Dementia Gateway: Eating well for people with dementia

Chewing and swallowing problems

Key messages

People with dementia can experience difficulties with chewing and swallowing as the dementia progresses.
These problems can affect how well a person with dementia eats.
If we can identify and act on signs of chewing and swallowing difficulties we can help to reduce the risk of malnutrition.

A person with dementia may have a sore mouth or gums. Their teeth may be sensitive or painful.

Explore the links below now to read more about this topic:

1. Introduction Open

People with dementia may experience difficulties chewing and swallowing as their dementia progresses. The person may become reluctant to eat if they are in pain or are frightened that they will choke on the food they are given. In addition, the person may struggle to find the words to tell you that they are having difficulties.
2. Problems in the mouth Open

A person with dementia may have a sore mouth or gums. Their teeth may be sensitive or painful. Dentures or dental plates may no longer fit correctly, making it difficult and painful to chew, in which case support the person to see a dentist as soon as possible. Over time the person may be reluctant to eat and drink and, as a result, the person will lose weight.
3. Soft foods Open

Providing soft textured foods for people who cannot chew can help. For example, stewed apple may be easier to eat than biting into a fresh whole apple. Ensuring meat is tender and moist will be much easier to eat than tough cuts of meat that are difficult to chew.
4. Swallowing difficulties: what to look out for Open
If a person with dementia has difficulties swallowing they may not be able to tell you, however you may notice some of the following:
- repeated coughing, throat clearing or choking after swallowing food or drinks
- a wet sounding voice after swallowing
- a reluctance to eat and drink or simply not swallowing food and drinks.
5. Pureed foods Open

It is often assumed that a pureed diet is the automatic answer when a person with dementia declines food or if they appear to show difficulties chewing and swallowing food and drinks, but this is not true. If given inappropriately it can worsen nutritional intake as people are reluctant to eat it.

There are various different strategies that can help to support a person to eat who has difficulties chewing and swallowing before resorting to pureed food. These can vary from person to person and professional qualified advice from a speech and language therapist is essential.
6. Specialist help Open

If there are any concerns about a person with dementia chewing and swallowing food or drinks, a speech and language therapist can provide advice and strategies to help the person at mealtimes. A speech and language therapist can be contacted through a person's GP.

It is vital that a person with dementia has access to a dentist to ensure that any dental health problems or difficulties with poorly fitting dentures can be addressed as soon as possible.

Over to you!

Click here to do a quick activity that will deepen your understanding of this topic. The activity can be done alone or with colleagues and you can also download a copy. Trainer's notes have also been provided.