Careful Eating Habits Limit Aspiration Risks with Dementias, and particularly with Lewy Body Other Dementia.
- Swallowing Can Be A Killer. Be Vigilant.
- Eat When Awake and Alert.
- Concentrate on eating. Avoid distractions.
- Start with Fluid and Keep Drinking During Meals.
- Keep Chin Level, or Down.
- Make Food Bite Sized or Pureed.
- Be Careful with Bones.
- Add Sauce to Keep Food Moist.
- Ensure Empty Mouth Before Next Bite.
- Finish with Yogurt or Apple Sauce.
- Make Smoothies, or Thicken Liquids If Helpful.
- Brush After EVERY Meal and Snack.
- Stay Up After Eating To Get Food Down.
Reduce Dementia-related Swallowing Problems
Swallowing Can Be A Killer. Be Vigilant.
Choking is always a risk, even when healthy. However, a slow, silent threat exists which needs to be actively avoided, aspiration: accidentally having food or fluids go into the lungs instead of the stomach.
Aspiration frequently leads to pneumonia by having fluid buildup in the lungs, which is a leading cause of death in the frail.
Dementia with Lewy Bodies affects the autonomic nervous system, which renders simple, otherwise automatic reflexes ineffective. This is why swallowing problems, blood pressure and heart rate fluctuations, incontinence, and sleep disturbances commonly become problems. The “unconscious” mind essentially becomes unable to tell the body what to do.
Although aspiration in Lewy Body Dementia may be inevitable in more advanced stages, there are many things that can be done to avoid it earlier on. Carefully monitoring eating can make a very big difference, and can significantly prolong a good quality of life.
Eat When Awake and Alert.
Daytime drowsiness is common with dementia. In addition, with Lewy Body Dementia, attention can fluctuate greatly. That makes it very important to eat when the opportunity arrives, if possible — when alertness is high. This will greatly aid in swallowing and the pace of eating, usually, as well.
Be vigilant that your loved one does not become too tired during the meal. If so, it may be prudent to stop, and leave some food uneaten, rather than risk other complications such as choking on, or aspirating, the food. Deciding on a time limit for eating, in advance, may also help. This will also allow a little time to remain before lying down, and to brush the teeth.
Since sundowning is another common dementia symptom, changing the eating time for the final meal may help as well. If it can be earlier, perhaps late afternoon, challenging behaviours may be less disruptive, and a small snack could be had in the evening if something was needed to accompany later-day medications.
Concentrate on Eating. Avoid Distractions.
There are many things that have helped with choking, and small-particle aspiration. The biggest has been limiting distractions. This means that eating is done in the calmest environment possible, with as little to draw the attention as possible. Limit visual distractions, noise, activity, and even conversation if talking while food is in the mouth is an issue. Concentrating fully on chewing, swallowing and clearing the mouth before the next piece of food goes in is critical.
Start with Fluid. And During Meals Too.
A moistened mouth and throat is needed for smooth swallowing. Having a small drink, or something very moist will usually activate salivation, which will aid in swallowing, and more fluids also aid in keeping hydrated in general as well.
Hydration is critical to overall health as well, lowering the risks of urinary tract infections, balancing electrolyte levels, maintaining proper digestive functioning and more. Active encouragement of fluid intake can make a big difference. Even though the old saying “you can lead a horse to water, but you can’t make it drink” is true, it is usually well worth the effort and frustrations to get the health benefits.
Keep fluid consumption as high as possible during the meal, and choose the drink according to what they like (so they’ll be more willing to drink it) as well as what will benefit the most in terms of caloric content, consistency, and what complements the food being consumed.
Keep Chin Level, or Down.
Looking up can increase the risk of aspiration. When your head is tilted backwards, your chin is tilted upwards, and that opens the air passage in your throat, and slightly constricts the esophagus which increases the likelihood that food or fluids will go down the wrong way.
If you can keep the chin more downwards, that will help. This often means that if there are things your loved one is looking at while eating, they should be at eye level or lower. In addition, if you assist with putting the food in their mouth, do so from a lower position so they aren’t tilting their head back to have the food put in their mouth.
Make Food Bite Sized or Pureed.
Find out what foods are difficult, and analyze other foods before you present them to see if they need to be modified. If you’re finding that chicken breast is posing problems, pork and other meats may as well. Sometimes modification may be as simple as cutting into small pieces, other times it may be pureeing or making juices or smoothies.
Cutting food into small pieces achieves two benefits: it makes it more difficult to put large amounts in the mouth at once, and they require less chewing.
Use small utensils so large volumes of food can’t be put in the mouth as easily or quickly.
Be Careful with Bones.
Be extra careful with anything that can be mistakenly eaten whole, such as a chicken leg where your loved one may not know not to eat the bone as well as the meat. Fish can have hidden bones or fine spines that you might not think of as an issue, but which can create a big problem.
Add Sauce to Keep Moist.
Sauces come in many forms, and they’ll pretty much all help with swallowing. Ketchup, mayonnaise, gravy, bbq sauce, jellies and more can make food more flavourful, fun, and make swallowing easier. Try some new ones to add some variety: as swallowing becomes more difficult, choice often becomes limited, and a new flavour can help.
Ensure Empty Mouth Before Next Bite.
Persons with dementia often will keep putting more food in before the previous bite has been swallowed. “Pocketing” is a common tendency: keeping some food in the cheeks or back of the mouth rather than swallowing fully. Keep an eye on this: even when it doesn’t happen frequently, it can happen spontaneously, especially when tired or temporarily distracted.
If you can encourage them to have a sip of something, that may help clean out the mouth. Also consider getting them to pause, and doing a double-swallowing action to ensure that as much as possible has been swallowed.
Yogurt or Apple Sauce as Dessert.
Having a few spoonfuls of yogurt or apple sauce will help clean out any remaining particles of food, especially if a few minutes pass before consuming it. This is usually relatively easy to swallow, and will also help prevent acid reflux as well.
Make Smoothies, or Thicken Liquids If Helpful.
Thin fluids like water can go too quickly down the throat and into the trachea instead of the esophagus. To avoid this, thicker liquids may help. There are differing consistencies in regularly available drinks. For example, tomato, mango and pulp-in orange juice are all “slower” than apple juice. This is something that differs for every individual, so I won’t go into it further, but there are tasteless gelatine powders which can be added to any “fast” fluid (water, juice, coffee, etc) that makes them “slower”.
An alternative is to make your own juices and smoothies with your own fresh or frozen ingredients. This allows you to make them as thick or thin as is best for the circumstances, and also allows you to very creatively adapt the calories, flavour, and contents of the drinks for your loved one. They may enjoy them so much they will not want to eat regular food.
Brush After Every Meal and Snack.
Clearing the mouth after eating will greatly decrease aspiration risk. If you can have your loved one brush their own teeth, that’s great. If not, you will likely have to help them or do it for them. You don’t need to use toothpaste, or use a bathroom: if you can get the particles cleaned, that is the main thing. Use a basin or bowl to have them spit anything out. If the tips above are followed, there shouldn’t be very much left in the mouth, but it is prudent to get everything out, so that choking and aspiration do not occur afterwards, when at rest.
Stay Up After Eating To Get Food Down.
Don’t go to bed immediately after finishing. Reclining too soon after eating can cause an increase in potential acid reflux (GERD) as well as aspiration. Stay upright for 20 minutes, or for as long as possible afterwards. This will help the food go lower in the digestive tract, which will increase the likelihood it will be processed properly, and that more of the food will be gone from the mouth which will decrease the potential for it to go into the lungs.
Lewy Body Dementia caused very significant swallowing and choking issues after only a few years into the progression, when many other functions were still working relatively well. We sought the help of different professionals, but it wasn’t until we got a referral from Sunnybrook to the swallowing specialists (Speech Language Pathologists) at Toronto’s Baycrest Health Sciences that we solved many issues. Much of the above information was learned from the exceptional staff at the clinic, and was modified and added to in time. The result has been a diminution of choking, and — I believe — much less frequency of pneumonia, although we have not avoided that completely.
Some swallowing specialists are better than others. If you don’t get a good one, try again. And again.
Be vigilant about how eating is done, analyze your loved one’s swallowing ability, and be ready to adapt and improvise as the condition changes.
Here’s hoping you’ll weather any swallowing storm smoothly.
Updated March 17, 2019