Typically problems develop mid later stages regarding dementia swallowing, on this page we give some useful advice on the impact of dementia in relation to nutrition.
good diet is essential for everybody if we are to remain well. This is particularly important for people with dementia and is something that we need to monitor carefully if additional problems are to be avoided.
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Typically, problems with eating develop in the mid to later stages of dementia. It is at this time that care needs to be taken with the preparation of food and also with eating and drinking and in particular swallowing. By the time a person with the diagnosis has reached this stage they will probably need help with other personal activities such as getting dressed.
An early sign of trouble with eating is difficulty in being able to use a knife and fork along with a little less care being paid to table manners. As the difficulties develop there may be a need to cut food into manageable pieces so that the person with dementia can continue to eat independently. As the condition progresses the person may still eat independently but quite slowly. They may need to use a spoon rather than a knife and fork. Sometimes, at the same time, but more commonly later, families notice that the person they care for is having problems with coordination and are finding it difficult getting the food to their mouths. At this stage in order to protect the dignity of the individual it is advisable to protect their clothes while they are eating. Many eating aids are available on the market, which can help preserve dignity and encourage eating.
In the latter stages of the condition it may be necessary to feed the person. Often this takes a lot of time and effort as the person is slow and may need to be prompted to eat.
Another difficulty that develops at this stage is that the person being cared for has trouble, once they have food in their mouths, in swallowing.There is a tendency for them to ‘pocket’ the food on one side of the mouth.
It is important to monitor the person’s ability to swallow as there is always a danger that they may choke on food. This uncoordinated swallowing can be caused because the brain and the nervous system are no longer able to send the right signals which enable the person to deal with the food in their mouths. At this stage the GP will usually ask for a ‘swallowing assessment’. This is usually undertaken by a speech and language therapist. The therapist may suggest that the food fed to the person is minced or pureed.
If the person you are caring for refuses to eat, stops eating or eats slowly, it may be because of other difficulties with the eating process. These can be identified without a formal swallowing assessment. There may be damage to the mouth itself which makes eating difficult – perhaps sore gums or badly fitting dentures are the cause of the problem. It is important to rule these as quickly as possible.
Everyone has occasional periods of illness and this applies equally to people with dementia. If they become unwell because of a viral infection or some other cause, there may will be a period when their appetite is poor or when swallowing becomes impaired. It is important to consult the GP when this happens.
Different types of dementia affect individuals in different ways. Temporal frontal lobe dementia affects that part of the brain responsible for social conduct skills – the person can show out of character social behaviour which can include eating. They may overeat or consume liquids or smoke excessively. There may be a tendency to become obsessed with eating sweet foods so that results in a weight gain. They may also only eat specific foods. In the later stages of the condition they may become orally fixated and attempt to put inedible objects into their mouth.
Useful strategies to overcome eating problems
Work out ways to make the eating process easier, such as knife, fork and spoons with easy grip handles, non- slip mats which sit under a plate or bowl, bowls instead of plates, plate guards or cups with a lids. The use of these aids will help to prevent the person you care for from becoming frustrated, tired or giving up. Additionally, by making it easier for them to eat by themselves, you will improve their feelings of independence and self- esteem. If the person you care for finds eating with utensils difficult try finger foods such as small sandwiches.
Try to avoid foods that may be difficult to swallow, in particular nuts, fruits with seeds and popcorn. You can make it easier for the person to consume fruit and vegetables by giving it to them as a purred drink. Try giving soft foods such as eggs, yoghurt or cottage cheese as alternatives at meal times – these require minimal chewing.
Ensure that foods and liquids are not too hot or cold, because the person you care for may have difficulty in telling the temperature. When the person is eating, encourage and prompt them to eat and to chew slowly.
People who forget how to eat will often copy others so having your own meal at the same time has extra value. Remember there is no need to rush or hurry the person. This may only serve to make them anxious or agitated, which will make it difficult for them to finish their meal. They are trying their best, so it is important to stay calm, be positive and encourage them.
Health and wellbeing is very important at this time and should be high on the agenda. It may, however be difficult to obtain the correct levels of nutrition in food if eating habits have changed. This could affect cognition, mobility and general wellbeing. Having suppliments to make up the deficiency.