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Starfish, your comment about choking screams for a need for a swallow study. He will be considered a risk for getting chronic aspiration pneumonia. The speech therapist can then write up a plan on which foods to give. The therapists do the same for hospital patients. If thickened liquids are to be given, you should stick with the plan
Do you have any sense if choking can occur in elderly with mild dementia with a negative swallow study? Such as muscles weakening or less coordination? This happened to a family member in their 80s (leading to asphyxiation) shortly after a swallow study with no findings.
When my husband was in the last stage of dementia, he stopped eating and before they could do swallow test, he went into a coma and hospice was called for those last few days. Hospice was wonderful. They will come and evaluate him if you want.
Is this a wish not to eat or is this a matter of swallow deficit? I would discuss with the doctor as you may require someone to give swallow deficit evaluation. Do not force food or fluid for sure until that is done. If this is end stage swallow difficulties I would get a Hospice consult. Good luck. Hope you'll update us with more information as you move along here.
I appreciate your responses. His swallowing problem seems to come in waves. He had been having trouble eating and choking several days in a row and I became really concerned. Now he seems to be fine. I had been checking to see if it specific types of food but couldn’t narrow it down. All of a sudden, after several weeks, he seems to be okay. As you all know, dementia is such an awful disease that I never know what to expect and am constantly on guard. I must add that this is a fantastic forum to get ideas, suggestions, and comfort that I am not alone in the things I am facing
Hi starfish, this is hard to answer without more information. Your husbands dementia may have gotten to the point where he forgot how to eat, or he just doesn't have an appetite anymore. I would fill in with a protein drink, like insure, or boost.
As people get older they can develop swallowing difficulties sometimes it’s in their mi d- other times not my father went thru a stage and tests showed he has a tear in his throat so it would have been painful after that - he would intermittently gagg on certain foods chicken - for example so a watch to see if certain foods trigger it next - we found my dad had lost a little weight and his dentures no longer fit snug - the mouth can shrink so his dentures started to rub on his gum causing pain ( nurse advised us denture gel ( glue) to keep dentures in place and that sorted that out The food was taking longer to chew so we changed food to easy to chew food sone we put in a mini blender to ease the chewing the soft foods and soups helped Then (and there’s more!) it became a liquid think- not enough liquid in the body bringing on Alzheimer’s type symptoms and delirium so we up’d water intake frequent sips - no one will drink a glass full all of a sudden after we hit the water issue corrected so did the other stuff water is so crucial we thought my dad was in cognitive decline now water intake and soft meals and meal replacement drinks to help ( tgey even so compact ones that have little liquid so not so much a chore) my father has his full mental faculties back Eating with them also helped even if yours was just a cup of tea- the company and we insisted dad hold his doll rather then rely on help eating and he started to eat more it’s not an easy journey
Starfish, if he is having difficulty swallowing and is choking, he needs to be on thickened liquids and soft foods!
There are two great liquid thickeners, which are not pasty; Hormel Thick & Easy clear, and Nestle Resource Thicken Up. Both are available on Amazon. There are some other thickeners you can buy at the drug store, but they are essentially corn starch, and make liquid like an uncooked gravy - yuck!
Rule of thumb on soft foods, if you can't smash it with the back of a fork, it is not soft enough. Try puddings, applesauce, mashed banana, mashed potatoes, sweet potatos, and soft cooked carrots. Hamburger or salisbury steak which you have cut up small, and gently smash with a fork. A little bit of gravy helps too. Other meats and vegetables are a difficult texture - I use a food processor to chop up meats or sandwiches to a minced texture. Most vegetables don't chop up well, they get stringy.
If you're having trouble getting enough protein and nutrients in his diet, try making protein shakes. You can make something like a smoothie, but for protein and vitamins, I buy Boost nutritional drinks, and I add Milk, juice, a little water, and I also add a clear thickener! You can also use instant pudding mix to thicken milk based drinks. Mix pudding in a blender, following the directions, and add an extra cup or two cups of liquid to thin to drinking consistency.
My husband can safely eat canned fruit filling, such as apple or cherry, and muffins are generally soft enough, but cut up in small bites, so he doesn't try to pick up and shove too much in his mouth. Your husband will probably require supervision or someone to spoon feed him, as he may not understand how to eat safely. My husband lives almost entirely on thickened protein drinks now, I mix up a large batch in the mornings, and pour into cups with a secure snap on lid, and use a bendy straw. He is able to feed himself independently this way. When I got tired of washing a dozen plastic cups every day, I started buying ripple sleeve paper coffee disposable cups with a lid and a straw. I can re-fill at least once before tossing in the trash. Make life simple when you can. Taking care of someone with dementia is hard enough!
@CaringWifeAZ, @Samad1, and others Unless you are an SLP (Speech Language Pathologist) who has done an evaluation, please do NOT advise using thickening agents or what to eat. Thickening is not prescribed for every swallowing issue. There are 3 levels of thickener available (nectar, honey, pudding) and if someone is not using the proper one, it may cause more issues.
As others have already suggested for ANY swallowing issues, it is imperative to be evaluated by an SLP with swallowing experience. All SLPs learn about swallowing but not all have had a lot of experience. I have found the better swallowing therapists are often affiliated with Rehab/SNFs because they are treating patients with Parkinson's, Strokes and other chronic diseases with swallowing issues.
The McNeil Dysphasgia Swallowing Therapy has been the most effective therapy for my husband. He has had swallowing issues with a feeding tube for10 years, but right now it is only used for meds and can eat a soft diet... but only as advised by his therapist. In fact, he has been advised not to use thickener but use thin liquids.
The most important thing to remember is try help him have good oral health because it is not necessarily the the aspiration itself that causes pneumonia, but the bacteria that goes down with whatever is aspirated.
@KLM700 Anyone can choke/aspirate at any time even if a swallowing evaluation did not reveal a specific area of weakness. You can aspirate on your saliva or even as a result of acid reflux. Aspiration is when something enters the trachea or further down to the lungs. Basically anytime you cough when swallowing, you probably aspirated. However elderly, especially with dementia, often do not have a strong enough cough to clear everything out which may lead to pneumonia.
My dad had frontotemporal dementia and also had swallowing problems that would come and go. They first time, it appears shortly after diagnosis while he was trying to eat soup. Then it ended a few days later.
He would do something they call “pocketing” food in his mouth, just kind of rolling it around and leaving it there without swallowing. He absolutely hated ThickIt and all blended beverages (Ensure, smoothies, etc— we tried them all). His appetite just withered away as well, and I have to assume his sense of taste was severely altered as well. The last year or so of his life, all he would consume was a small bowl of vanilla ice cream and maybe 3 ounces of orange juice per day. He did go in home hospice 4 months before he died and he did pass from aspiration pneumonia. If anything, I was grateful because on top of dementia, he also had two different kinds of cancer plus kidney failure and other problems.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
The speech therapist can then write up a plan on which foods to give. The therapists do the same for hospital patients.
If thickened liquids are to be given, you should stick with the plan
I would discuss with the doctor as you may require someone to give swallow deficit evaluation. Do not force food or fluid for sure until that is done.
If this is end stage swallow difficulties I would get a Hospice consult.
Good luck. Hope you'll update us with more information as you move along here.
I must add that this is a fantastic forum to get ideas, suggestions, and comfort that I am not alone in the things I am facing
sometimes it’s in their mi d- other times not
my father went thru a stage and tests showed he has a tear in his throat
so it would have been painful
after that - he would intermittently gagg on certain foods
chicken - for example
so a watch to see if certain foods trigger it
next - we found my dad had lost a little weight and his dentures no longer fit snug - the mouth can shrink
so his dentures started to rub on his gum causing pain ( nurse advised us denture gel ( glue) to keep dentures in place and that sorted that out
The food was taking longer to chew so we changed food to easy to chew food
sone we put in a mini blender to ease the chewing
the soft foods and soups helped
Then (and there’s more!)
it became a liquid think- not enough liquid in the body bringing on Alzheimer’s type symptoms and delirium
so we up’d water intake
frequent sips - no one will drink a glass full all of a sudden
after we hit the water issue corrected so did the other stuff
water is so crucial
we thought my dad was in cognitive decline
now water intake and soft meals and meal replacement drinks to help ( tgey even so compact ones that have little liquid so not so much a chore)
my father has his full mental faculties back
Eating with them also helped even if yours was just a cup of tea- the company
and we insisted dad hold his doll rather then rely on help eating and he started to eat more
it’s not an easy journey
There are two great liquid thickeners, which are not pasty; Hormel Thick & Easy clear, and Nestle Resource Thicken Up. Both are available on Amazon. There are some other thickeners you can buy at the drug store, but they are essentially corn starch, and make liquid like an uncooked gravy - yuck!
Rule of thumb on soft foods, if you can't smash it with the back of a fork, it is not soft enough. Try puddings, applesauce, mashed banana, mashed potatoes, sweet potatos, and soft cooked carrots.
Hamburger or salisbury steak which you have cut up small, and gently smash with a fork. A little bit of gravy helps too. Other meats and vegetables are a difficult texture - I use a food processor to chop up meats or sandwiches to a minced texture. Most vegetables don't chop up well, they get stringy.
If you're having trouble getting enough protein and nutrients in his diet, try making protein shakes. You can make something like a smoothie, but for protein and vitamins, I buy Boost nutritional drinks, and I add Milk, juice, a little water, and I also add a clear thickener! You can also use instant pudding mix to thicken milk based drinks. Mix pudding in a blender, following the directions, and add an extra cup or two cups of liquid to thin to drinking consistency.
My husband can safely eat canned fruit filling, such as apple or cherry, and muffins are generally soft enough, but cut up in small bites, so he doesn't try to pick up and shove too much in his mouth. Your husband will probably require supervision or someone to spoon feed him, as he may not understand how to eat safely. My husband lives almost entirely on thickened protein drinks now, I mix up a large batch in the mornings, and pour into cups with a secure snap on lid, and use a bendy straw. He is able to feed himself independently this way.
When I got tired of washing a dozen plastic cups every day, I started buying ripple sleeve paper coffee disposable cups with a lid and a straw. I can re-fill at least once before tossing in the trash. Make life simple when you can. Taking care of someone with dementia is hard enough!
Unless you are an SLP (Speech Language Pathologist) who has done an evaluation, please do NOT advise using thickening agents or what to eat. Thickening is not prescribed for every swallowing issue. There are 3 levels of thickener available (nectar, honey, pudding) and if someone is not using the proper one, it may cause more issues.
As others have already suggested for ANY swallowing issues, it is imperative to be evaluated by an SLP with swallowing experience. All SLPs learn about swallowing but not all have had a lot of experience. I have found the better swallowing therapists are often affiliated with Rehab/SNFs because they are treating patients with Parkinson's, Strokes and other chronic diseases with swallowing issues.
The McNeil Dysphasgia Swallowing Therapy has been the most effective therapy for my husband. He has had swallowing issues with a feeding tube for10 years, but right now it is only used for meds and can eat a soft diet... but only as advised by his therapist. In fact, he has been advised not to use thickener but use thin liquids.
The most important thing to remember is try help him have good oral health because it is not necessarily the the aspiration itself that causes pneumonia, but the bacteria that goes down with whatever is aspirated.
@KLM700
Anyone can choke/aspirate at any time even if a swallowing evaluation did not reveal a specific area of weakness. You can aspirate on your saliva or even as a result of acid reflux. Aspiration is when something enters the trachea or further down to the lungs. Basically anytime you cough when swallowing, you probably aspirated. However elderly, especially with dementia, often do not have a strong enough cough to clear everything out which may lead to pneumonia.
He would do something they call “pocketing” food in his mouth, just kind of rolling it around and leaving it there without swallowing. He absolutely hated ThickIt and all blended beverages (Ensure, smoothies, etc— we tried them all). His appetite just withered away as well, and I have to assume his sense of taste was severely altered as well. The last year or so of his life, all he would consume was a small bowl of vanilla ice cream and maybe 3 ounces of orange juice per day. He did go in home hospice 4 months before he died and he did pass from aspiration pneumonia. If anything, I was grateful because on top of dementia, he also had two different kinds of cancer plus kidney failure and other problems.
Good luck!
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