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Key points
- Eating involves cognitive activities including choosing how to cut up food, how much to put in your mouth, and how long to chew.
- Although most dementias start with impairment in memory and other aspects of thinking, they usually disrupt eating and drinking at some point.
- A doctor can order a swallowing evaluation and a speech-language pathologist can provide tips and advice to improve it.
Anyone can have trouble eating or drinking from time to time. Most of us have had the experience of stuffing too much food into our mouth when we were extremely hungry, only to find it difficult to chew and swallow such a large amount. Or, when drinking, we accidentally send liquid “down the wrong pipe,” into our lungs instead of our stomach. These difficulties occur because eating and drinking are complex functions of the body controlled by our brain, and the first part of these functions is under our conscious control.
Let’s say we are going to eat a steak. We have some choices to make. Are we going to cut it up into 15 small pieces or five large ones? How many pieces will we put into our mouth at once? How long will we chew before swallowing? Although we may not spend much mental energy on them, we do make these decisions (usually unconsciously) when we are eating.
Individuals with dementia commonly cut their food into pieces that are too large, put too much in their mouths, and do not chew long enough before swallowing. One cause is difficulty in exercising self-control when hungry. They may also have lost some of the manual dexterity required to cut their food, making it difficult for them to cut it into small pieces. The automatic part of swallowing may also be impaired. Although unconscious, this automatic process is under the control of our brain, and may not function properly in individuals with dementia. Food may end up in the wrong place in the mouth or throat. Drinking “thin” liquids, such as water, may become difficult.
Regardless of the cause, trouble eating and drinking can lead to choking (when the airway is blocked by food) and aspiration (when liquid or food is sent into the lungs). It is therefore important to let the doctor know if your loved one is having trouble swallowing, and you and other care partners should learn the Heimlich maneuver so you can be prepared if choking occurs. (Not familiar with the Heimlich maneuver? We recommend you find out more information from the internet, the Red Cross, or your local library.)
To reduce choking, start by making sure that food is cut into appropriate-sized pieces; help your loved one cut it up, if needed. If your loved one cannot use utensils, consider serving “finger foods” that are usually eaten by hand. Either way, ensure they only put a few pieces of food into their mouth at a time. Encourage them to chew their food adequately prior to swallowing. If they don’t chew properly, you may need to cut their food into smaller-than-usual pieces or to puree their food. If they are choking when swallowing thin liquids, such as water, thickening agents can be added to make swallowing easier.
If your loved one is choking despite these measures, ask their doctor for a swallowing evaluation, which typically includes a “video swallow” (where your loved one has an X-ray when they are eating and drinking), a consultation with a speech-language pathologist, or both. An appointment with a dietitian can also help you think through how your loved one can eat healthy foods despite their difficulty eating.
Most individuals eventually need to be fed as their dementia progresses. Although this activity may not sound appealing, many families find that nourishing their loved one can be a tender, intimate experience that they either don’t mind or actually enjoy.
© Andrew E. Budson, M.D., 2021, all rights reserved.
Facebook/LinkedIn image: theshots.co/Shutterstock
References
Budson AE, O’Connor MK. Six Steps to Managing Alzheimer’s Disease and Dementia: A Guide for Families, New York: Oxford University Press, 2021.
Budson AE, O’Connor MK. Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It, New York: Oxford University Press, 2017.
Budson AE, Solomon PR. Memory Loss, Alzheimer’s Disease, & Dementia: A Practical Guide for Clinicians, 3rd Edition, Philadelphia: Elsevier Inc., 2021.
