By Priscilla Pittman, MSW, MA
Alzheimer’s Arkansas Programs and Services
Swallowing is a complex motor function and, therefore, may be affected by some chronic illnesses. The process begins unconsciously as the amount of saliva increases in the mouth when we see food. Then, the food is taken into the mouth where it is chewed and moved from side to side for chewing, tasting and shaping by the tongue. When the tongue pushes the food to the back of the mouth, the food touches the tonsil region and a swallow is initiated setting into motion the movement of the food through the throat and into the esophagus. The Mayo Clinic advises us that the swallow requires approximately 50 sets of muscles and nerves.
When swallowing problems occur it is important to seek medical assistance. Often a swallowing study is ordered in order to determine the cause and treatment needed. Some swallowing occurs when food sticks or seems to be lodged in the throat (esophageal dysphagia). There may be problems with the nerves and muscles in the throat that make it difficult to perform the normal swallowing action (oropharyngeal dysphagia).
Depending on the chronic condition, swallowing can become uncoordinated and result in choking or aspiration (food going into the lungs). Persons with a dementia diagnosis may eat slowly, have too much or too little saliva, or forget to swallow and store or pocket food.
Suggestions to aid swallowing:
- Body position is important. A speech therapist recommended the person sit upright at a 90-degree angle for 10 minutes before, during, and for 30 minutes after eating.
- Incline the head slightly forward for easiest swallowing. Sometimes positioning can be aided with a U shaped pillow behind the neck in a high-backed chair. If a person is helping, they can place their hands gently on top of the head, but not on the back of the neck.
- Best results are obtained when all of the person’s senses are engaged. Dentures that are properly fitted and placed, plus hearing aids and/or glasses at meals will provide optimum sensory input.
- Sensory overload can be distracting. Turn off TV, use soft, relaxing music, and if possible limit traffic. Food placed in small colored bowls or plates may decrease the overload experienced when food is piled on a single plate.
- Color is important; some research has shown people eat more when food is served on a red plate.
- Some swallowing problems can be eliminated when caregivers limit servings of milk products and other foods that increase mucous levels or sticky foods that are difficult to swallow.(white bread, mashed potatoes, pasta)
- It is a good idea for the caregiver to encourage their care-recipient to use the restroom before the meal begins because when they begin eating a gastrocolonic reflex may occur stimulating elimination.
- Have a mealtime routine-set a time and try to stick to it. Relax; they are not in a hurry.
- Finger foods may be easier to manage if the person has difficulty using eating utensils. Delicious soup could be sip ped through a straw if properly blended; potato is one of my favorites.
- Food temperature-the desire for warm or chilled foods may change, gut very hot foods or plates can be dangerous.
- Watching a fish swim can be calming and some research credits this activity with a 27% increase of appetite. When mentioned at a support group meeting one participant later reported his autistic son’s appetite improved using this tactic.
It is important to not be overly concerned about a balanced diet if your care partner is losing much needed weight. The loss of smell can increase the difficulty caregivers’ face; therefore it is good to experiment with ways to add taste and calories. Try adding sour cream, or other dipping sauces for bite-sized meat or vegetable products.
Nibble foods are good; place these where the person can see them and sample regularly. Tailor these to meet your care recipient’s likes and dietary needs. Fruit or cookies are possible examples to try.
Swallowing exercises are important also. A swallowing study can provide excellent information and improve quality of life! Check with your doctor.
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