Many of us are aware speech and language therapists can offer support to people who are having difficulty with their thinking, speaking, and understanding. If you are living with dementia you might experience changes to how you communicate and this can be stressful and hard to deal with. You and your family members may need to adopt new strategies for successful conversations. Joy Harris, a specialist speech and language therapist has previously offered advice on this in a series of blog posts that you can find here http://bit.ly/2mpi4TR and here http://bit.ly/2luWcsw.
However, in my experience, what people often don’t realise is that speech and language therapists can help with changes to your eating, drinking and swallowing. Changes to the swallow can be a common issue for people living with dementia and is referred to as dysphagia.
With that in mind, I’ve put together some information on what you need to know about dysphagia and mealtimes, and what you might need to do if you notice similar changes.
What should I know about eating and drinking in dementia?
Changes to thinking and memory that dementia can cause can affect how you go about daily activities. You might find you have some problems with your usual routines, for example, you might find it harder to prepare for and carry out your usual meals. You might find that you are having trouble remembering mealtimes, are hungry at unusual times, such as during the night, or you might not recall that you have already eaten. If you or your loved ones notice these or similar changes, it can be helpful to set up some reminders and have a discussion with your loved ones about sharing these responsibilities.
Picture from www.yourspeechtherapy.co.uk
Dementia can also cause changes to how eating and drinking occurs. Some of the changes that can occur will be because of the disease affecting your thinking and memory but some of them will be physical changes. Common problems are not recognising foods, or needing support to use cutlery and containers. A lot of these changes are happening because of how the dementia is affecting your thinking and memory. Because your communication might also be affected, it might mean you and your loved ones may find it difficult to speak about these changes.
Picture accessed from www.olderadultfocus.org
Why is it important to know this?
If these things are happening it could mean you are at risk of small pieces of what you are eating/drinking going into your lungs, increasing your risk of getting chest infections and pneumonia. Additionally if you are having problems with remembering and preparing meals you could be at risk of losing weight and becoming malnourished and dehydrated. You might find it harder to fight infection and recover from illness. This can have serious consequences for your overall wellbeing and functioning.
What do I need to look out for?
Some things that you should look out for are:
- Choking, coughing or throat clearing when eating or drinking
- A wet sounding voice after eating and drinking
- Drooling saliva or drinks
- Frequent chesty coughs
- Difficulty in starting to swallow
- Unexplained weight loss
- Feeling food stuck in your throat
- Long mealtimes
What should I do if I notice these things?
If you or your loved ones are having any problems similar to the ones listed above it is very important to seek help. You should see your GP and ask for a referral to a speech and language therapist.
What will the Speech and Language therapist do?
The speech and language therapist works as part of a team including occupational therapists, dietitian, doctors and physiotherapists. Their goal is to keep you as independent as possible for as long as possible while working to prevent you from becoming ill or getting infections.
The speech and language therapist will usually begin by asking you questions about your problem and about your medical history. They might then watch you while you eat or drink a small meal to see the kinds of problems you’re having. If you need some help to eat or drink they might watch how this is happening and observe who is helping. The speech and language therapist might make suggestions and comments throughout the meal and may show you some strategies to try to make eating and drinking a bit easier and safer.
A puree cottage pie. Picture by Aisling Egan.
The speech and language therapist might also give some advice about things you and your family can do to support your mealtime routines. Sometimes, with the occupational therapists support, they might suggest changes you can make to cutlery or placemats to help if you have visual issues. There might also be a need to change the type of food and fluids you eat and drink and the speech and language therapist will give specific advice about this to you and your family according to your needs.
If you have any questions or concerns about your communication you can ask your speech and language therapist about these at the same time and they may be able to offer support.
What else can I do?
Some other things that could help:
- Eating with no distractions, for example loud TV or radios,
- Slow down your meals! Eating slowly and carefully makes it easier to eat safely,
- Take smaller bites and sips to make it easier to control what’s in your mouth,
- Continue to use familiar brands and table-settings as familiarity can make mealtimes easier to navigate, and
- Having a loved one eat meals at the same time to offer support and company.
- See your dentist if you have any concerns about your teeth or dentures. This can be a simple way to make eating easier.
You might find it helpful to discuss with your family and loved ones what your priorities and goals are for eating and drinking, what you might compromise on, and where your lines in the sand are. For example, for some people any change to their way of eating is very difficult to face and they may prefer to take some risks rather than miss their comforts. For other people being as safe as possible and minimising the risk of getting an infection is what is most important and they will be willing to make sacrifices in this knowledge. Everybody will have different priorities and it’s important that you make yours known. These conversations can be difficult but it can be important that you make your wishes known and it may help your loved ones make decisions if they know they are acting on behalf of what you want.
Thanks for reading!
Thank you for taking the time to read this blogpost. I’m really interested to hear your thoughts and opinions and would love to hear about your experiences managing some of the issues discussed. Please comment below!
Note: I am currently completing a PhD in the University of Strathclyde part of which involves speaking with carers of people with dementia about their experiences of swallowing and mealtime difficulties. If you would like to be involved or more information you can contact me at firstname.lastname@example.org or see https://tinyurl.com/h24btox
Picture from http://www.unforgettable .org
PhD Researcher in Speech and Language Therapy
I am speech and language therapist currently completing a PhD in the University of Strathclyde. My research is exploring perceptions and practices around the management of mealtime and swallowing difficulties experienced by people with dementia. I firmly believe in supporting people with dementia and their loved ones from the point of diagnosis to maintain independence and quality of life.