Difficulty swallowing solids or fluids is referred to as dysphagia. It is common in late stage Alzheimer's and other late stage dementias. Swallowing is an amazingly complex function and there are many points at which damage to the brain and muscle wasting or weakness can cause major problems.
- The brain sends a message from its swallowing center, which is located in one cerebral hemisphere. The message is food, drink, saliva, needs to be swallowed. Problem number one- Alzheimer's and many other types of degenerative neurological disorders, cause brain damage and the message might be faulty or not get through at all.
- As a result of the message from the brain a number of sequential muscular movements and muscle contractions get the mouth moving. The food/fluid has to be safely moved over the upper airway and into the esophagus (food tube). Second problem: The muscles may not get the message from the brain in the correct sequence. The result is choking and in severe cases chest infections due to inhalation of contaminated fluids and food stuffs.
- A third problem, complicating the matter even more, is that some of the muscles involved in swallowing are skeletal muscles. These are prone to weakness and wasting as old people age, become frail and adopt a sedentary, immobile lifestyles. Skeletal muscle deteriorates progressively and can suddenly fail completely if another event, such as chest infection (pneumonia), malnutrition or dehydration, puts more stress on the already failing muscles.
How can a Caregiver Help?
Caregivers can help by identifying the early stages of dysphagia (swallowing problems) to prevent more serious complications such as pneumonia caused by inhaling fluid. Early signs of dysphagia include a moist sounding voice, a moist cough and coughing immediately after sipping a drink.
Caregiver Action Required
If any of these symptoms are present call the doctor urgently and seek an urgent referral to a specialist in swallowing assessment such as a speech and language therapist. Do not give any more fluids or food until they have been medically assessed.
Caregiver Actions That May be Recommended to Help with This Type of Swallowing Problems
- Careful positioning of the head and body
- Attention to consistency of food, for instance, no lumps, no runny liquids
- Smaller more frequent meals making sure each mouthful is swallowed before another spoonful is given
- Frequently check the mouth to make sure there is no accumulation of food
- Give meals when your loved one is more awake. Be careful about feeding when they are fatigued
- Minimize distractions, feed in a quiet room
- Do not use feeders (cups with spouts as they present fluid towards the back of the mouth and it is more likely to go straight into the airway
- Thickening agents, such as Thick and Easy, can help minimize choking yet deliver fluids to prevent dehydration.
Feeding Tubes Systems For Severe Swallowing Problems
If dysphagia, (swallowing problems), are severe and persistent tube feeding will need to be considered. Short term a nasogastric tube can deliver liquid feeds. This type of tube feeding is good to help someone with swallowing problems recover from acute illnesses such as a urinary infection. The problem with nasogastric tubes is that they are not tolerated well especially if someone is confused and uncooperative.
A more permanent solution is a PEG (Percutaneous Endoscopic Gastrostomy) feeding tube system.
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Mouth Care Tips for Caregivers of People with Alzheimer's Disease