Coughing every time she drinks or eats?

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.

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.

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.

https://www.agingcare.com/search.aspx?searchterm=dysphagia

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.

She definitely would not agree to a feeding tube!
These are all good ideas so far, I’ll check in with her doctors about it. It just seems so out of place for dementia symptoms. My grandma still walks (not well and with a walker) and talks coherently (even though she uses wrong words and mixes up stories) and generally has no other health issues. She was in an psych unit about a month ago for two weeks and I don’t think they saw this at that time but I think she did get all the therapies daily. What’s happening now had happened occasionally before (happens to me too, like I don’t know how to breathe and eat at the same time, haha) but it’s been a lot more frequent and noticeable the last two weeks...

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!

I just ordered mechanical meals on wheels, against her son's wishes. I did this out of guilt. Homemade lunches, because I thought that frozen meals at lunch were not healthy and breakfast is oatmeal with more water added to it as she is not drinking much water any more. I'm sorry I don't have any thing different to add to the remarkable answers and suggestions you have been given here.

Best of luck to you and your grandmother!

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.

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.

Yes, that was happen to my mom, she starts coughing after each food, then spasms came, she refuses to eat puree food and finally aspiration pneumonia, intubation and then feeding tube in the stomach. I wish I was more insisting on puree foods...because its seems that her swallow ability may not be back....combining with dementia its all complicated and sad...

Poetry21, I’m sorry! That must have been hard for her. I guess I always believed that losing the ability to swallow comes way at the end of dementia along with losing ability to talk or walk and things like that. It just seems too early to be having trouble swallowing... and we have so many changes coming up in the next six months as far as moving with her and new caregivers and new activity centers, new medications recently. I’m scared of what more of a decline this might be..

This was happening to my mom. We had a speech therapist come to the home through Medicare to test her. They watch how she chews, swallows, etc. She also was referred for an upper GI. She was diagnosed with dysphasia and she has a spiral-like esophagus which usually occurs as you get older. She is receiving therapy for it as they are teaching her how to chew, move the food back and forth before swallowing and soon will be on a modified diet.

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.

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.

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.

You have excellent responses from wonderful people. All I can add is that my husband was having choking/coughing fits with every meal or drink. He had the endoscopy and it showed a bone lying too close to his esophagus (not life threatening but sometimes pressing on the esophagus). It could be corrected with a very invasive surgery. But the radiologist just commented during the exam that turning his head to the side before eating might help. It has nearly solved the problem for my husband! He just takes a sip of water and turns his head before the meal, it doesn't have to be done over and over. This of course would require supervision and reminding, and simply may not help you. But since my husband had the same choking problem I thought I would add my 2 cents. Good luck to you all and God bless you🍴💟

This was happening with my mom as well. She's 71 and at the beginning stages of dementia. She was admitted to the hospital for chest pressure and what was thought to be a COPD exacerbation and mentioned her trouble swallowing to the hospitalist, who consulted with GI. They chose to do an endoscopy, which required her to come off of her Coumadin for a few days... Once her INR was down enough to do the endoscopy, it turned out she had an esophageal yeast infection (esophageal candidiasis). Most likely it was caused by the steroids for her COPD, the prednisone for her psoriatic arthritis, and/or her generally lower immune system due to multiple autoimmune diseases.

Treatment was 14 days of Diflucan - which interacts with Coumadin and raised her INR dangerously high (therapeutic range is 2.5-3.5 and she was at 7.9, meaning her blood was REALLY thin), but we got that fixed with no ill effects, though I really wanted to wrap her in bubble wrap til her INR was down to therapeutic range!

Just wanted to give you another possibility - when she mentioned her dysphagia my mind went to aspiration or esophageal stricture (her mother and sister both had to have surgery to dilate their esophagus), but it turned out to be something completely different that could be fixed fairly easily.

get with a speech pathologist asap! swallowing eval, and video-fluoroscopic swallow study if they feel it is needs and if grandma can cooperate.

Ema, yes dementia effects body functions even eating or drinking.
The caregiver should be right there (if this in home-care) while your Mother eats; not doing anything but watching over your Mother.
My Mother is in an assisted living group home; the caregivers are in the dining room for every single meal just for this reason.
Have the calcium tablet grounded and mixed into her food or give her a calcium liquid, these are flavored so she will think she is drinking orange juice.
Test to see if she does better using a straw (bending one). Smaller sips are better than her trying to 'gulp'.
Cut her food into toddler size pieces or even mash things like vegetables. It's a horrible thing to see or have to do, but your Mother has become a child again.

My mother has begun having eating issues. She’s in a nursing home. 93. Dementia getting worse over last 6months - not as responsive or cognitive. Now she’s also chewing and chewing but possibly ‘forgetting ‘ to swallow. The speech therapist theres is working with her- but that’s m-f. Some days are better than others but it’s an overall downward trend. She has not gone to puréed yet because like another person said eating food is one of their last pleasures really. It takes my mother several hours to eat her lunch and she gets supervision . I am concerned that there is not much else that can be done and getting proper nutrients and hydration will become a bigger problem(She was already in the hospital wants a few weeks ago before we noticed this was going on) She also had been over the last six months or so occasionally chewing her food and then spitting it out. So the fact that she has in their medical directive no artificial means of support I am not sure where this will go. There will be no feeding tube or IVs for fluids. It is pretty tragic and that’s basically I guess they end up starving to death slowly.? There have been moments where hospice has been already discussed -Anyways there’s so many things to think about… Good luck with your situation

My Mom had to go to the ER because of this. Her esophagus had to be dilated (stretched) at the sphincter. It is a simple procedure done by the gastroenterologist. She had this done 3 times. She would start spitting up as soon as she swallowed food and coughing. She needs an endoscopy it sounds like to me. He showed me color photos of the problem and what he did to remedy the problem. He also said that some of his patients end up coming every couple of months for this after a while if they have that problem. If she is just feeding herself too fast, that's just another issue that would require someone to feed her. Since my Mom has dementia and many other things wrong with her (can't walk), etc. she is now in assisted living and she has to be fed pureed food which she takes very well. Your post sounded just like my Mom's except for her putting too much in her mouth and she was "squirreling" some in her cheek we found out too. This is her particular situation. I would suggest taking her to the gastroenterologist for a consultation. Good luck. I know this is a challenge. By the way, my Mom's water is even thickened now at assisted living.

Small sips -then turn head downward toward right shoulder works for my wife.

Swallowing reflex requires adaptation

My husband recently began doing this and has had aspiration pneumonia twice. Though he did not have to be hospitalized, he still shovels food, begins coughing and though I try to slow him down, he just cannot seem to control it. He does not chew the food well either. We were sent to a specialist who was really helpful. She did a swallow test with different foods and suggested two things: 1. Beginning a regimen of using nectar thick juices, waters and milks. He is ok with the juices-have bought cranberry and mango. Some come in large bottles or individual small cups. I will gradually introduce the milk. He takes his meds with thus too.bi was able to purchase these on Amazon. 
2. Begin putting most foods into a blender, avoid chunky or "dry" foods like sandwiches, crackers. Serve more soups and stews. Cut up all foods into very small bites and supervise as they are eating. It was explained that due to the dementia, the signals from the brain to the muscles in the tongue are delayed creating the problems with swallowing and that exacerbates the choking and coughing.

My late mom had the same problem with drinking and eating some liquids food right after she had TIA. She and I could not understand why. Then it got worse when her dementia set in. At the end of her life, she had aspiration pneumonia.

Be careful of Aspiration pneumonia. They cough, the food goes into their lungs and becomes infected. My mom spend a week in the hospital because of this. We had no idea she was sick until one morning she wouldn't stay awake. Called 911 they ran test and BAM!
They told us do not let her drink while she eats and to make sure all food is out of her mouth before she drinks. She shouldn't lie down for 30 minutes to an hour after she's eaten. We also had to puree and use thickening agent for the food. I hope this helps.

After sharing my experience on this, I am once again amazed that so many folks are experiencing the same issues and that this is yet another common symptom. Why are there so few hospitals and doctors who can prepare us for these things?? It would be so very helpful to not have to be so fearful and to know ahead of time about things that can happen. I know that every patient is different and the symptoms happen at different stages, but docs had better get a handle on this stuff, as there is a huge increasing number of dementia diagnoses happening due to other medical advances that keep folks living so much longer. 

My mom is in a nursing home and after a swallow test was put on a pureed diet, which she mostly refused to eat because it was inedible. I kept tasting the stuff they put in front of her and it was mostly disgusting. I asked the dietitian to taste the stuff a number of times and no improvement. Finally filed a grievance and met with all of the heads of departments that were involved including the head of the care facility. The only thing they would agree to was tasting the food before serving it, which should have been happening already, of course. Still no change. Then I found out that they had a "bland" diet which was way different from a standard pureed diet and was for people with big allergies to all spices, butter, etc. I believe they were passing off the bland diet for the pureed one in most cases. I had already asked them to get some rarebit dishes, which is a sort of boat type dish, and scoop the puree into it side by side with a drizzle of gravy or sauce over it to make the presentation better. They had been serving the pureed items in three separate plastic sherbet cups. When they refused to buy the dishes, I bought some from a restaurant supply placed; some inexpensive china used ones which were great. Now that they are using them for my mom, the food has taken a distinct turn for the better. I have tasted it several times now and it is tasty more times than not. My mom is eating it also, which is the real test. She had lost 18 lbs until I pushed this issue. We had to start bringing her food from home and from Whole Foods for a month or two to get her weight back up. Sometimes you just have to shed some needed light on an issue to get it changed. I kept telling myself that 20% of the residents at the care home, roughly 20 people, were eating that flavorless pureed food and I was doing it for more than my mother. I hope in the end that they buy more of the rarebit dishes and serve all of their residents on a pureed diet that way.

Before you schedule the swallowing test, have a medical professional explain what the different results will mean. Then you can decide if you want to have it done.

My Father failed his test and had a feeding tube put in, which he promptly pulled out (Alzheimer’s). My adopted Papa (Parkinson’s) is now having trouble swallowing, but his doctor knows he doesn’t want a feeding tube, so he is going with quality of life over quantity, since food is one of Papa’s few enjoyments left. We have eliminated some foods and cut others into very small pieces, but he won’t use thickeners at all.

I wish you calm during this journey.

She1934 said
"I am once again amazed that so many folks are experiencing the same issues and that this is yet another common symptom. Why are there so few hospitals and doctors who can prepare us for these things??"


It has been my experience that nobody ever prepared me for any of it; the doctors treated the symptom of the moment and social worker pushed the idea of a facility and the home care company sent me workers who had no clue how to manage or were seniors themselves and shouldn't have been undertaking heavy physical care. I've had to educate myself, that's how I found AgingCare.




KayDoubleU said
"It is pretty tragic and that’s basically I guess they end up starving to death slowly.?"

It's a lot more complicated than that but I guess it is essentially true, my mom has no desire for anything and barely eats now, I'm amazed that she keeps hanging on. I prefer to think of it as fading away....

yes, it is appalling that this is so common and receives so little attention. Although my mom's paperwork clearly says "honey-thick liquids only" the hospital repeatedly offers her just water with her pills. She, too, has been thru' aspiration pneumonia. My mom's speech therapist taught her to put her chin down to her chest while swallowing, which also helps. And we've done the esophagus stretching during the endoscopy, as noted above. She doesn't have to have food pureed, but is careful when eating things like rice. They don't go down well.

A swallow study with a speech pathologist is in order. Simple dietary modifications can usually fix this. I know I hate choking.... possibly some slightly thickened liquids or softer foods, or what ever the study shows to be of benefit could make all the difference in the world for him. Hope it helps!!