Difficulties With Swallowing
In the later stages of dementia, a person living with dementia can develop severe difficulties with swallowing.
Changes in parts of the brain that control swallowing may affect and weaken the muscles involved, affecting various parts of the eating process. As a result, the person living with dementia may not maintain sufficient fluid and nutritional intake for bodily sustenance. Difficulty in swallowing also increases the risk of food or drinks entering the lungs. This can lead to a serious lung infection.
Watch out for these signs and symptoms of difficulties with swallowing:
- Coughing during or after meals
- Frequently clearing the throat
- Feeling breathless while eating
- Holding food in the mouth and refusing to swallow
- Having difficulty swallowing
- Spitting lumps of food out
If your loved one or a person you know lives with dementia has any of the symptoms above, have an assessment with a speech therapist. They will provide advice on the safest dietary options, including changes in diet texture and liquid consistency where appropriate. They may also provide strategies on feeding the person safely. This may minimise their risk of aspiration.
What You May Observe & Suggested Strategies to Prevent This
Coughing/choking
- Ensure that the person living with dementia sits in an upright position when eating
- Prepare food and liquid that are of the correct texture (for e.g., thickened fluids, minced or pureed diets)
- Engage in a slow feeding rate
- Control the amount being fed
- Avoid offering mixed textures of liquid and solid food (e.g. milk with cereal, or noodles with soup), as it can increase the risk of choking
Holding food in their mouth
- Offer food that does not require much chewing
- Give verbal reminders to swallow
- Present an empty spoon near or in their mouth to prompt them to perform the swallowing action again
Food Refusal in Advanced Dementia
A person living with dementia may start losing interest in food and consequently losing weight from reduced food intake.
This tends to happen towards the advanced stage of dementia. It may seem as though the person is being starved. However, the reality is that their metabolic rate goes down and they use up less energy too.
The person living with dementia may not be as active or mobile as before and may not require the same amount of calories they had when they were more active. In fact, having a reduced interest in food or fluid intake can be a part of the natural progression of ageing.
Here are some strategies that may help you deal with this issue:
- Look for opportunities to encourage the person living with dementia to eat. If they are mostly at night, light night-time snacks may be a good idea.
- Encourage them to get involved in preparation during mealtimes where possible.
- Encourage them to enjoy a snack.
- Offer familiar or favourite food and drinks.
- Choose the most flavourful food for mealtimes.
- Offer small amounts of food and drinks throughout the day.
In advanced dementia, when swallowing is weakened, the person living with dementia may have an increased risk of food and fluid entering their lungs. Offering food and drinks may no longer be safe when signs of choking or aspiration occur.
The priority may then shift to making the person feel comfortable. Care professionals can:
- Moisten their loved one’s lips
- Continue to let them have a little taste of their favourite food
This is part of comfort and pleasure feeding as it allows the person living with dementia to maintain some dignity and retain the enjoyment of certain tastes. It is important to never force feed or make them eat when they are drowsy.
Artificial Nutrition
With the family caregivers’ consent, a person living with dementia may be offered artificial nutrition. Artificial nutrition can be delivered through a nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tube. A NG tube involves the insertion of a feeding tube via the nose into the stomach while the latter is inserted directly into the stomach through the abdominal wall via a surgical procedure.
Artificial nutrition can help a person receive adequate hydration, nutrition and may help in weight gain. However, it is important to note that artificial nutrition have not been proven to:
- Reduce the risk of aspiration and pneumonia
- Improve survival or prolong life in persons living with advanced dementia
- Prevent pressure ulcers
- Improve functional status
Having a feeding tube may add discomfort to the person living with dementia and prolong their suffering. Additionally, they may need to be restrained, especially if there is a tendency to pull out the feeding tube.