People with dementia can experience difficulties with chewing and swallowing as their condition progresses. This may affect how well they eat and drink. If the causes of chewing and swallowing problems are identified and acted upon, the risk of malnutrition can be reduced.
Problems within the mouth
It is important to rule out some common causes that may affect how a person is eating and drinking, for example, sore gums, ill fitting dentures, a dry mouth, or oral thrush.
How to identify a sore mouth or gums:
- Do their gums look red and inflamed or do they appear to bleed easily when touched or when teeth are cleaned?
- Do they have mouth ulcers?
- Do they have bad breath or complain about a bad taste in the mouth?
How to identify sensitive or painful teeth:
- Do they show discomfort with cold foods e.g. ice cream?
- Do they have signs of gum disease? (See above).
- Do their teeth look loose, or in bad condition e.g. broken or discoloured?
- Do they have bad breath or complain about a bad taste in the mouth?
Do dentures or dental plates still fit correctly?
Often if people have lost weight, gums can shrink and dentures become loose. This can cause sores in the mouth or an excess of saliva. If the person seems reluctant to wear their dentures, this may be their way of telling you that there is a problem.
Do they have a dry mouth?
This could be caused by some medications, mouth breathing, very warm environments or the person may not be drinking enough.
If you feel that it may be a side effect of medications, discuss this with your doctor. It is important that you take medical advice before stopping any medication.
Temporary illness that may cause swallowing problems
Any infection or illness, for example, a urine infection, chest infection, cold or sore throat, may affect swallowing and increase confusion. If you suspect an infection, seek advice from your General Practitioner (GP) and encourage plenty of fluids.
If a cold or sore throat is affecting the person’s eating and drinking, discuss this with your local pharmacist, GP or practice nurse. Offer frequent drinks and soft moist foods that are easier to swallow.
Oral care
Establishing a good relationship with your dentist in the early stages of the condition can help the person become familiar with the dental practice and the staff. This will help to make it less frightening and confusing as the disease progresses. Let the dentist or dental practice staff know about the person’s condition before a consultation.
Dental care will vary depending on the stage of dementia progression. If the person you care for is having high sugar food or nutritional supplements, this can increase the risk of tooth decay. It is important to maintain good mouth and tooth care for as long as possible to minimise the risk.
Further advice on oral care can be found in the following leaflets:
Dementia Care - A Practical Guide to Eating and Drinking
See Living Well with Dementia link or your healthcare professional.
Where to go for help?
It is important that you get help if there are any problems with the person’s teeth or mouth. Your GP or Dentist can provide further advice. If you do not have a dentist, contact the new NHS 111 service
If the person you are caring for is housebound, there may be a community dental service available - ask your GP or healthcare professional.
Some private dentists will visit patients at home if trips out for the person with dementia are not possible.
What can I do while I wait for treatment?
You may not be able to see your dentist or GP straight away so in the meantime:
- Your local pharmacist should be able to provide an “over the counter” treatment to soothe mouth ulcers.
- A fixadent may help in the short term if dentures are loose.
- Offer soft moist food that requires minimal chewing, ADD gravies and sauces.
- Encourage regular drinks, even if the person only drinks small quantities each time.
- If you are concerned the person is not drinking enough, consider offering foods with a higher water content, for example, jelly, ice cream, custard, yoghurts, and soups
How to identify swallowing problems
Key signs to look for include:
- Repeated bouts of chest infections or pneumonia.
- Repeated coughing, throat clearing or choking after swallowing food or drink.
- A wet sounding voice after swallowing.
- Expressing fear during eating.
- A reluctance to eat and drink.
- Holding food in the mouth.
- Packing food into the cheeks.
- Swallowing several times on one bite.
- Grimacing when swallowing.
- Tilting the head back to eat and drink.
- Food or liquid falling out of the mouth or drooling liquids from the mouth.
- Exaggerated movements of the jaw, lips or tongue.
- A delay in swallowing after the food has been chewed.
- Tiredness during or after a meal.
- Weight loss over time.
If you have concerns about a person’s swallow, ask your GP or consultant to refer them to a Speech and Language Therapist for a swallow Assessment.
The following section should NOT be used as a replacement for specialist advice from a Speech and Language Therapist.
What can I do while we are waiting for a Speech and Language Therapy Assessment?
- Provide soft moist foods which are easy to MASH.
- Offer the person the opportunity to self feed where possible.
- Ensure foods are not too hot or too cold.
- Ensure the person is sat in an upright position and is well supported to eat and drink.
- Sit at eye level if you are assisting them to eat.
- Try using smaller utensils, such as a teaspoon. If the person is self feeding, give them the teaspoon or assistance loading up the spoon.
- Limit distractions in the eating environment.
- Don’t rush feeding.
- Encourage the person not to talk when they are eating.
- Make sure the person is ready to eat: glasses on, hearings aids switched on, dentures in place.
- Remind the person to chew the food thoroughly.
- After the meal encourage them to clear their mouth.
What if the person doesn’t have a swallowing problem but there are issues with eating and drinking?
A number of behavioural challenges can arise as dementia progresses. These can include:
- Refusing to swallow.
- Pouching food in the mouth.
- Cramming too much food in the mouth.
- Biting down hard on feeding utensils.
This section contains some ideas to help. You may also find some further information in the leaflet Dementia Care – A Practical Guide to Eating and Drinking (See Living Well with Dementia link or your healthcare professional).
Refusal to swallow, pouching food or excessive chewing
The following ideas may help stimulate swallowing:
- Use frequent verbal prompts.
- Offer smaller bites of moist food.
- Encourage highly flavoured food and drinks as these provide more stimulation to the brain to prompt a swallow response.
- Alternate temperature and taste within meals, for example, warm stewed apple with ice cream, or curry with yoghurt.
- Keep the eating area free from distractions.
- Allow plenty of time for meals.
- Once you have noticed that the person has chewed the food adequately remind them to swallow.
- If they do not respond to a verbal prompt to swallow, putting the spoon or fork back up towards the mouth as if you are offering the next mouthful may remind the person to swallow.
Cramming food into the mouth
People with dementia may try to cram food in too quickly or place several mouthfuls in without swallowing. The following tips may help:
- Try hand over hand feeding. Put your hand over the hand of the person who has dementia and gently guide them with your hand to slow them down.
- Use small utensils, such as a teaspoon, to limit the amount they can put in with each mouthful.
- Make frequent verbal prompts to chew and swallow each mouthful before placing another in the mouth.
You may also find that some of the points mentioned in the section above may help.
With special thanks to the Coventry and Warwickshire Dietic Department for the use of information from the
Dementia Care – A Practical Guide to Swallowing Problems’ March 2014