Expert: Mary Gordon - 12/30/2011

Question
QUESTION: Dear Mary,

I am writing to you from Hungary, as I have read some of your comments and they showed me with how great care and love you turn people who have disease and their relatives.

My Grandfather, who we love a lot is loosing more and more his memory, but he was walking every day some hours in the park, talking to us, eating etc. But now, just after Christmas, one morning he woke up with nearly no voice, his throat is red etc. He can nearly not speak and can absolutely not drink anything. What is strange that he can eat some things. Doctors say that he might have a problem that his reflex to swallow.. now this is since 3 days, now he gets infusion not to dry out.. and it becomes even more hard to him to swallow hard things (not only the fluids), so it is not possible to give the medicine against throat ache.

Can you give some advice how to get him to drink something, or what we could give him?

Thank you a lot in advance!

Anna

ANSWER: Hi Anna, it sounds like the main problem is some sort of throat infection or inflammation, not related to his dementia. If he is confused, and it is painful or difficult to swallow, he is going to refuse to try, and because he cannot understand logic or explanations, he will not listen to what you say.

I think they are doing the right thing having him on an infusion or IV to make sure he stays hydrated until he recovers from the infection or whatever has happened.

When people start having trouble swallowing due to coordination problems related to dementia, they will start choking on things - they will cough and choke and gurgle and sound congested after they eat or drink. The condition is called dysphagia. The person will have difficulty with thin liquids and with mixed textures like solid vegetables in a liquid soup or crisp cereal with milk on it. Thin liquids can be a big problem. What you can do is add a thickening agent (usually a powder) to liquids to make them thicker or even solid, and then the person may find them easier to consume. They will also have problems with solids that need chewing, which is why they end up eating pureed foods (i.e. blended or ground to the consistency of porridge or pudding).

Here is an examples of one of two commercial products  http://www.thickitretail.com/ and http://www.simplythick.com
You can make a liquid the consistency of honey, or even thicker and more solid if that is helpful - but the person should be evaluated for swallowing problems to determine how thick the drink or food needs to be. There are many, many brands of these products. I don't know what is available in Hungary, but in North America, these products can be bought from large pharmacies, or medical supply stores.

If you cannot buy these, you can use many common things to achieve the same effect
http://agedcare-nutrition.com.au/resources/thickening-agents-for-dysphagia
Here is some information about the issue http://journals.lww.com/ajnonline/Fulltext/2010/11000/Managing_Dysphagia_Through

Hope this helps

Mary
Toronto Canada



---------- FOLLOW-UP ----------

QUESTION: Dear Mary,

thank you a lot for your fast answer!
I think my grandfather's problem is what you have mentioned: he gurgles and coughs after he has drunk a little fluid. He can eat icecream or banana and even meat, but drinking is very stressful for him. Maybe his throat infection just "helped" this problem to come up..

Thank you very much for your answers, I will look in the pharmacies what I can find here to thicken the liquids. He is trying so hard, I hope he will succeed.

You are doing a great job, I am happy I have found you on internet!

I already wish you a happy new year in advance!

Greetings from Hungary!

Answer
In the UK and in North America, the specialists who evaluate dysphagia are speech pathologists, which I know sounds odd, but they are the mouth and throat function specialists. I don't know who deals with it in Hungary, but you should ask your grandfather's doctor. Your grandfather should have a proper evaluation of how well he can chew and swallow, so a proper diet can be recommended.  

Dysphagia can be very serious, not just leading to dehydration or major weight loss, but it is a cause of choking and aspiration pneumonia. The person will literally breathe food and drink into their lungs. A dear friend's mother literally died eating banana pudding. Rather than swallow it, she was keeping it in her mouth, and the person who was feeding her did not realize this, and kept spooning more and more in. My friend's mother then took a big breath and all the pudding went into her lungs, and she died before help could come.  Aspiration pneumonia is even more common - if they breathe food or drink into their lungs, they will often get pneumonia from it, and as you know, in an older person, this is often fatal.

You will want to avoid anything that requires a lot of chewing and anything that has hard bits like crispy or fried foods, chewy candies, seeds, nuts etc. and also anything very sticky or gluey like peanut butter.

The consistency of the food is not the only important factor. You should make sure he is sitting upright when eating or drinking and stays sitting up for some time after a meal to make sure everything is gone from his mouth.

Get some specialist advice on his diet and how best to get nutrition and liquids into him.

Thinking of you from Canada.

Mary Gordon