So my grandma eats and drinks unnecessarily fast and basically just keeps shoving the food or drink in her mouth without really swallowing first. She ends up looking like a greedy chipmunk at every meal. I didn’t think much of it until last week when she actually choked on something and the caregiver had to do abdominal thrusts to save her. Traumatic (probably more for me than her honestly). So I've been watching more closely now and I’ve noticed her coughing like the liquid goes down the wrong pipe or she’s got too much food in her mouth she can’t even chew it. So at first I thought she just needs to be monitored and reminded while eating (I have to like stop her arm from stuffing more food and say “first, chew”). But then she nearly choked on a calcium tablet. Granted they are big, but she never had a problem before. I started breaking them in half the last two days. I’m very worried about aspiration, but she seems very far from the stages of dementia where that’s usually a concern. Ideas? Tips? I cut her food small and don’t give her huge glasses of liquids, but it doesn’t seem to help much.

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Ema, time to have your Grandmother have a swallowing test done. Aspiration could be starting. Or she could be forgetting to swallow between bites.

My Dad use to cough when he ate, but it got worse as he aged. Test were run when he went to the hospital at the recommendation of Dad's aide at Assisted Living. Turned out Dad had aspiration pneumonia.
Helpful Answer (24)
Reply to freqflyer

She would benefit from speech therapy. I know, it sounds weird, but speech therapy will help her to practice swallowing and she will experience a difference. Contact her primary care giver to arrange for it and they will come to her home for about 6 sessions. If she does not have a primary care giver, please contact your County Aging Services office. Please do this soon.
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Reply to dinlawduzit

Ema, she may have dysphagia, a swallowing condition in which foods can be aspirated into the lungs instead of going down into the stomach (not the correct medical terms, but I think you can get the idea).

Choking and coughing, as well as inadvertent "pouching" of food in the pockets outside the teeth can occur. As FF states, a videoscopic swallow study should be done to determine if this is the issue.

In our experience, my father's pulmonary doctor was the one who ordered swallow studies, as did a speech therapist at rehab and a speech pathologist at a hospital.

It's an easy test. The individual is given little bits of liquids to swallow and food to eat. The pathologist monitors the intake and path flow to determine if "frank" aspiration is occurring.

A modified diet is then prescribed, based on the level of dysphagia. As Inlaw mentions, modifications such as chin tucking, slower eating and more processing time before the next bite, and exercises can be recommended, depending on the severity of the condition.

Several of us here have been through that, pureeing foods for our dysphagic relative.

A search of other dysphagia posts here brought up a lot of hits, which you can read to familiarize yourself with the issues.

If dysphagia is diagnosed, then you move to the next step of acquiring a food processor or something similar to puree the food, buying Thik-it or other brand to thicken the liquids.

Be aware that if the condition is severe, a feeding tube might be recommended. Think seriously if it gets this far, as that would typically mean an NPO status - no foods or liquids by mouth. That's a drastic and emotionally challenging step.
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Reply to GardenArtist

Therapy will help strengthen the throat muscles. However, my mother didn’t remember the exercises. Like the rest of the body, muscles become weaker as along with the memory.
Saying several “K” and “G” words and saying Grrrrrrr loudly were her exercises.
The therapy was covered when ordered by the Dr. Your Grandma is eating like a 2 yr. old the way it sounds. They make yummy chewable calcium pills.
You’re a wonderful Granddaughter!
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Reply to ConnieMH71

Nectar thick liquids plus small bites are what the remedy will be if she is a risk for aspiration. Failure to do this will result in hospitalizatons and lots of them. Ask for speech therapy assessments. Meanwhile if she is living with you or family, it sounds as if she needs full supervision with limiting what is in front of her if you want to prolong her life.  If she I'd at that stage of aspirating family will have to follow those strict rules and you may have to lock up all access to food.  You need to stay a few steps ahead of dementia.
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Reply to MACinCT

Ema, dysphagia may be common with some folks who have dementia, but it's also a function of deteriorating strength in the muscles. My father's first episode was as a result of having been intubated and trached; muscle atrophy occurred and he lost the ability to swallow. He wasn't even old at that point, just in his 80's. The second and more permanent time was in his late 90's.

I've also been told by medical pros that dysphagia can be a side effect of a stroke.

There are two levels of fluid thickening: nectar and honey thick, just as there are differences between "mechanical soft" and "pureed" food. This is why a swallow study is mandatory, to determine which level she's at, and use the correct level of dysphagia diet if she does have dysphagia.

The exercises that Connie's mother did were similar to those my father did. Making guttural sounds when consonants are used together (as in some of the European languages) helped strengthen the swallow muscles, as did "sit ups" for the throat (those were harder).

W/o challenging anyone's advice, ONLY a qualified speech pathologist or therapist can make determinations on what level of diet and which exercises are appropriate.

In fact, I used to do the speech exercises with my father so he wouldn't feel awkward about doing them. His speech therapist at the time advised me NOT to do them. She said they could harm the vocal chords of someone who didn't have dysphagia.
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Reply to GardenArtist

If she's amenable to re-learning how to eat more carefully--she'll stop the coughing and choking. My hubby ALWAYS has a coughing fit at a meal. He shovels his food in like there's no tomorrow. And he ""sucks" a drink, rather than letting gravity take over and run it in. He's certainly capable of changing, but any comment about his eating habits just end in a fight.
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Reply to Midkid58

My DH took the "swallow test" and he had dysphagia. So I had to thicken all his drinks with Thick-It. Easy-peasy.

For soda, Hormel Thick & Easy works better. I used the Honey consistency and it thickened half a 16 oz bottle of soda without killing all the carbonation. (Carbonation will kill the Thick-It, no idea why, but it would get thinned out again very quickly.) I just split the soda between 2 bottles and then added the packet of Hormel Thick & Easy to each bottle. It kept DH happy for 6 months as he could go back to drinking his Coke. At 96, I was told to give him what he wanted.
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Reply to RayLinStephens

Don't rely heavily on the lists of what happens in each stage. Every patient is different and has a unique time schedule. My husbands dysphasia began many years before the onset of Alzheimers. (An esophageal problem) He had been treated for it repeatedly. It worsened with the worsening of the dementia. A slide from one to the other cause, we've been told. There is a test - an x-ray which shows the swallowing of liquids, a variety of solids -- in real time! I was present and saw this happen. One can SEE the tiny fragments of well-chewed foods going the wrong direction and into the lung. He is now more accepting of the pureed diet -- it beats being hungry! And I have stopped fighting for a normal diet. I saw the evidence. Food is one of their last independent pleasures and it is hard to give up. And it is hard for us to see them have to do so. Pneumonia is not easy on the elderly and is often fatal. Even the aspirational kind. Be glad if that can be avoided and trust that the diet will be acceptable soon and nutrition will be available as pleasantly and safely as possible.
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Reply to GenKazdin

Definitely concur that the swallowing disorder is not necessarily a phase of dementia at all. My mother's dysphagia began well before her dementia got bad at. Don't confuse the two. I have been thickening my mom's drinks and soups for years. There are actually three levels of thickening -- nectar, honey, and pudding. In addition to purchasing Thick-it, I buy bottles of prethickened juices (can even get them in coffee, tea, and water flavors) to have on hand. My mom likes the cranberry and apple juices best. I order everything on amazon.
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Reply to Teri4077

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