Helping Service Users with Eating difficulties

Eating difficulties

Chewing and swallowing problems

Chewing and swallowing problems (also called dysphagia) can be life threatening for elderly people and people with diseases such as stroke, cerebral palsy, Parkinson's disease, muscular dystrophy, multiple sclerosis and dementia. The muscles of the mouth and throat may no longer be working properly, so bits of food and liquid will be aspirated or drawn into the lungs. Other factors contributing to dysphasia could be level of consciousness, medications, distractions and eating patterns.

As the lungs' airways become blocked, the person will begin to choke. For frail, elderly people, a choking fit can be fatal. The aspiration of food and fluid into the lungs can also cause aspiration pneumonia, a condition that is prevalent in people who are in the final stage of dementia. Repeated bouts of aspiration pneumonia will weaken a person's system and may eventually cause death.

Chewing problems, specifically, may be related to missing teeth and poor fitting dentures. Better dentures, proper oral hygiene before and after meals, and regular dentist visits may help minimize the problem.

Signs of chewing and swallowing problems

Extra effort chewing or swallowing
Eating very slowly
Packing food into the cheeks
Swallowing several times for a single mouthful of food
Shortness of breath during eating
Coughing or choking while eating or drinking
Drooling
Fluid leaking from the nose after swallowing
A wet-sounding voice after eating
Increased congestion in the chest after eating
Repeated bouts of pneumonia

If a parent is coughing or choking too often when eating and you are getting worried, ask the following questions:

What type of food or fluid was he eating when the choking occurred?
If the person wears dentures, were they in at the time?
Was the person walking around with food in his mouth?
Was he laughing or talking?

If you have a swallowing disorder, you may have difficulty swallowing and may also have pain while swallowing. Some people may be completely unable to swallow or may have trouble swallowing liquids, foods or saliva. This makes it hard to eat. Often, it can be difficult to take in enough calories and ...

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What type of food or fluid was he eating when the choking occurred?
If the person wears dentures, were they in at the time?
Was the person walking around with food in his mouth?
Was he laughing or talking?

Anyone can have a swallowing disorder, but it is more likely in the elderly. Swallowing problems often happen because of other conditions, including

Nervous system disorders, such as Parkinson's disease and cerebral palsy
Problems with your including gastro esophageal reflux disease
Stroke
Head or spinal cord injury
Cancer of the , or

How to assist someone to eat and improve nutritional intake

Ensure that foods are neither too hot nor too cold
Feed attractive, tasty, pleasant-smelling foods to enhance appetite
Use finger foods to encourage independence and safety
Make sure he is ready to eat i.e. the dentures, eyeglasses and hearing aid are in place.
Try to make the eating environment quiet and inviting with as few distractions as possible. Try playing some quiet music.
Make sure he is seated correctly i.e. as close to 90 degrees as possible
Try to tuck the chin under so it points to the chest (if necessary have the person in a chair offering head support)
Sit at eye level as you assist the person with eating
Use a teaspoon to avoid putting too much food in the mouth at once
Remind the person to chew each mouthful thoroughly
Touch the person's lower lip to stimulate opening the mouth
Massage the throat to stimulate the swallow reflex
Take as much time as necessary to help the person enjoy the meal
Ensure the person remains sitting in an upright position for at least 30 minutes after each meal
Clean out the mouth after each meal

How to help a service user with Chewing and swallowing problems

There are Special diets that may be recommended a service user with Chewing and swallowing problems and these are the following:

Minced diet

In a minced diet, all food is minced for easier chewing or swallowing.

Pureed diet

A pureed diet may be the only alternative for a person with dementia or severe eating and swallowing problems. Use a blender or food processor to puree foods to the consistency of baby food. Soft and smooth foods, such as applesauce, puddings and eggs can be served in their normal form.

Thickeners

Thickened fluids may be recommended as a remedy to chewing and swallowing problems. Natural thickeners include tapioca, flour, instant potato flakes, oats and matzo meal. Thickeners can be used in hot or cold fluids. Add the thickener gradually until the fluid reaches the desired consistency.

Liquid supplements

Nutrition drinks and liquid supplements, such as Ensure, can be used to supplement the diets of people who are having trouble eating and drinking and not getting enough nutrients.

Tube feeding

Tube feeding bypasses a person's swallowing mechanism and delivers food and liquids directly into the stomach. The tube may be inserted into the nose, for short-term use, for instance, after surgery. Or the tube may be inserted into the stomach for long-term or permanent use. In the late stage of dementia, when swallowing difficulties and loss of interest in eating become extreme, caregivers may be asked to make a decision about tube feeding.

Confused patients

As dementia progresses, eating and drinking can become difficult for some people. This factsheet looks at some of the difficulties that people with dementia may have with eating and drinking, and suggests ways to help.

A person with dementia may no longer recognize the food in front of them. They may struggle to use a knife and fork as co-ordination becomes difficult. The person may not open their mouths as food approaches and may need reminding to do so. Food may be difficult to chew or swallow or they may not want to accept assistance with eating.

If you are supporting a person with dementia at mealtimes it is important to remember that these reactions are not a deliberate attempt to be 'difficult', or a personal attack. The difficulties are likely to be related to changes caused by the person's dementia. When supporting a person at mealtimes it can be a challenge to identify what the problem is, particularly if the person themselves is finding it difficult to find the words to explain.

Tips: Supporting a person with dementia to eat and drink

Meals should be relaxed and unhurried. Allow plenty of time and make sure that there are no distractions such as a television or excess noise in the background.
Do not feel you need to prepare elaborate meals - it is probably better to devote your energy to ensuring that the person eats and enjoys their food. Preferences and styles of eating may change, try to be flexible.
If a person is agitated or distressed, do not pressurize them to eat or drink. Wait until the person is calm and less anxious before offering food and drink.
If the person is drowsy or lying down, they may struggle to swallow safely. Ensure that they are alert, comfortable and sitting upright or, if in bed, well-positioned, before offering food and drink
Take care when offering 'just boiled' hot drinks - some people with dementia may lose the ability to judge temperature.
If the person appears to have difficulty using cutlery, you may need to prompt the person and guide their hand to their mouth to remind them of the process involved.
Alternatively, if a person is struggling to use cutlery to eat, offer foods that can be eaten without a knife and fork, i.e. finger foods. Foods that can be picked up with the fingers are often easier to eat when co-ordination becomes difficult.
If you have to assist a person to eat and drink, talk about what you are offering them to help remind them of tastes and flavors.

Difficulties with eating and drinking can have an effect on a person's health and on some of the symptoms of their dementia. It can result in weight loss and worsen confusion. There are numerous reasons why a person may have difficulty eating and drinking or decline food and drink. These include:

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