Chewing and swallowing problems in dementia

Some of the changes that you may see in your loved one with dementia can be surprising. Have you ever noticed that some foods are harder for your mom to chew? Are you worried because your granddad choked or gagged when they were eating? Have you ever wondered if you should give your mother in law softer food or pureed food because you think it would be easier for them to swallow? It sounds like your loved one might be having a problem with chewing or swallowing.

Importance of chewing and swallowing

Chewing in dementia

Chewing makes harder foods easier to swallow safely. As people with dementia become more confused, this can affect their ability to chew. They can also stop wanting to use their dentures because they have forgotten that they need them. I’ve had many clients who refuse to use dentures for this reason, but can still chew softer foods without their dentures.

Swallowing in dementia

Swallowing is actually a complicated sequence of movements, some of which are automatic and controlled by the brain. In dementia, this process can be affected. There can be changes to the brain in dementia in which a person has more difficulty swallowing safely as easily as they did before. When swallowing doesn’t work properly, food may not move the way it should from the mouth to the throat and down into the stomach. This means that they may have trouble swallowing some foods, they may have food going down the wrong way, or may simply take a long time to eat and swallow. They may also do much better on very soft, moist foods rather than drier foods.

The dangers of chewing and swallowing problems

Having swallowing problems can be scary. If I was worried that I would choke every time I ate, I would be less likely to want to eat something.

Eating less

A person with a chewing or swallowing problem is more likely to take longer at a meal, or eat less. Eating less can lead to poor nutrition, weight loss, and loss of muscle. Poor nutrition reduces a person’s strength and make someone more susceptible to illnesses.

I remember having a client who was afraid to eat harder foods and would only want to eat oatmeal. While oatmeal is very soft and moist, there is not enough nutrition in it for a whole day! For that client, pureed foods, which have a lot more variety and nutrition, were just as soft and moist!

Drinking less

If someone isn’t drinking well, they can become dehydrated quite easily. It is actually easier for older people to become dehydrated because as people age, they can have less sense of thirst. A senor who is dehydrated is also more likely to have a fall or develop a urinary tract infection.

Food going down the wrong way

The more dangerous results of swallowing problems would be choking, or of things going down the wrong way. If foods go down the wrong way, this can send food and bacteria to the lungs, and that can lead to pneumonia. That’s also really dangerous for anybody, especially an older person with dementia.

What can we do?

As a Dietitian, one of the things I do is help keep clients safe if they have trouble swallowing. I do this by figuring out what foods are causing problems and find foods that are easier for the person to swallow. This can make mealtime more comfortable and safer for clients or prevent them from having to take a very long time to eat, which can make them tire by the end of the meal.

Helping at home

If you think that your loved one with dementia has a swallowing problem, it is important to see a professional trained in swallowing in your area, like a Doctor, a Speech Language Pathologist, or a Registered Dietitian. They may be able to help you figure out exactly what is going on with your loved ones’ swallowing, and tell you exactly what foods and fluids are best for them.

If you or your loved one notice that they find softer foods easier to eat, or a health professional has told you to make foods softer for them, there are many ways you can make food that is easier for your loved one to eat.

Softer Foods

Perhaps your loved one has trouble with foods that are really dry or harder to chew. These can include anything tough, like a steak, or crisp like crisp fries, or any meat that is battered and fried. Your love one may do better with foods that are soft and moist.

Making softer foods

It can help to make sure that the foods are soft and cut up. It can also help to have extra moisture in the foods they get, by adding extra gravy, sauce, butter or margarine to their food.

Vegetables and Fruit

• Cooked vegetables, particularly if they are cut up or diced, are usually easier.
  • Diced cooked carrots and peas are a good idea
• Soft fruits like bananas and mandarins.

Starches

• Breads can be tricky. Some breads can be very chewy or crumbly, which can make them more difficult to chew and swallow safely.
  • Try very soft sliced sandwich breads.
• Hot cereals, pastas with sauce and rice with a sauce are good choices.

Protein foods

• Meats
  • Meats can be hard to chew. Soft meats include anything made with ground meat, like a burger patty, meatball, or shepherds pie.
• Plant proteins
  • Try well cooked beans and lentils, or a soft tofu.
• Dairy
  • Softer cheeses or diced up harder cheeses are usually pretty soft.

Enjoy foods with your loved one

Your loved one can still eat with you and share food even if they need their foods to be softer. Even if their food looks a little different, you know that you’ve made it with love and you know that it is safer for them.

For more information on chewing and swallowing problems, you can go to the dysphagia page of the National Institute on Deafness and other Communication Disorders.