Swallowing hard food and pill problem for Mom. Any idea what's going on? - AgingCare.com

Swallowing hard food and pill problem for Mom. Any idea what's going on?

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My mother is 85 years old and in Stage 6 Alzheimer's disease. She recently lost the ability to swallow pills, because she forgets how to do it, and I started crushing her pills and mixing them with pudding. Now she is losing the ability to swallow any food which is not almost liquid. She can't eat a poptart, and is losing ability to swallow even pancakes. All I can get her to eat is macaroni and cheese and pudding. This is happening very suddenly in the past several days. Does anyone have any idea what is going on, based on your experience? She is often incontinent, but I have a strict bathroom schedule for her.

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Jeffrey, if your mother does have some dysphagia, a speech language therapist is the medical professional to diagnose it. That person knows how to listen for and feel the vocal chords to determine if there's a swallowing disorder.
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Jeffrey most of your questions have been answered and advice given regarding not crushing long acting meds, having an evaluation by a speech pathologist ASAP. Your PCP can order this.
Dysphagia is very common in older adults and may be more pronounced in those with advanced dementia.
A proper diagnosis can only be obtained with an endoscopy which you may not want to subject an elderly dementia patient to. Even then they many not be able to determine the exact cause as there are often multiple factors involved goal things considered treating the problem without investigating may be the best course in these circumstances.
What to do at home. Keep the diet soft and moist and have a drink handy. Take small mouthfuls and sips of liquid. Things like sandwiches need to be laced with butter and /or dressing as bread is dry. Never feed tough meat and remember even chicken breast or fish may need too much chewing. Any kind of food can be blended to a thick soup like consistency and fed about a teaspoonful at a time.

Learn the Hemlich ?sp maneuver. If you suspect aspiration, (patient will usually cough) if you can lie patient on their face with feet elevated and gently pat each side of the chest. if they can tolerate the fluid will drain out of the nose. Otherwise again if possible have them stand bent forward at the waist and pat back as before. You can also try massaging the throat.
Thicket is the product recommended to thicken clear liquids and has to be used if needed but in my opinion it ruins any drink. Before you feed it to a loved one try it in your own favorite beverage.
Jeffrey you are wondering if the time has come to place mother in a facility and this is the decision only you can make.
As far as the fecal incontinence is concerned I am guessing although you don't say it is probably leaking diarrhea caused by the antibiotic and may cease in a few days.
The next step to consider would be tube feeding but not usually advisable with an elderly dementia patient. A tube can be placed in the stomach through the nose but this is uncomfortable and irritating for the patient.Simple procedure can be done by a nurse in the home. Strong possibility that a dementia patient will pull this out. Tube can be also surgically placed under sedation directly through the belly wall into the stomach or small intestine. In the stomach there is a greater risk of regurgitation and then aspiration. Personally I would only consider this if the patient had some quality of life and an expectation of recovery of swallowing. Then there is TPN (Total Parental Nutrition) in which a catheter is inserted into a vein and fluids are given IV. Only consider this in an acutely ill patient likely to recover. I have had TPN and currently have a J tube but gradually beginning to eat solid food so eventually will have it removed. With this feedings are set up overnight with amounts adjusted to your needs. Takes a while to get used to but is really simple to set up. It is expensive and Medicare will only approve about 25% of the time. I had failed 3 swallow tests. It is inconvenient in that you are tethered to a pump but very manageable. The downside is that it is quite a small tube and blocks easily so you need to be vigilant about flushing it with water. Some medications can be crushed and given this way but it is not advised because of blocking the tube. Gastric tubes can be used with either a pump or by directly drawing the feed into the tube which can be much more convenient for an active person who still wants to be out and about or even working, playing sports etc. No one knows you have it, just don't go out to dinner and expect to push a french fry in!

I have covered more than the original question but I felt it might be helpful to others who are contemplating having to have a tube or caring for a loved one for whom it is an option.
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Good question, Babalou.

Of course it is also true that having advanced dementia does not prevent you from picking up throat infections. But in that case, if an infection were bad enough to prevent swallowing, your mother's throat would be really sore and she'd soon let you know about it. So on balance I think Babalou is right to suspect - ? - that this doctor is not taking the AD progression properly into account; and you'd be well advised to get another review from a specialist, or at least a GP/PCP with training in dementia.

I second CW's point about not crushing certain tablets/capsules. Again, ask her prescribing physician - many meds are available in other forms for patients with an impaired swallow reflex.
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Is this a doctor who knows about dementia?
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As I was mentioning, she can continue to drink liquids. I took her to MD and her checked her throat, etc. - she is physically. She said her throat might be sore, but she could have been confused, he is pressing around and asking her if it is sore - I am not sure she knows what her throat is in terms of words. So we are on the last day of a liquid antibiotic. But after that, we know are getting fecal incontinence starting. I am starting to think I am over my head with her living at home.
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Jeffrey20832, When you see a serious change like this, you call the MD and report that she can't swallow. Then you ask if it is time for Hospice.
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Should have mentioned that I bought a large container of Thick-It to thicken water, juices and other fluids so that they're safer to drink. I got it at our local pharmacy, but one of the local chain grocery stores also carries it. ...Just in case that's one of the speech pathologist's recommendations, which I'm sure it will be.

There are also different stages and levels of dysphagia; a speech pathologist can determine your mother's stage and provide information on what foods can and cannot be eaten at that stage.
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Jeffrey, supporting what Angel and CWillie, wrote, your mother likely has dysphagia. If you have a PCP, internist or pulmonary care doctor for your mother, contact one of them ASAP and find out how you can get an appointment with a speech pathologist.

This person can first do a manual evaluation to get a sense of the extent of the swallowing difficulty and script for a videoscopic swallow study, which will reveal if your mother is in fact aspirating (when food and/or fluids) enter the lungs, and can cause aspiration pneumonia).

Watch also for signs of choking, coughing (especially a productive cough).

The speech pathologist can then recommend an appropriate change in diet. There are different levels of dysphagia diets, some of which are all thickened liquids and others of which are a combination of different foods that are less dangerous to eat. Changing her diet will be mandatory to protect her from choking and aspiration.

We're going through this now, but not at as severe a level. There are a lot of helpful answers and suggestions on my post - reading it will give you an idea what others have experienced and adaptations they've made.

https://www.agingcare.com/questions/Does-anyone-have-experience-with-sourcing-food-for-a-mechanical-soft-diet-I-need-some-help-urgently-203290.htm

Also check the many posts on dysphagia on this site:

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

Good luck; this can be a frightening situation, but getting a speech pathologist on board ASAP will be very helpful
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This is so common there is a name for it, dysphagia. Do a search of the site and web to learn more. There is a huge leap between pop tarts and pancakes and a totally liquid diet, I'm not sure you have to be that drastic. Tell her doctor and have her evaluated by a speech-language pathologist, they can help you decide the best way to modify her diet. Inability to swallow properly can lead to aspiration pneumonia and needs to be addresses asap. Ironically, often thin liquids are also a problem and need to be thickened, there are products available for this.
You also mention crushing her pills, make sure that is OK by speaking with the pharmacist, some medications are designed to be timed release or to dissolve in the gut rather than the stomach.
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Forgot to mention, depending on the severity of the swallowing loss, the doctor may put her on a pureed food only diet or thickened liquids.

Angel
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