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Eating and Swallowing

Eating sustains life and gratification. Eating with others is a social event. However, people with dementia may have swallowing difficulties over time. It is necessary to observe their eating in order to offer help when needed and help them maintain their quality of life.

Factors affecting eating:

  • Environment
  • Cognitive decline caused by dementia, resulting in decreased concentration,
    reluctance to eat or being picky with food; slowly worsen to forget how to eat
  • Declining swallowing function
  • Declining sensory function
  • Disease, such as Parkinson’s disease
  • Oral muscle
    coordination
  • Oral muscle strength

Symptoms:

  • Drooling
  • Bad oral hygiene
  • Inattentive when eating
  • Takes longer to eat
  • Not speaking clearly after eating
  • Cough or pant when swallowing
  • Food left in the mouth
  • Forget eating procedures
  • Appetite and weight loss
  • Chewing non-stop

Normal Eating Process

People with dementia with a normal swallowing function should be able to finish half or more of a normal diet within 20 minutes. If he or she finishes less than half of the food and liquid in each meal over two consecutive days, he/she may be having a swallowing problem.

01
Stage 1
Oral Preparation Stage

Food and saliva are mixed to form a food bolus after chewing. The bolus then moves in a front-to-back squeezing action by the tongue.

  • Time required: Voluntary
02
Stage 2
Pharyngeal Stage

This is a natural physical response in three consecutive actions: the soft palate elevates so as to prevent food from going into the nasopharynx; the epiglottis closes off the trachea; the food bolus will go downward to the oesophagus.

  • Time required: Within one second

03

Stage 3
Esophageal Stage

The food bolus moves gradually from the upper to the lower esophagus and then finally reaches the stomach.

  • Time required: 8-20 seconds

Improving Eating Abilities

Suitable setting and utensils

  • Eat in a quiet place
  • Use strong colour contrast placemats and utensils
  • Choose plates and bowls in plain colours so they won’t worry that the bowls and plates are dirty

Maintain good oral hygiene

  • Ensure dentures are firmly in place before eating
  • Check no food is left inside the oral cavity after meals, and clean the oral cavity and teeth thoroughly
  • Clean teeth or dentures twice daily

Maintain good posture

  • Head up and centered and chin tilted slightly forward
  • Sit upright with back straight

Offer diverse food and textures

  • Prepare food in different colours to enhance their appetite
  • Prepare food with strong flavours or sweetness
  • Make sure the food is of the right temperature
  • Consult nurses or dieticians before giving dietary supplements, for patients who are underweight or having nutrient absorption problems

Control the eating speed and portion sizes

  • Use small spoons to make sure they feed in small bites
  • Don’t rush the feeding
  • Consult therapists whether to use straws to control drinking flow or food thickener

Give the right hints

  • Make it clear it is meal time before starting
  • Give verbal or action prompts such as “hold the spoon, scoop up the rice and put it into your mouth”, patting his/her arm or pointing to the spoon when giving the instructions
  • Give physical prompts such as holding their hand and guiding the spoon near the mouth. Let him/her try after a few attempts
  • If he/she still cannot eat by himself/herself, then proceed to feeding

Stop eating when required

  • Do not force them to eat when they are agitated, refusing to eat or taking too long to eat. Continue only after he/she calms down
  • Do not argue with them when they ask for food having forgotten they have eaten. Use a timetable or logbook to track the time and meals they have taken, or arrange to have smaller meals more frequently

Functional Swallowing Disorder

If a person coughs, chokes and sounds phlegmy before, during or after a meal and have lots of sputum and recurring pneumonia, please consult an occupational therapist or a speech therapist for further assessment and recommendations.

Acknowledgement: Clinic of Speech Therapy, the Institute of Human Communicative Research, the Chinese University of Hong Kong