Dementia is a progressive disease that affects an individual’s memory, thinking, problem-solving ability, language and behaviour. Currently, there is no cure for dementia, but treatments can help to manage the symptoms. As the disease progresses, individuals often require increasing levels of care and support.
Caring for individuals with dementia is a complex journey that requires addressing both physical and cognitive challenges. Among these is dysphagia, a condition that often accompanies dementia and makes swallowing difficult. Dysphagia can occur at any stage of the swallowing process, from the mouth to the throat, making it hard for people to eat and drink safely.
In this article, SPD speech therapist Lye Yue Ning explores the connection between dementia and dysphagia, identify key signs, and discusses how managing the condition can significantly enhance the quality of life for those affected.
Why does dysphagia occur in dementia?
Eating and swallowing are complex processes that require several co-ordinated actions and cognitive processing abilities. Individuals must recognise what is safe to eat, concentrate during meals, and know how to use utensils correctly.
Physical co-ordination is essential to assist the individual to scoop up food with a fork or spoon, bring it to the mouth, chew, and swallow. Saliva production, stimulated by the sight or anticipation of the food plays an important role in moisturising and digesting the food. To prevent injuries, individuals need to be able to feel the temperature, taste, and texture of the food. Effective chewing to break down food into smaller pieces is also crucial to prevent choking. Additionally, they should be able to recognise when they are full to avoid overeating.
As dementia progresses, the muscles involved in swallowing can weaken or become less co-ordinated. Individuals with dementia may also experience sensory changes, leading to difficulties distinguishing food and non-food items, reduced awareness of food in their mouth, or have difficulties chewing or moving food around their mouth. These factors can all lead to the development of dysphagia.
What are the signs and symptoms of dysphagia?
Some common signs of swallowing difficulties include food or liquid leaking from the mouth, food residue remaining in the mouth after swallowing, and difficulty chewing. Individuals may experience pain when swallowing or have a sensation of food or drink being stuck in the throat. Other signs include throat clearing, coughing or even choking during meals, sometimes accompanied by a gurgly or wet-sounding voice after swallowing.
Dysphagia management for individuals with dementia
It is important for caregivers to be informed about the signs of dysphagia. When symptoms are suspected or identified, they should consult and work with a healthcare professional for treatment.
Effective management often involves a multi-disciplinary team involving doctors, speech-language pathologists, dietitians and caregivers, to create individualised care plans. Some approaches can include dietary changes such as modifying food textures, implementing specific swallowing techniques or environmental modification. In some cases, tube or enteral feeding may be necessary to ensure proper nutrition.
During mealtimes, caregivers should try to ensure that the individual is seated upright and allow extra time for chewing and eating. Checking that the person has swallowed their food before offering more is important to prevent choking. Distractions such as television or loud conversations should be minimised to create a calm environment where the individual can focus on their meal.
Monitoring health closely, such as watching for weight loss or signs of respiratory issues, like coughing during meals—is crucial for early intervention. Serving smaller, more frequent meals can also be beneficial for seniors with reduced appetites, as some may find large meals overwhelming. Understanding and managing dysphagia is crucial for maintaining the health and quality of life for individuals with dementia. With the right support and interventions, the challenges of dysphagia can be effectively addressed, ensuring safer and more enjoyable mealtimes.
References
Egan, A., Andrews, C., & Lowit, A. (2020). Dysphagia and Mealtime Difficulties in Dementia: Speech and Language Therapists’ Practices and Perspectives. International Journal of Language and Communication Disorders, 777-792.
Flynn, E., Smith, C. H., Walsh, C. D., & Walshe, M. (2018). Modifying the Consistency of Food and Fluids for Swallowing Difficulties in Dementia. Cochrane Database of Systematic Reviews, 1-45.
Sura, L., Madhavan, A., Carnaby, G., & Crary, M. A. (2012). Dysphagia in the Elderly: Management and Nutritional Considerations. Clinical Interventions in Aging, 7, 287-298.
Swan, K., Hopper, M., Wenke, R., Jackson, C., Till, T., & Conway, E. (2018). Speech-Language Pathologist Interventions for Communication in Moderate-Severe Dementia: A Systematic Review. American Journal of Speech-Language Pathology, 1-17.
