only pleasure. Pete never stopped eating right to the end; he didn't follow the path of refusing food or being unable to eat completely. He passed away after I had fed him a full liquidised meal- he simply choked and vomited his food once-but he didn't let the rest of the food come out so it went in his lungs and he died of aspiration pneumonia. His eyes rolled back, he took two or three more breaths and he was gone.

    Sorry if this account is too graphic; but I really should have known that Pete's passing would be against the norm! He lived his life differently than most people so I shouldn't really be surprised that he died in a way that didn't follow the rules.
     
  4. Izzy

    Izzy Volunteer Moderator

    Aug 31, 2003
    59,923
    Female
    Dundee
    #4 Izzy, Sep 30, 2015
    Last edited: Sep 30, 2015
    Bill's swallowing issues started around a year ago. He loves his food and if he is encouraged to he can still cut up some foods and use cutlery properly. The first indication that there was a problem was when he choked on a Brussels sprout a year ago. He fell to the floor from the table and by some miracle we got the sprout out!

    As the year progressed it became clear that Bill's biggest problem is eating too quickly. He can have a mouthful of food and he still tries to shovel more in. This inevitably leads to him choking. After having to use the Heimlich manoeuvre on him not long ago I got a referral to SALT for him. She watched him eat and agreed that he can still actually swallow but strategies were needed to try to slow him down. She also gave me a list of foods to avoid. This includes things like flaky pastry, toast, tomatoes, sweet corn, peas etc etc. If cooking something like mince he has to have it with a fairly thick gravy in case he chokes on a lump of mince.

    To be honest I have found this quite difficult. I want him to continue to use cutlery and eat 'ordinary' food as long as possible. I don't believe he needs to have his food puréed but it is really important that I choose things he can swallow easily. I no longer make casseroles as even very tender bits of meat take him a long time to chew. We eat a lot of fish but of course I need to make sure there are no bones - no more Arbroath smokies for us!

    At mealtimes he has to be closely supervised. I need to put my hand over his fork hand while he is chewing so that he doesn't put any more in his mouth. The SALT recommended that I don't cut up his food. Her thinking is that he will slow down if he has to cut his own food.

    Both times he has been in hospital with bad chest infections they have said that they felt they were aspiration chest infections.
     
  5. rincewind

    rincewind Registered User

    Jun 30, 2011
    6
    Swallowing difficulties

    Hi I find having music on quietly in the background and talking to my mum so distracting her when she drinks helps as once she has started sucking she carries on. We use syringes with the doctor's permission to feed her puréed food. Mum opens her mouth for the syringe but not for a spoon.
    Rincewind
     
  6. nitram

    nitram Registered User

    Apr 6, 2011
    19,262
    Male
    North Manchester
    At this stage I obtained some advice from SALT.

    Check that there is no inflammation or infection in the mouth.

    Rub your finger fairly firmly from the top of the throat under the chin to the jaw.

    If possible wait for second swallow.

    Taste promotes a swallow.

    Sweetness is usually the last taste to go.

    Temperature of the food affects the ability to taste, soft icecreams from a machine taste sweeter that frozen ones because they are warmer. Hot drinks should be colder than usual.

    Watch out for food being pouched between checked and gum, fish out with finger if needs be. Also check that liquids are not being retained in mouth.
     
  7. Padraig

    Padraig Registered User

    Dec 10, 2009
    1,039
    Hereford
    My late wife reached the stage where she began to refuse food. At the time she was bedridden, suffered with pressure sores, was reduced to less than six stone. Against all advice I removed her from a Nursing Home and my local GP told me not to force feed to which our daughter agreed. None the less I chose to continue my attempts to feed her. She threw the food back up and fainted. She was admitted to hospital but they failed to uncover the problem and told me that she was too ill to under go an operation. Once again I insisted on taking her home. A rapid response team were assigned to visit our home for a period.
    Again these people insisted she was dying and entered that fact in her medical diary, plus they recorded that I refused help even though out daughter agreed with them.

    There were a number of underlying causes to the problem I concluded, and set about treating them. One was lack of proper oral hygiene, two, lack of body movement, she required physical therapy treatment, three, she was laid in the one position, mostly on her back with her mouth open. She was incapable of supporting her head. As a result she was badly constipated. Once these problems were treated her physical health returned to normal and she regained her normal weight. In addition she lived in excess of a further four years.
     
  8. Shirleyanne

    Shirleyanne Registered User

    Feb 2, 2015
    3
    Newport
    I met a carer who helped her husband to swallow by putting her hand under his chin.

    I met a carer who helped her husband to swallow by putting her hand under his chin.
    Shirleyanne
     
  9. Okie

    Okie Registered User

    Mar 16, 2012
    5
    Swallowing

    It seems as if there are loads of really good ideas out there and amazing, heart-warming stories. I think they reflect the fact that not all suggestions will fix everyone with swallowing difficulties and dementia. I applaud the assistance and assessment from a SALT, as they are the experts in this field. IF the person can swallow liquids easily, then small sips (not gulps!) of cold water between mouthfuls is sometimes helpful.
     
  10. jsymoonbeam2

    jsymoonbeam2 Registered User

    Feb 27, 2014
    4
    Dursley Gloucestershire
    Difficulty in swallowing

    My Mum had Alzheimers and Vascular Dementia. She was assessed a while back as she was having trouble swallowing and mealtimes could take anything form 30 minutes to one and a half hours. Then I thought that we would try singing while we ate so that the vocal cords were stretched allowing food to pass into the oesophagus (pureed food) and we managed to bring feeding times down to 20 minutes. She sadly passed away on 20 August this year peacefully
     
  11. nitram

    nitram Registered User

    Apr 6, 2011
    19,262
    Male
    North Manchester
    "IF the person can swallow liquids easily, then small sips (not gulps!) of cold water..."

    Small can be critical, for her last two months my wife lived off a 10ml syringe of strawberry Complan made with full cream milk every hour, anything else she either spat out or retained in her mouth.

    About 10 days before she died this feeding was stopped as the Complan was coming down her nose instead of being swallowed, from this point it was just mouth swabs.
     
  12. Raggedrobin

    Raggedrobin Registered User

    Jan 20, 2014
    1,427
    This is not exactly on topic, but quite early on before we understood my Dad had dementia, he developed a habit of just retaining food in his mouth for ages and not swallowinf it. It is only in retrospect that I realise he was forgetting how to swallow. So he could put the food in his mouth, himself, but forget what came next. Swallowing. My mother was rather unsympathetic about it, not realising it was a symptom. I wish I had known at the time that he couldn't help it.
     
  13. animallover

    animallover Registered User

    Apr 21, 2014
    33
    Help with swallowing

    I found my Mum took her pureed food from a babies plastic spoon better than a normal metal spoon .I found when she closed her teeth it was easier to get the plastic spoon back out without the worry of breaking a tooth .One of the nurses suggested dipping a swab in pineapple juice and using it to clean inside Mums mouth and it really does help .
     
  14. Aunttess

    Aunttess Registered User

    May 30, 2015
    9
    My mom sometimes holds food and liquids in her mouth. Sometimes she spits it out but not ice cream or cake which are things she always loved. But other times she won't eat foods she always loved. Some days she'll eat her favorites but other days not. There's no rhyme or reason.

    QUOTE=SerenaS;1171621].
    Do you have any tips to help someone who is having difficulties when swallowing?

    Swallowing can be difficult for people with dementia - do you have any knowledge you'd like to share with someone who is having this problem?

    We're planning to include more real life experiences of dementia in our Living with Dementia magazine and we'd love to hear from you.

    Please do add your comments below, and we may feature it in the next issue of the magazine.

    Thanks,

    Serena :)[/QUOTE]
     
  15. Aunttess

    Aunttess Registered User

    May 30, 2015
    9
    Yes
     
  16. Aunttess

    Aunttess Registered User

    May 30, 2015
    9
    Yes. Sometimes it takes Mom a long time to eat but we've found that if we don't bother her about it she WILL eat and finish what's in her plate.
     
  17. chingford

    chingford Registered User

    Nov 28, 2011
    15
    Essex
    swallowing

    My wife had this.she had a closing of the throat 20 minute operation put it wright .
     
  18. CaringDaughter

    CaringDaughter Registered User

    Sep 22, 2013
    47
    Mum was diagnosed - whilst in hospital - with mild dysphagia and the SALT gave us plenty of information and advice.

    I prepare a category D (soft, or pre-mashed) diet - help with each category is available online - search for dysphagia diet.

    Fluids are at present normal, and when she came off the drip I started using a dessertspoon to give her fluids. (A syringe frightened her, and the SALT recommendation was that beakers/spouted cups and straws should *not* be used. Fluid is delivered to the throat too quickly for the dementia brain to realise that it needs to trigger a swallow.)
    I use the dessertspoon sideways - not 'feeding' her the fluid but holding it to her lips allowing her to sip as much or as little as she can. This helped her manage normal fluid and swallowing can still be prompted by asking her if she's swallowed it. (She suffers from uncoordinated swallowing so we have to wait for the swallow before continuing.) Using a dessertspoon also helps cool hot fluids - tea, coffee, etc.

    Putting an empty spoon in her mouth - either eating or drinking - helps trigger the swallow and clear the mouth of whatever is left inside it.


    Liquid is important when preparing soft food - sauce, stock, milk or cream etc helps get the texture of the food right. I'm fortunate in that Dad bought me a Kenwood triblade blender with various accessories, which makes food preparation much quicker and simpler. Use more liquid than you think you'll need to help the preparation process.
     
  19. dave1946

    dave1946 Registered User

    Mar 12, 2015
    2
    This is slightly sideways from the main topic, but I'd appreciate any suggestions ...

    My wife has no trouble swallowing while eating (though she does sometimes get a small attack of coughing). So, it would seem there is no "mechanical" problem.

    However, taking pills is a problem, particularly capsules. The pill goes into her mouth and she drinks the water, but somehow the pill does not get swallowed - often it ends up back in the water glass!

    Any ideas?
     
  20. Izzy

    Izzy Volunteer Moderator

    Aug 31, 2003
    59,923
    Female
    Dundee
    I have to put my husband's pills in with his yogurt and berries at breakfast time. He doesn't chew them. They just go very with the yoghurt. One capsule is opened and sprinkled on the yoghurt. I would get advice from the doctor or the pharmacist at your surgery though. Not all medications can be taken this way. Whenever he is prescribed antibiotics I get a soluble one or a syrup. He also has liquid paracetamol available in the house if he ever needs it.
     
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