RespiteMatch.com Health Blog

Special Situations

Dehydration

Dehydration occurs when a person is either not getting enough liquids (about six cups) daily or excreting too much urine. The body’s ability to detect thirst diminishes with age. Illness and medication can also cause dehydration. A dehydrated person may need help drinking from a cup or glass and have trouble swallowing liquids.

Signs and symptoms of dehydration

Headache — the most common symptom
Dry mouth and tongue
Cracked lips
Dry skin
Sunken eyes
Nausea, vomiting, diarrhea
Dark, strong smelling urine
Weight loss
Fast heart beat
Low blood pressure
Confusion, light-headedness
Disorientation
Use ice chips, popsicles, juice bars, gelatin, ice cream, sherbet, soup, broth, fruit and vegetable juices, lemonade and flavoured water to incorporate liquids into the diet.

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Chewing and swallowing problems

Chewing and swallowing problems (also called dysphagia) can be life threatening for elderly people and people with diseases such as stroke, cerebral palsy, Parkinson’s disease, muscular dystrophy, multiple sclerosis and dementia. The muscles of the mouth and throat may no longer be working properly, so bits of food and liquid will be aspirated or drawn into the lungs. Other factors contributing to dysphasia could be level of consciousness, medications, distractions and eating patters.

As the lungs’ airways become blocked, the person will begin to choke. For frail, elderly people, a choking fit can be fatal. The aspiration of food and fluid into the lungs can also cause aspiration pneumonia, a condition that is prevalent in people who are in the final stage of dementia. Repeated bouts of aspiration pneumonia will weaken a person’s system and may eventually cause death.

Chewing problems, specifically, may be related to missing teeth and poor fitting dentures. Better dentures, proper oral hygiene before and after meals, and regular dentist visits may help minimize the problem.

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Signs of chewing and swallowing problems

Extra effort chewing or swallowing
Eating very slowly
Packing food into the cheeks
Swallowing several times for a single mouthful of food
Shortness of breath during eating
Coughing or choking while eating or drinking
Drooling
Fluid leaking from the nose after swallowing
A wet-sounding voice after eating
Increased congestion in the chest after eating
Repeated bouts of pneumonia
If a parent is coughing or choking too often when eating and you are getting worried, ask the following questions:

What type of food or fluid was he eating when the choking occurred?
If the person wears dentures, were they in at the time?
Was the person walking around with food in his mouth?
Was he laughing or talking?
Record this information for a visit to the doctor. Top

How to assist someone to eat and improve nutritional intake

Ensure that foods are neither too hot nor too cold
Feed attractive, tasty, pleasant-smelling foods to enhance appetite
Use finger foods to encourage independence and safety
Make sure he is ready to eat i.e. the dentures, eyeglasses and hearing aid are in place
Try to make the eating environment quiet and inviting with as few distractions as possible. Try playing some quiet music.
Make sure he is seated correctly i.e. as close to 90 degrees as possible
Try to tuck the chin under so it points to the chest (if necessary have the person in a chair offering head support)
Sit at eye level as you assist the person with eating
Use a teaspoon to avoid putting too much food in the mouth at once
Remind the person to chew each mouthful thoroughly
Touch the person’s lower lip to stimulate opening the mouth
Massage the throat to stimulate the swallow reflex
Take as much time as necessary to help the person enjoy the meal
Ensure the person remains sitting in an upright position for at least 30 minutes after each meal
Clean out the mouth after each meal
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Feed small amounts of food first, then gradually increase the amount as the ability to swallow increases.
If the person is not swallowing between spoonfuls, put an empty spoon into the mouth to trigger the swallowing mechanism.
Use wide, shallow glasses instead of tall, narrow ones.
Never feed someone lying down if at all possible and do not tilt the head back. If the person must be fed in bed, prop up with pillows
Watch for foods that have a double consistency i.e. anything with a skin such as peas, grapes. These may be difficult to manage.
Do not wash food down with a liquid.
Do not use straws for chewing and swallowing problems. Straws increase air swallowing and add to the number of steps required for drinking.

Swallowing test

If choking and drooling become excessive, contact a speech pathologist or speech therapist to arrange for a swallowing test through your physician or home care. The test is called a Videofluoroscopic Swallow Study. While the person swallows liquids of varying amounts and consistencies, the therapist watches a screen showing which liquids proceed to the stomach and which are aspirated into the lungs. If the test has to be done at home, a therapist will observe the person eating and drinking without the equipment. The therapist will then recommend appropriate changes, such as changing the size of the spoon, placing food on a specific area of the tongue and positioning the person at a certain angle during or immediately after eating. The therapist may also recommend a special diet.

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Special diets

Special diets may be recommended following a swallowing test.

Minced diet
In a minced diet, all food is minced for easier chewing or swallowing.
Pureed diet
A pureed diet may be the only alternative for a person with dementia or severe eating and swallowing problems. Use a blender or food processor to puree foods to the consistency of baby food. Soft and smooth foods, such as applesauce, puddings and eggs can be served in their normal form.
Thickeners
Thickened fluids may be recommended as a remedy to chewing and swallowing problems. Natural thickeners include tapioca, flour, instant potato flakes, oats and matzo meal. Thickeners can be used in hot or cold fluids. Add the thickener gradually until the fluid reaches the desired consistency.
Liquid supplements
Nutrition drinks and liquid supplements, such as Ensure, can be used to supplement the diets of people who are having trouble eating and drinking and not getting enough nutrients.

Fortified nutritional drinks such as Carnation Instant Breakfast are a good source of nutrition and may be cheaper than liquid supplements. Powdered protein can also be used to make a high protein drink.

Tube feeding
Tube feeding bypasses a person’s swallowing mechanism and delivers food and liquids directly into the stomach. The tube may be inserted into the nose, for short-term use, for instance, after surgery. Or the tube may be inserted into the stomach for long-term or permanent use. In the late stage of dementia, when swallowing difficulties and loss of interest in eating become extreme, caregivers may be asked to make a decision about tube feeding.
In making the decision to tube feed or not to tube feed, caregivers may want to consider what the sick person would have wanted if he or she were capable of making the decision. Also, ask about the implications of tube feeding: Can the body make use of the nutrition that is being provided through the tube? Will tube feeding prevent aspiration pneumonia? Will it lessen or increase the person’s suffering? Will it prolong the person’s life? Is there an alternative to tube feeding?

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Complications associated with tube feeding

Nausea, vomiting, diarrhea
Constipation and cramping
A swollen stomach
Coughing, wet breathing, a feeling of having something caught in the throat
Infection at the site where the feeding tube enters the body
Clogged tubes
Tubes pulled out by the person with dementia
Aspiration pneumonia
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