Alzheimer Swallowing Strategies

Alzheimer's disease causes a progressive deterioration of the brain, resulting in increasing confusion and eventually impairing all body systems, including the nerves and muscles that control swallowing. As the swallowing reflex is impaired, dysphagia (difficulty swallowing) occurs and can lead to aspiration of food and fluids down the trachea (windpipe) into the lungs. Symptoms that indicate possible dysphagia include frequent choking, hoarseness, drooling, cough, and pneumonia.

Positioning

• Position the person as upright as possible so that gravity aids swallowing, and keep the chin tilted slightly downward as that position makes swallowing easier. You can support the person with pillows to prevent slumping. Avoid giving the person food or liquid when they are agitated. Patricia A. Tabloski, MSN, Ph.D, in "Gerontological Nursing," advises maintaining the person in the upright position for at least an hour after the meal.

Liquids

• Avoid thin liquids, which can run down the throat before the swallowing reflex occurs. Thicken liquids by adding commercial thickening products, such as Thicken-it. The Alzheimer's Library (see reference 2) also suggests using infant's rice or wheat cereal, pureed fruit, powdered milk, and yogurt as thickening agents. A milkshake may be easier to drink than milk, but avoid overly thick liquids, which can choke the person.

  Offering liquids in a toddler's "sippy" cup helps to slow the flow of liquid and reduces the risk of choking. Some people swallow liquids better when drinking with a straw as they have more control over their intake.

Foods

• Avoid sticky foods, such as thick cooked cereals, rice, and bread as they may make a thick plug of food that can easily choke the person. Use care with finger foods, such as hot dogs or carrots, which can be too big to swallow if not chewed properly. Provide soft foods and cut food into small pieces that can be easily chewed.

  If the person feeds herself or himself and is prone to taking large bites, provide a smaller eating utensil such as a small spoon, and offer only small amounts of food at one time if there person is likely to hold food in the mouth. Never rush the person while she or he is eating, and if you are feeding the person, describe the food: "This is a bite of fish." When possible, assist the person to eat or drink by guiding their hand as the act of holding utensils may help to trigger the swallowing reflex.