Somewhere around the middle to end of Stage II about 45% of people coping with dementia begin “pocketing” food between their teeth and cheeks in the corners of their mouth.  Check regularly to make sure your loved one is not doing this as it can cause them to aspirate.  This may be a foreshadowing regarding swallowing issues and a swallow evaluation may become necessary to help rule out or confirm a disorder called “dysphagia.” 

Dysphagia means you have trouble swallowing.  A loved one with dementia cannot let you know they are having swallowing issues as they may not be cognizant to that fact themselves.  Get them in for a swallow evaluation if you discover pocketed food in their mouth after a meal.  A onetime event does not necessarily mean there is a problem, but let the experts figure that one out. 

Preparing for success

According to St. Luke’s online article, “Dysphagia Diet,” you will achieve the best results if the loved one sits upright (at 90 degrees) while eating, using pillows if necessary to help keep their back straight.  Vacillating between solid foods and liquids can improve swallowing  as well.  Have them take small bites – 1/2-1 teaspoonful at a time.  They should remain in an upright position for at least 30 minutes after eating as this too can minimize risk for aspiration.

Along with that advice, Jackson/Siegelbaum Gastroenterology recommend:

• 1. Have your loved one eat slowly, eating one food at a time.
  2. Avoid talking while they are chewing and if one side of their mouth is weak, place the bite of food into the stronger side.
  3. Check inside their cheek at end of meal to make sure no food has been pocketed.
  4. Tuck the chin onto the chest while bending the body forward when they swallow.
  5. Do not mix solid foods and liquids within the same mouthful as it changes its viscosity.
  6. Do not “wash down” the bite they just took.
  7. Make mealtimes relaxing with no distractions.

Aspirating

Besides the more obvious signs of gaging and struggling to breathe, a person may be aspirating if they:

• • are coughing or wheezing while eating or immediately after
  • have excess saliva
  • exhibit shortness of breath or appear fatigued while eating
  • there is a wet-sounding voice during or after eating and/or drinking
  • develop a fever within 30-60 minutes after eating

Bump up their nutrition

Dysphagia makes eating tiresome and difficult.  This often translates into your loved one not getting enough nutrients in their diet. The whole process simply becomes too difficult and too tiring, encouraging them to “give up” on the meal. Calorie and protein intake can be increased however, by fortifying the foods the patient does eat.  Along with giving the reader menu ideas, including nutrition information, Jackson/Siegelbaum Gastroenterology share some helpful fortification solutions that may help strengthen the loved one’s nutritional intake.  They suggest you:

• • Fortify milk by adding 1 cup of dry powdered milk to one quart of liquid milk. Use this protein fortified milk when making hot cooked creamed soups, sauces, milkshakes, and puddings. Also add margarine, sugar, honey, jelly, or puréed baby food to increase calories.
  • Add strained baby fruit to juices, milkshakes, and cooked cereals.
  • Add 1 jar of strained baby meat to soup, such as strained chicken noodle soup. Also add strained baby meats to sauces and gravies, and mix with strained vegetables.
  • Add juice to prepared fruit, cereal, or milkshakes.

As you can see there is an increased need for care which also translates into an increased need for nurturing, assurance, and validation to minimize or eliminate the probability of unwanted behaviors.  It’s very important you strengthen the loved one’s overall quality of life in word and in deed.  Meeting their psychosocial needs becomes pinnacle not only to their care but to their mood state as well.

Psychosocial Encouragement

• During mealtime comfort and assure the loved one they are safe. “You are doing a great job eating.”  Keep your facial expression calm, your intonation relaxed, and make sure your body language is saying something like, “We’ve got all the time in the world to do this and I love being here with you right now.”
• Gently massage their arm, shoulder or back.  The loved one is more apt to get clinical rather than physical touch most of the time.  They need physical touch as it demonstrates they are worthy to be loved.
• Listen to and validate their feelings as they talk.  Even if their story is not true or doesn’t make sense.  It’s not the content in their statement, it is the emotions.  To validated simply echo back their own words, “‘You were madder than a wet hornet‘ when you discovered they stole all your shirts.  Yes!  I would be too!”