Thursday, July 2, 2020

Alzheimer's, Dementia - Mealtime - Swallow and Choking Issues

With my Mom eating is not much of a problem at this time. We have noticed that either she eats constantly and her preferences change within weeks. Meaning she had asked for fruit cocktail and chocolate milk for the past 8 weeks, as of last week she refuses them. Oh well, time to change the desserts around. Other than that she eats pretty much everything right now.
With individuals affected with
Alzheimer's disease or other Dementias, the act of eating can present many challenges, as always depending on which stage of the disease they are in.
Alzheimer's and Dementia disease robs the individual of their sense of smell and taste which has an impact on the appetite; it also affects the ability to chew, swallow, or recognize thirst.
Swallow issues are the most common when you notice that the chocking on food episodes are occurring more often, then it is recommended that a swallow evaluation be done. You can talk to your PCP about a referral to get it. The test will be done and more often than not, the patient will be put on a diet that would require the food to be chopped up, it can be coarsely, finely, or presented in a puree consistency. Food choices might be reduced, and the use of "thick it" will probably be recommended as the name says it is a thickener in a powder form that depending on the amount used can transform liquids into nectar, apple sauce, or oatmeal consistency. The dietician will usually be the one that will recommend the appropriate consistency to start with. If one starts with the nectar it will gradually move to the next level of thickness. It's supposed to be tasteless, but our patients, the ones that could verbalize their comments would usually say it changed the flavor of the drinks. It is not only used in drinks many times it is also utilized in soups. If you have used Knox gelatin powder, then you are familiar with thick it.

Yes, it is very challenging to feed an adult person pureed food. The only suggestion I can make is to make it as tasty as possible! if the patient starts losing weight mention it to the PCP or the dietician, they might suggest adding snacks throughout the day or a nutritional drink to add extra calories.



We also have to pay attention to their liquid intake, as it tends to diminish as the disease progresses. Get creative, ice cream, jello, fruit cups, soups, fresh fruit, and yogurt count as liquid intake. Offer juices, flavor waters. Dehydration and UTI are always looming in the shadows of poor water intake, and those two can cause a lot of behavioral havoc in an Alzheimer's or Dementia individual, keep them at bay at all costs.

The Alzheimers and Dementia brain may get very overwhelmed at mealtime If you find yourself being challenged by what you may think is a picky eater. Don't despair, try to simplify the items served. Keep the color scheme of the foods to two,
don't serve everything at the same time, ie- the salad, soup, main course, dessert, and beverages all at once! serve one or two items at a time, wait until they are done, then offer whatever is next. We have to keep in mind that all the food served at one time, may confuse them and instead of start eating, they might get confused, anxious, and not know where to start.

I like to use solid color plates and serve a bowl of soup and half a sandwich. If my mom is still hungry after that I usually offer her tea or lemonade with some sort of pastry. When she is done, I always ask her is she is still hungry, most of the time she will say no. If she says yes, she gets a banana, did you know that the banana is the perfect snack, as it already comes pre-packaged ;).

We used to have a patient that would push all of her food to the side and just move it around the plate, and not eating much. Then later on the day she would get "mad-hungry" she would get in a foul mood and it was because she was hungry and could not communicate that to us. Until we figured it out, and we started serving her two items at a time and we would wait for her to be done, to offer more. Like I've mentioned in the past, you have to be a detective, pay attention to their behaviors and ask yourself why?, Say Hmm, I wonder what is the cause of that? and then proceed to figure out how to change things around to best help the individual.

Pocketing, what is that you may ask? it is the action of holding the food in their mouth, not swallowing it or spitting it out. That can create a tense situation, as much as you tell them to swallow the food or spit it out, it doesn't work! what to do if that happens? well, tickle their chin, their check! tickle, tickle. Depending on which side they are pocketing, it sounds funny but it totally works! encourage small sips of water between bites, I like to offer lukewarm tea, as it helps to relax the throat muscles. I'll be honest with you sometimes nothing that you do will work for the person to swallow the food. IMPORTANT: do not let them fall asleep with food in their mouth! You have to get them to open their mouth and get the food out with your hands.

The perfect mealtime scenario:
Quiet space - NO distractions - NO engaging conversations.
If tolerable soothing background music.
Utensils that they are familiar with.
Seated in an upright position while eating, that will encourage swallowing and chewing properly.
As always I hope that this information is of some use to you.
the individual should remain in an upright seated position for about half an hour after eating aiding digestion.
In my previous job right after lunch, we would go for walks, the ones in wheelchairs would get help from the CNA's and join us.
when we came back we would have a "lite exercise class" slow-moving.

You have done everything right to prepare right? When Affected by Alzheimer's or Dementia these scenarios may happen swallowing issues, coughing episodes, and chocking. You need to act quickly, as it can turn to an emergency in seconds. knowing how to do the Heimlich Maneuver is a must! Always have your phone nearby and fully charged.

P.D.
After my first post I received the following comment on my reddit account, I leave you with this gold nugget:

I am a speech therapist and just want to add that it is a speech therapist you will see for the swallow evaluation. This is often confusing for folks, but it makes good sense when you consider that the musculature for the speech mechanism and the musculature for the swallow mechanism have considerable overlap.

There will be a couple options for tests: watching the loved one eat in an office, home, or the hospital (a bedside swallow eval), watching them eat in front of an x-ray-like machine (Modified barium swallow) and/or watching them eat through a camera in fed through one nostril (FEES). Each can be administered in about 1 hour — ask your PCP which (s)he prefers (pros/cons to each).

One thing to note - all of us swallow substance (be it saliva, food, liquid) down the wrong pipe (into lungs) from time to time. This happens more frequently as we age typically, and still more frequently as we age pathologically (as in Alzheimer’s). We can minimize the health concern with a strong cough and good oral hygiene. Some of the best things to do to minimize the risk of complications from swallowing into the wrong pipe are keeping your lungs active (exercise) and keeping your mouth clean (brushing with a bristled toothbrush, even the tongue/gums of a person who wears dentures). These changes may keep you from needing to downgrade diet (e.g., cut solids, puréed solids, etc) for a time.

Be well! -SLP (speech therapist)

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