One of the challenges in advanced dementia is when a person struggles to eat and drink.
It can be difficult for a loved one or a carer to see such a state, and many worry that the person may not be getting adequate nutrition and hydration.
But there are things that you can do to assist people with dementia.
When people are in later stages of dementia, they will often cease to drink fluids by themselves.
In most cases, the only time they will receive hydration, is when given by another person.
Hydration is important to maintain as water is often a key part of many bodily functions.
And for people with dementia, especially those breathing through their mouth, they can feel very dry and parched.
Whenever you feed a person who cannot feed themselvese, make sure that they are sitting upright in their chair or bed to avoid choking.
When trying to help them drink, the first thing you need to do is “introduce” the fluid to them – this means holding it to their mouth, for a moment, and then giving them a tiny sip.
What’s important to watch here is how the person swallows – is it quick or slow? Was it a complete swallow? Did they swallow right away or hold the fluid in their mouth?
If you notice the person doesn’t swallow right away, and is holding the fluid in their mouth, what you can do is a “dry swallow” – hold the cup to their mouth as if you’re going to give them another sip, but don’t actually give them any fluid.
What happens is that they may respond and open their mouth, and end up swallowing their last sip. The motion tricks the brain into thinking that something else is coming and they, therefore, swallow what was already there.
If the person with dementia has a slight cough after consuming liquids, it may be time to consider introducing a speech pathologist or thickened fluids.
If a person is no longer swallowing drinks, what you can try is to bring in foods that are high in liquids but viewed by the brain as “food” rather than “drinks”.
Typically, this is started with foods that have some sweetness to them – because sweet foods are instinctively favoured over savoury.
Again it important to see how they react and take the foods – are the swallowing?
If their swallowing is getting bigger or faster, this is an indication that they are taking in the food, and potentially even enjoying it.
This is when a carer needs to consider giving fewer liquids and more purees – and finding a way to get as much hydration as possible in a puree.
In some cases, liquids may be totally abandoned in favour of a puree only diet, which will be their source of hydration.
In processes such as feeding, it’s vital that the carer is focussed and not distracted by other things. They need to be vigilant and observes minute details in how the person is responding to food and drink.
There will eventually come a time when no amount of help or thickened fluids will make a difference.
If the person is coughing when they drink thickened fluids, then what needs to be considered is that with every swallow, there’s an increased risk of some of the fluid going into the person’s lungs.
There’s nothing more the person with dementia or the carer can do at this stage, in respects to feeding, what needs to be considered is “what is the person’s advance care directives?” assuming that they’ve had them.
What conversations have they had about end-of-life stages? This way, all parties are ready to recognise when things are not working anymore.
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Very good information. My sister has early onset FTLD and Cortico Basal Syndrome. She has a very slow swalow reflex and now throws food across the room in a very controlled manner, i.e. she catefully “aims” !! Although a speech pathologist advised against using straws my sister always swallows after a sip and actually drinks lots of fluids, so everyone is different! I have found now that variety of taste during a meal is important so I supplement her boring nursing home food with things like Heinze spaghetti, extra tomato sauce or mayonnaise, Nutella, and extra rich moose.
Francine, you are doing a good job looking at alternative ways. You can also look at the RoseCup google http://www.lifemere.com. Maybe you can find an effective alternative solution that is robust, to help your sister drink fluids. I totally agree everyone’s needs are totally different. But the end result is important. Keep hydrated.
You offer good advice and I do worry about my husband choking but sometimes he does and other times he is fine.He does have thickened fluids and moist and soft foods. He has vascular dementia and Parkinsons. He says he is not hungry but eats everything I feed him. He has a super pubic catheter so I make sure he has plenty of fluids. That is one of my biggest concerns when he goes into respite for two weeks at a time. Thank you for your advice.
Good information…..
But I would add tha Hand under Hand technique by Teepa Snow…..she has excellent videos online demonstrating this and other Positive Approach to Care Techniques. The assistants Hand is placed under the clients hand and the utensil is held by the assistant but the clients hand moves with the assistants.