Post by Neo on Jan 19, 2005 21:30:03 GMT -5
Attributed to Norbert
FAQ - swallowing difficulties 06/01/04 05:32 PM
<<<MY HUSBAND GOT A 6 MONTH RENEWAL FROM HOSPICE BECAUSE HE CANNOT SWALLOW LIQUIDS. HE IS STILL WALKING AROUND BUT GETTING WEAK. I KNOW THAT HE IS GETTING DEHYDRATED - BUT THEY TOLD ME NOT TO FORCE HIM TO DRINK. HE MAY CHOKE. -- I BOUGHT HIM A LOT OF SIPPY CUPS WITH A STRAW AND ALL HE DOES IS BITE ON THE STRAW. IF HE DOESN'T DRINK IT - THAT IS NATURE'S WAY OF TELLING THE BODY IT IS READY TO SHUT DOWN. THIS IS VERY PAINFUL FOR ME - I AM STARTING TO GIVE HIM SOME SMOOTHIES WHICH HE LIKES - THAT SEEMS TO GO DOWN BETTER THAN OTHER LIQUIDS.>>>
At this point, some doctors will order a swallowing evaluation. This is done by a speech therapist and will result in a recommendation on the consistency of food needed for the level of swallowing impairment. The person can still get liquid - in thickened form and in water content of food. I believe there are specific procedures and body positions that can be used to decrease the swallowing difficulties. I don't think these evaluations are done very often for residents of nursing homes - the staff already know the drill.
---------------------------------------
Excerpts from “What if it’s not Alzheimers? (a book about Frontotemporal Dementia) Pgs 107-108 and 150-154 and 157.
Swallowing
Once food is chewed, then the tongue pulls it together in a ball (called a “bolus”) and starts to push it to the back of the mouth. As this happens, you stop breathing, your throat elevates to close off your airway and open your esophagus, and the food bolus is pushed down the throat and into the esophagus. All of this happens in one second. As the food enters the esophagus, the throat relaxes and drops and you can now breathe.
The pharyngeal phase (of swallowing) is a coordinated, involuntary reflex in which all muscles of the throat except one, the cricopharyngeus, relax to allow passage of food/liquid into the esophagus which anatomically is behind the larynx. The cricopharyngeus controls the epiglottis, and tightens or contracts concurrently while other throat muscles relax, to protect entry of ingested materials into the larynx.
Your mouth and throat have to try to control liquids every time you take a sip. Regular liquids are the most difficult texture to swallow, especially water.
There are several ways to help a person who is coughing or having difficulty with food and liquids. One called a “chin tuck” reduces the amount of muscle effort needed to close of the airway.
If this is difficult, then thickening the liquid can help. A thicker liquid swallows slower and may give the person the extra time needed to achieve airway closure. You can try an artificial thickener (like Thick It) or try making smoothies in the blender with yogurt or pudding.
When a person is not drinking regular liquids, it is important to keep him hydrated. Use snacks of ice cream, sherbet, pudding, yogurt, and creamy Popsicles during the day for hydration.
--------------
This information (except for the second paragraph) is from chapter 10
By Erica Wollman CCC-SLP
Clinical specialist in speech language pathology
Department of Otorhinolaryngology
University of Pennsylvania Medical Center
---------------------------------------------
Food can be thickened with a commercial product called Thick-It, available comprehensive pharmacies (the ones that have walkers, support stockings, etc.)
The nurse at the Alzheimers Association told me that baby cerial tastes better and is cheaper than thicket.
---------------------------------------------
From “Clinics in Geriatric Medicine – Alzheimers disease and Dementia
May 2001
Article – Management of severe Alzheimers Disease
Ladislav Volicer MD
Individuals, who survive into late stage dementia, may become unable to open their mouths and swallow spontaneously. Feeding of these patients requires verbal cues for both mouth opening and swallowing, and sometimes requires gentle massage of the cheeks to prevent “pocketing” of food. Some patients may be able to use straws to drink liquids and nutritional supplements, but the use of straws sometimes causes choking. Patients who develop choking during feeding, usually choke first when given thin liquids, because swallowing of thin liquids requires the most complete coordination of all muscles involved in the swallowing process. Switching from thin liquids to foods with thicker consistency that still contain mostly liquids (e.g., yogurt instead of milk) may prevent choking in these individuals. Alternately, thin liquids may be thickened by adding thickening agents, such as Thickit ( or baby cereal is cheaper and costs less) . It is possible to maintain adequate nutrition in most individuals with severe and terminal stages of dementia without the use of tube feeding using modified diet textures and skillful feeding techniques.
-------------------
From the Rush Manual for Caregivers
As alzheimers disease progresses to the late stage, the person may no longer have the coordination to chew and swallow correctly, which can lead to chew and swallow correctly, which can lead to poor nutrition and weight loss. If there is choking with each bite of food, there is a risk that the food could go into the lungs and cause pneumonia. These suggestions may ease the problems with swallowing
• Make sure that food is cut up in small pieces and is soft enough to eat
• Ground or pureed foods may ensure safe swallowing. You can grind or puree most foods in a blender or baby food grinder.
• Offer soothe soft foods such as ice cream, milk shakes, yogurt, cream soups, applesauce, Jello or custard.
• Thin liquids are most difficult to swallow. Remember these tips:
- Do not have the person use a straw. Instead, have them drink small sips from a cup.
- Milk may not be a good choice; It tends to get caught in the throat.
• Cold drinks are easier to swallow than hot drinks
• A product called “Thick-It” is available in most drugstores. It can be added to liquids to thicken their consistency.
• Don’t hurry the person. Each mouthful should be chewed and swallowed before taking another bite.
• Don’t feed a person who is drowsy or lying down. The person should be in an upright position during the meal, and for at least 20 minutes after the meal.
• When swallowing, have the person keep their neck forward and chin down. (Norbert’s note - This is called a chin-tuck, a position where liquids cannot simply run down the throat. With the chin-tuck, conscious swallowing is needed. It may also help with a proper coordinated swallow.)
• A book called The Non-Chew Cookbook is available from Wilson Publishing Co., PO Box 2190, Glenwood Springs, Colo., 81602; order by calling (303) 945-5600
-------------------
Also, consider the use of nutritional supplements, which can be thickened if necessary.
You may want to do a web search on "dysphagia"
Norbert
Swallowing information suggested by Ridzene
www.pdsg.org.uk/Factsheets/swallowingfacts.htm
www.hormelhealthlabs.com/home.asp
Hormel Health Labs has several products useful for nutrition and swallowing problems -
- Pureed vegtables
- thickeners
- 2 cal/gram suppliments (higher calorie content than what is available in grocery stores.)
For more information on High calorie suppliments, see FAQ29
alzheimers.proboards.com/index.cg....lay&thread=7150
FAQ - swallowing difficulties 06/01/04 05:32 PM
<<<MY HUSBAND GOT A 6 MONTH RENEWAL FROM HOSPICE BECAUSE HE CANNOT SWALLOW LIQUIDS. HE IS STILL WALKING AROUND BUT GETTING WEAK. I KNOW THAT HE IS GETTING DEHYDRATED - BUT THEY TOLD ME NOT TO FORCE HIM TO DRINK. HE MAY CHOKE. -- I BOUGHT HIM A LOT OF SIPPY CUPS WITH A STRAW AND ALL HE DOES IS BITE ON THE STRAW. IF HE DOESN'T DRINK IT - THAT IS NATURE'S WAY OF TELLING THE BODY IT IS READY TO SHUT DOWN. THIS IS VERY PAINFUL FOR ME - I AM STARTING TO GIVE HIM SOME SMOOTHIES WHICH HE LIKES - THAT SEEMS TO GO DOWN BETTER THAN OTHER LIQUIDS.>>>
At this point, some doctors will order a swallowing evaluation. This is done by a speech therapist and will result in a recommendation on the consistency of food needed for the level of swallowing impairment. The person can still get liquid - in thickened form and in water content of food. I believe there are specific procedures and body positions that can be used to decrease the swallowing difficulties. I don't think these evaluations are done very often for residents of nursing homes - the staff already know the drill.
---------------------------------------
Excerpts from “What if it’s not Alzheimers? (a book about Frontotemporal Dementia) Pgs 107-108 and 150-154 and 157.
Swallowing
Once food is chewed, then the tongue pulls it together in a ball (called a “bolus”) and starts to push it to the back of the mouth. As this happens, you stop breathing, your throat elevates to close off your airway and open your esophagus, and the food bolus is pushed down the throat and into the esophagus. All of this happens in one second. As the food enters the esophagus, the throat relaxes and drops and you can now breathe.
The pharyngeal phase (of swallowing) is a coordinated, involuntary reflex in which all muscles of the throat except one, the cricopharyngeus, relax to allow passage of food/liquid into the esophagus which anatomically is behind the larynx. The cricopharyngeus controls the epiglottis, and tightens or contracts concurrently while other throat muscles relax, to protect entry of ingested materials into the larynx.
Your mouth and throat have to try to control liquids every time you take a sip. Regular liquids are the most difficult texture to swallow, especially water.
There are several ways to help a person who is coughing or having difficulty with food and liquids. One called a “chin tuck” reduces the amount of muscle effort needed to close of the airway.
If this is difficult, then thickening the liquid can help. A thicker liquid swallows slower and may give the person the extra time needed to achieve airway closure. You can try an artificial thickener (like Thick It) or try making smoothies in the blender with yogurt or pudding.
When a person is not drinking regular liquids, it is important to keep him hydrated. Use snacks of ice cream, sherbet, pudding, yogurt, and creamy Popsicles during the day for hydration.
--------------
This information (except for the second paragraph) is from chapter 10
By Erica Wollman CCC-SLP
Clinical specialist in speech language pathology
Department of Otorhinolaryngology
University of Pennsylvania Medical Center
---------------------------------------------
Food can be thickened with a commercial product called Thick-It, available comprehensive pharmacies (the ones that have walkers, support stockings, etc.)
The nurse at the Alzheimers Association told me that baby cerial tastes better and is cheaper than thicket.
---------------------------------------------
From “Clinics in Geriatric Medicine – Alzheimers disease and Dementia
May 2001
Article – Management of severe Alzheimers Disease
Ladislav Volicer MD
Individuals, who survive into late stage dementia, may become unable to open their mouths and swallow spontaneously. Feeding of these patients requires verbal cues for both mouth opening and swallowing, and sometimes requires gentle massage of the cheeks to prevent “pocketing” of food. Some patients may be able to use straws to drink liquids and nutritional supplements, but the use of straws sometimes causes choking. Patients who develop choking during feeding, usually choke first when given thin liquids, because swallowing of thin liquids requires the most complete coordination of all muscles involved in the swallowing process. Switching from thin liquids to foods with thicker consistency that still contain mostly liquids (e.g., yogurt instead of milk) may prevent choking in these individuals. Alternately, thin liquids may be thickened by adding thickening agents, such as Thickit ( or baby cereal is cheaper and costs less) . It is possible to maintain adequate nutrition in most individuals with severe and terminal stages of dementia without the use of tube feeding using modified diet textures and skillful feeding techniques.
-------------------
From the Rush Manual for Caregivers
As alzheimers disease progresses to the late stage, the person may no longer have the coordination to chew and swallow correctly, which can lead to chew and swallow correctly, which can lead to poor nutrition and weight loss. If there is choking with each bite of food, there is a risk that the food could go into the lungs and cause pneumonia. These suggestions may ease the problems with swallowing
• Make sure that food is cut up in small pieces and is soft enough to eat
• Ground or pureed foods may ensure safe swallowing. You can grind or puree most foods in a blender or baby food grinder.
• Offer soothe soft foods such as ice cream, milk shakes, yogurt, cream soups, applesauce, Jello or custard.
• Thin liquids are most difficult to swallow. Remember these tips:
- Do not have the person use a straw. Instead, have them drink small sips from a cup.
- Milk may not be a good choice; It tends to get caught in the throat.
• Cold drinks are easier to swallow than hot drinks
• A product called “Thick-It” is available in most drugstores. It can be added to liquids to thicken their consistency.
• Don’t hurry the person. Each mouthful should be chewed and swallowed before taking another bite.
• Don’t feed a person who is drowsy or lying down. The person should be in an upright position during the meal, and for at least 20 minutes after the meal.
• When swallowing, have the person keep their neck forward and chin down. (Norbert’s note - This is called a chin-tuck, a position where liquids cannot simply run down the throat. With the chin-tuck, conscious swallowing is needed. It may also help with a proper coordinated swallow.)
• A book called The Non-Chew Cookbook is available from Wilson Publishing Co., PO Box 2190, Glenwood Springs, Colo., 81602; order by calling (303) 945-5600
-------------------
Also, consider the use of nutritional supplements, which can be thickened if necessary.
You may want to do a web search on "dysphagia"
Norbert
Swallowing information suggested by Ridzene
www.pdsg.org.uk/Factsheets/swallowingfacts.htm
www.hormelhealthlabs.com/home.asp
Hormel Health Labs has several products useful for nutrition and swallowing problems -
- Pureed vegtables
- thickeners
- 2 cal/gram suppliments (higher calorie content than what is available in grocery stores.)
For more information on High calorie suppliments, see FAQ29
alzheimers.proboards.com/index.cg....lay&thread=7150
I am no longer able to hold your hand my beloved but I cherish the remembrance of your hand in mine...and the wonderful person that touched so many lives with joy. : ) 
