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Dementia care: Managing chewing and swallowing difficulties

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Caring for someone with dementia can be challenging at times, with different problems occurring as the disease progresses. Various difficulties associated with eating can arise, and if your loved one has issues with chewing food or swallowing, mealtimes can become a challenge. Difficulties related to swallowing are referred to as dysphagia.

If you are providing companion care at home for someone who is living with dementia, it is important that you watch for possible signs of dysphagia. Addressing these as early as you can will help to maintain their well-being and prevent possible problems such as recurrent chest infections.


Chewing and swallowing

If your loved one is living with dementia, they may have problems with chewing their food. Sometimes you may find that they have forgotten to chew, or they may keep food in the mouth, forgetting to swallow. Some foods are more difficult to chew or swallow than others, and your relative may have particular difficulties with, for example, dry biscuits, bread or sweetcorn.

Dysphagia becomes more common as dementia progresses, although difficulties vary with different individuals. Ninety percent of people who have dementia are likely to experience problems with chewing or swallowing at some point in their illness.

As well as leading to dehydration, weight loss and malnutrition, swallowing difficulties can also cause the person to develop chest infections, including aspiration pneumonia, when food or drink enters the lungs rather than being swallowed properly.

Why do people with dementia develop dysphagia?

Dysphagia can be caused by several different factors. These include damage to the parts of the brain responsible for controlling swallowing. In the case of a person with dementia, dysphagia usually occurs progressively over time, unlike the acute dysphagia that can occur suddenly in other elderly care situations, such as if a person has a stroke.

Symptoms of dysphagia

Look out for the following symptoms in your loved one with dementia:

  • They may begin to drool saliva, fluids or food
  • Chewing may become more of an effort, and they may chew for much longer than previously
  • Check that they are not storing food in their cheeks and that they are not pooling fluid in the mouth
  • They may spit food out or cough while they are drinking or eating
  • You may notice that their voice becomes wet or gurgly due to swallowing difficulties
  • Food may become stuck in their throat

Look out for signs of fatigue when your relative is eating, or any pain or discomfort. Even if they do not appear to have any of these symptoms, unexplained weight loss or repeated chest infections can also be indicative of dysphagia.

What our customers say

“It is reassuring to know that my father is being cared for by someone who understands his needs and his dementia symptoms.”

Patricia, Norwich

How can you help someone with chewing or swallowing difficulties?

Avoid giving your loved one certain foods they find difficult to chew or swallow. It is important to ensure that their oral hygiene is good because pain in their mouth can make chewing difficult.

Soft, moist food is easier to manage, especially if your loved one tires easily. If your relative wears dentures, ensure that they fit correctly and are comfortable. If not, their dentist should be able to help.

Referring a person who has problems with swallowing to a speech and language therapist may help. If your elderly relative holds food in their mouth, chews continuously or leaves hard to chew food on the plate, ask their doctor for a referral.

If your elderly relative is drowsy or does not sit up properly, they may have difficulty in swallowing safely. It is important, particularly in the later stages of dementia care, to ensure that the person is sitting upright, and is comfortable and alert before offering them anything to eat or drink. If they are in bed, they need to be well supported and positioned correctly.

A physiotherapist will be able to advise you on how best to position your loved one for eating and drinking, and an occupational therapist may be able to suggest suitable aids to help them eat and drink. Their GP will refer them to a physiotherapist or occupational therapist if appropriate.

Around half of people with dementia will eventually need full assistance with eating. If you are feeding your loved one, ensure they are correctly positioned and sit opposite them, so you are at eye level.

It is important to feed them slowly, giving them plenty of time to swallow each bite before offering more. You can ensure that they have swallowed by observing the movement of their Adam’s apple.

Offer a mouthful of fluid between each mouthful of food, so that their mouth can be cleared properly. Always let the person know when you are going to give them the next mouthful and try to keep the atmosphere calm and relaxed.

Problems with eating and drinking sometimes mean that the texture of the food and drink needs to be changed. Food may have to be minced or pureed to make it safe enough for the person to swallow. Fluids can be thickened so that they are less likely to cause the person to choke. A speech therapist will advise, and your loved one’s doctor will prescribe special thickener that can be used to thicken water, tea and other fluids.

It can be difficult helping someone who is in the later stages of dementia to eat and drink, but patient and calm assistance can make the experience much more pleasant for your loved one.