10 ways to cope with chewing and swallowing difficulties when you have dementia

It can be very scary to watch someone with dementia choke on their food or seem unable to swallow. Find out what you can do to help them cope with these issues

In a nutshell

Eating is a complex process which people with dementia can find increasingly difficult as their illness progresses. Swallowing and chewing problems tend to occur in the later stages of dementia, and can be very worrying for carers, particularly if their loved one is already frail.

Here’s how you can help overcome some of the most common difficulties around chewing and swallowing and make mealtimes less stressful for everyone.

Six signs of swallowing or chewing problems

1. Coughing during or after eating or frequently clearing the throat.
2. Grimacing when swallowing.
3. Exaggerated movement of jaw, lip or tongue.
4. Holding food in mouth but not doing anything with it.
5. Refusing to swallow or spitting lumps of food out.
6. Cramming too much food in the mouth or eating very fast.

This behaviour can be very distressing to watch but if you can work out what’s causing it you might be able to prevent it happening or at least reduce how often it occurs.

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Why might you experience swallowing or chewing problems?

A sore mouth

Mouth ulcers, or red, bleeding gums can make chewing food very painful.

Tooth ache

Decayed, discoloured, lose or cracked teeth may also be causing pain. Do they grimace when they eat cold food such as ice cream? This could mean their teeth are very sensitive.

Dentures that don’t fit

If the person you’re caring for has lost weight their dentures may no longer fit properly. Loose dentures can cause painful mouth ulcers. If they seem reluctant to wear their dentures, this could be why.

Medication

Some medication causes a dry mouth, making swallowing and chewing more difficult.

Infection

Chest, throat or urinary tract infections (UTI’s) can cause further confusion and loss of appetite.

Dysphagia

This is the medical term for the swallowing difficulties which can occur in moderate to advanced dementia. Dysphagia is also quite common in frail elderly people who’ve suffered other acute or chronic illnesses such as a stroke or respiratory diseases. As dementia progresses, dysphagia can become increasingly difficult to manage.

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Two facts worth knowing

-  A clinical study from Sungkyunkwan University School of Medicine in Korea compared swallowing problems in people with later stage Alzheimer’s and later stage vascular dementia and found that those with Alzheimer’s had more difficulties swallowing fluid, whereas those with vascular dementia found semi-solid food more difficult to manage.

Frontotemporal dementia affects the frontal lobe of the brain which is linked to behaviour, and can cause some particularly challenging issues around food, including swallowing and chewing. Some people start eating compulsively, often sweets and other sweet foods. It’s also quite common for people with frontotemporal dementia to eat extremely quickly and cram food into their mouth, often resulting in choking.

Who can help?

Go to the dentist – any teeth or gum problems might be quite easy to spot.

Ask your doctor to refer you to a speech and language therapist for a swallow assessment, which could identify the precise cause of a swallowing problem. The therapist should also be able to offer you advice on coping.

Ask for a referral to a dietician for nutritional advice and support.

10 ways to make eating easier

1. Offer soft food that requires minimal chewing.

2. Use smaller utensils and specially designed cups which allow drinking whilst keeping the chin down (avoid feeder beakers as they encourage people to tip their head back).

3. Choose strong flavours rather than bland ones, as these can stimulate the brain to swallow, and also try to offer a variety of hot and cold food in one meal.

4. If the person you’re caring for is extremely slow to swallow, try putting an empty spoon to their mouth, as if offering more food. This can act as a reminder to swallow.

5. Make sure they’re sitting upright and are as calm and comfortable as possible before you begin.

6. Consider thickening fluids to make the food easier to control, you can get advice about how to use them from your GP or a dietician.

7. Avoid small hard textures such as sweetcorn, peanuts and peas, and stringy textures such as cabbage, or bacon.

8. Cook food longer, mash it with a fork, or puree it in a blender or liquidiser.

9. Try not to offer mixed textures of liquids and solids, such as milk and cereal or minestrone soup as they can make choking more likely.

10. Be patient. Accept that meal times are probably going to take much longer than they used to, but try to prioritise them. If you can help the person you care for to eat more than they normally would, it’s probably worth the extra time and effort.

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