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She won't swallow or spit to take night time meds.

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This is my second answer for this question. There are several answers stating that she should be on hospice. Hospice will maintain PICC lines, GI tubes, pain medication, etc. They can come to your home.
Godismystrength, see if hospice could be right for you if they come to your home. My husband's doctor mentioned several different agencies we could use that would do it that way.
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good for you . thats how I feel.
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Pixie, is she on Hospice? The nurse can help you with this.
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Mom has it too for the last few years. She now takes glucerna on her gtube. She will now be prone to pneumonia or silent aspiration. Her doctor advised us to put her on hospice but I refused to. It is hard to take care of her but our love for her takes precedence over that. We put transderm scop patches on her to make her saliva thick and swab her every now and then.
It will not eliminate the chances of her having silent aspiration but it will decrease it at least.
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My mom is 93 and has normal pressure hydrocephalus which causes dementia. She was "pocketing" food, liquid, saliva in her mouth which would end up drooling out of the corners of her mouth. She had speech therapy which consisted of muscle stim and exercise as they lose muscle strength and forget to swallow. Until I experienced this, I had never heard of it before. Mom is still drooling so we have to put ointment in the corners of her mouth so they will not get infected. Plus, she now aspirates so is on pureed food that she hates. If I give her medication, I must touch the side of her cheeks and remind her to swallow. That helps. Until I experienced this, I had never heard of it. And now, eating is one of her few enjoyments but she can only have food that is pureed. They say she just forgets to swallow - she can swallow but forgets. Good luck.
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First consult with her doctor about the nighttime difficulty with swallowing. Also my dad gets confused more in the evening, so your mom might not be able to say why she is refusing her meds. See if the evening meds can be crushed (MD or pharmacist) I give Dad his evening meds with his dinner. They can make him dizzy, and pee, so this seems like a good time.

Give her a warm herbal tea, maybe with lemon grass in it (Lemon Zinger by Stash). That would cleanse her mouth, and make sure the pills are not too large or weirdly shaped. See if the evening meds can be crushed into a jello pudding?
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I'm wondering how she does with her meals? If she can swallow her food fine, it likely not a true structural wallowing problem. If it's only in the evening, could meds taken earlier in the day be making her too sedated to swallow at the later time.

It is possible for dementia to actually make someone forget to swallow their own secretions. And of course, Alzheimers does progress to the point that they are not able to swallow. This can be first evident with choking on food. But when it gets bad, they no longer choke, just aspirate, because they lose their gag reflex.

She definitely needs a swallowing evaluation.
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It may be tongue muscular problem, you must consult speech therapist at first
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Maybe a suction machine. She can hold the wand herself and suction as needed.
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Your mother needs to be evaluated by a doctor or speech pathologist for swallowing difficulty. She may also have strep throat or another infection that causes painful swallowing. Contact her doctor/case worker to set up an appointment. If she is severe enough for injectables or IV meds, you need to go that route.

If there is no physiological/medical reason for her problem, it may just be part of dementia. If it only happens at bedtime, there may be a perceived power struggle or just disgust with the taste. Ask for help from her nurse, caseworker, etc. They probably have seen this before and will have suggestions.
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Swab out the excess saliva. Do not attempt to give pills, she cannot swallow. Ask for injectable drugs or IV drugs. If you don't have Hospice, you need them now. Call them.
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