Chewing and swallowing problems in dementia

You may be interested to read the feature, Eating and drinking at the end of life, in the section on End of life care, which also looks in particular at problems with swallowing.

Problems in the mouth

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. Dental treatment may be necessary or dentures may need to be adjusted or remade if the fit is poor.

Softer textured food

If a person has difficulty chewing foods due to poor dental health, loose-fitting or missing dentures or a sore mouth, it is better to try softer textured food.

Any item of food that can be mashed easily with a fork is likely to be easy to chew and eat. The person themselves will guide you as to their response to the food served. Meat that is tender, cut into small pieces or minced can be easier to chew. Serve with gravy or in a sauce.

Make sure that fish is free of bones and flaked, and again if this is served in a sauce it can help with chewing. If fresh vegetables are unavailable, frozen and tinned varieties of vegetables will cook more quickly and develop a softer texture. Instant mash potato can be a great help if time is limited. Make it with milk and butter for extra nourishment.

Bread can be dipped into soup to make it soft and easy to chew. Fruit that is ripe can be blended into a smoothie – this is easier to take in as a drink rather than biting into pieces of whole fruit. Stewed apple may be easier to eat than biting into a fresh whole apple.

Swallowing difficulties: what to look out for

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 and/or throat clearing after swallowing food or drinks
• choking when eating and drinking
• a wet sounding voice after swallowing
• a reluctance to eat and drink
• food and drinks are not swallowed but are held in the mouth.

Pureed foods

It is often assumed that liquidised or pureed textured food is the automatic answer when a person with dementia declines food or if they appear to show difficulties chewing and swallowing, but this is not true. Poorly prepared pureed diets can be bland, unappetising and nutritionally poor. If given inappropriately, nutritional intake can decline as people are reluctant to eat the food, increasing the risk of malnutrition.

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.

Issues to be aware of if blending food is recommended

If you are advised and given guidelines to provide a modified texture diet – for example, blending food to produce a soft puree consistency – each item of food should be prepared separately before placing on a plate (and ideally preheat the plate).

Pureed textured food can be bland so ensure seasoning is added to enhance the flavour. This will vary according to the preference of the person. Adding butter or cream to some blended foods can add calories and flavour. Blending meat with gravy adds flavour. Describe the food so the person has the opportunity to recognise it.

Pre-prepared modified textured meals may also be bought in by care providers. These meals may be soft or pureed textured food that is remoulded back into the shape of the food it was before being blended. The aim of pre-made modified texture diets is to ensure that the food looks good, tastes good and is nutritionally balanced.

Specialist help

If there are any concerns about how a person with dementia is chewing and swallowing, a speech and language therapist can assess and provide advice on 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.

People who have difficulty chewing and swallowing are at a higher risk of malnutrition, particularly if their diets are pureed or modified in texture. A dietitian can provide assessment and advice on food fortification to enhance nutritional intake. A GP can arrange a referral to a dietitian.

• Further reading Open

  Alzheimer’s Society, ‘Food for thought: finger food ideas’, Online information.

  Coleman, G. (2009) Alzheimer’s Society guide to catering for people with dementia, London: Alzheimer’s Society.

  Crawley, H. and Hocking, E. (2011) Eating well: Supporting older people and older people with dementia, London: The Caroline Walker Trust.

  Kindell, J. (2002) Feeding and swallowing disorders in dementia, Milton Keynes: Speechmark.

  Marshall, M. (ed) (2003) Food glorious food: Perspectives on food and dementia, London: Hawker.

• Useful links Open

  Alzheimer’s Society
  The Alzheimer’s Society website has a section entitled Eating and drinking, which covers a wide range of issues to do with helping people with dementia to eat well: difficulties with eating and drinking, preparing meals, the eating environment and finger foods. The Society also produces a factsheet on Eating and drinking (511).

  Eating and drinking well: supporting people living with dementia
  A team from Bournemouth University has developed a 26-minute training film aimed at nurses and care home staff, based on findings from a major study in this area. A workbook to accompany the film is also available from the research team.

  Eating well for older people and older people with dementia: Practical guide
  This 2011 guide from the Caroline Walker Trust explains why eating good food matters for older people with dementia, suggests types and amounts of food that might be appropriate to meet nutritional needs, and includes sample menus.

  Eating well for people with dementia: a guide for carers
  This 24-page booklet has been produced by the Northern Health and Social Care Trust in Northern Ireland. It covers topics such as ‘Encouraging eating’, ‘Common problems with eating and drinking’, ‘Dealing with diabetes’, as well as explaining the role of occupational therapists and speech therapists in this area, and the importance of mouth and dental care.

  Nutrition and dementia
  This 2014 report from Alzheimer’s Disease International investigates the links between diet and dementia and looks in detail at a range of ways in which nutrition can be improved for people who live with dementia.

  Prevention and early intervention of malnutrition in later life: best practice principles and implementation guide
  The Malnutrition Task Force have produced a range of guides, each bearing this main title and then focusing on a particular area (such as hospitals, care homes or community). The guides each include detailed attention to the particular needs of people with dementia.

• Related pages from this section Open

  • Eating well
    • Why nutrition is important for people with dementia
    • Chewing and swallowing problems
    • Promoting independence at mealtimes
    • The eating environment
    • Can diet prevent or slow down dementia?
    • Eating well at home
    • Activities based around food