Swallowing difficulties and Dementia - Advice for families and carers of people living with Dementia 

General mealtime considerations:

1. Plan doses of medication around mealtimes (medication may affect the person’s desire or capacity to eat).

2. Ensure that the person has been to the toilet beforehand, and that they are equipped with well-fitting glasses/hearing aids/dentures.

3. Keep the environment calm with reduced noise.

4. Consider if the person eats better when alone or in company.

5. Ensure that the person is seated in an upright position and is well supported in the chair/wheelchair; there should be no gap  between the seat pad and the seat back.

6. Clear the table of clutter; only give the cutlery needed for each individual course. Less clutter results in less confusion.

7. If a person needs help feeding, sit at the same level to assist them.

8. Encourage eating by talking about the meal (eg what the food is called, what does it taste/smell like?)

9. Consider the colour of foods on the plate - a variety of colours is helpful. A blue plate is a good choice. Not many foods are blue and therefore they will contrast with the plate making them easier to see. 

 

Difficulty/Problem
Management Suggestion

Difficulty using cup to drink due to spillage.
  • Try hand-over-hand support.
  • Try a double-handled cup.
  • Try a spouted beaker.

Difficulty taking a drink due to poor positioning.
  • Try a straw.

Difficulty sucking fluid up straw due to weak suction.
  • Try a shorter straw.

Tips too much fluid into mouth at one time.
  • Try hand-over-hand support.
  • Try a measured-dose lidded cup.

 

Difficulty/Problem
Management Suggestion

Refusal to eat.
  • Check that there is not a problem with teeth or oral health.
  • Speak to relatives about likes/dislikes.
  • Would a favourite plate from home help.
  • Leave it 5-10 minutes and then try again

Eating only small amounts/parts of a meal.
  • Offer food/snacks on a “little/often” basis.
  • Turn the plate round in case only a section of the portion has been seen

Taking a long time to eat.
  • Use a plate warmer.

Can’t get food onto fork/spoon.
  • Serve on a plate with a lip around the edge.

Putting too much food in their mouth at one time.
  • Give verbal cue to swallow what’s already in mouth.
  • Give a smaller fork or spoon

Biting fork/spoon.
  • Use shatterproof plastic cutlery e.g., Maroon spoons from Kapitex www.kapitex.com

Plate moves on the table.
  • Try a rubber placemat.

Unsure what to do or does nothing when food is placed in front of him/her.
  • Give verbal cue.
  • Place cutlery in hand /use hand over hand support.

Forgetting to chew food/holding food in mouth.
  • Give verbal cue.
  • Touch lips with spoon to stimulate person to chew.
  • Try different tastes i.e., sweet/tangy/spicy.
  • Switch from hot to cold or vice versa.
  • Try small pieces or hand-held foods that the person can hold themselves.

Spitting-out lumps.
  • Offer smooth foods/blended food.

Won’t sit at the table to eat.
  • Offer finger foods/bite-sized pieces.

Food left in the mouth after eating.
  • Offer sips of fluid to clear the mouth.
  • Offer toothbrush and assist in mouth care to remove the food.
  • Check the mouth is clear before the person lies down.

 

If any of the following symptoms are noted please contact Speech and Language Therapy for a full swallowing assessment:
  • Coughing/choking when eating/drinking.
  • Repeat chest infections.
  • Eyes red/watering when eating/drinking.
  • Breathlessness/disturbed breathing pattern when eating/drinking.
  • Weight loss (if noted alongside any of the other signs) 

Speech and Language Therapy contact details: 

Speech and Language Therapy Department
Area 1, level 2
Burnley General Hospital
Casterton Avenue
Burnley
BB10 2PQ
Telephone: 01282 804075 
Speech and Language Therapy Department
Level 2, Audiology Department
Royal Blackburn Hospital
Haslingden Road
Blackburn
BB2 3HH
Telephone: 01254 732866 
*The above advice responds to the ‘Supporting people to live well with Dementia’ Quality Standard 30. It also complies with NICE Clinical Guideline 42. For more information on these policies please visit http://www.nice.org.uk/Guidance/cg42. It also acts as an improvement priority to meet ELHT’s quality vision to offer safe, personal and effective care* NICE (2012).  
 
Other supporting documents:
Quality standard 24 for nutrition support in adults. www.guidance.nice.org.uk/qs24
Dementia strategy (2009).  Department of Health
Food First Project www.bapen.org.uk