ASK THE EXPERT: Managing dysphagia

Emily Stuart, dietitian at Wiltshire Farm Foods Dietitian, part of the apetito group, offers tips on managing dysphagia in dementia patients

Nearly 50 million people are currently living with dementia, a number which is expected to increase to 131.5 million by 2050. To help tackle this, it is important to highlight the problems faced by dementia patients and to demonstrate how we can overcome them.

Dementia is most commonly caused by a number of progressive brain disorders that affect the ability to perform activities of daily living, memory and behaviour.  As the illness progresses into the advanced or severe stages, individuals may experience oral deficits which can cause dysphagia. Swallowing is a complex process with many stages, any one of which can stop working, causing the swallowing process to become defective. This is becoming a common complaint in dementia patients. Seeing a loved one struggle with dysphagia, as well as dementia, can be extremely difficult for carers or family members to witness, as dysphagia can be an indicator of the progression of the condition.

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Treatment for dysphagia in dementia patients is more difficult than for those without dementia. If left untreated, it can cause serious health problems such as: malnutrition, dehydration and aspiration pneumonia. Here are some tips on how to avoid the possible consequences and how to manage it:

  • Triggering the eating process – Mealtimes can become stressful for someone with dysphagia and dementia. The patient can become confused by the food and cutlery, and can worry about choking. For a patient with advanced dementia, finger foods may aid the eating process. This taps into the automatic motor rhythm that has been used all their life and gives them the freedom to feed themselves. Another way to trigger the eating process is through alternating between hot and cold food, as this can trigger a swallow. Placing the cutlery in the patient’s dominant hand and guiding the hand to the mouth may also trigger the eating process and therefore help with the swallow.
  • Getting the right nutrients – It can be hard for dementia patients to get the right balance of nutrients without the added issue of dysphagia. A patient could easily become disinterested or agitated by the meal in front of them. In this instance, the meal should be split onto two plates, serving half the meal at a time. This will help the patient to eat the whole meal without having to sit down for an extended period. Another idea would be to serve five or six small meals throughout the day. If a patient becomes fussy about what food they are eating, a list of food preferences and dislikes could be developed and regularly reviewed so they are always given their favourite meals.
  • Tube feeding as a last resort – If the dementia becomes severe, it may be more appropriate to provide hydration and nutrition through tube feeding. The decision to go ahead with a feeding tube is complex so it is important the patient, family and caregivers are aware of all the risks and benefits and where possible a patient led approach to decision making is taken.

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