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.
Making Sure the Mouth is Moist and the Person is Hydrated
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.
Watching the Swallow
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.
Introducing Foods in the Place of Drinks
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.
Advance Care Directives
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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