Dysphagia and Dementia FAQ

Many of our survey participants expressed interest in learning more about dysphagia and ways to support their family member with dementia who may be dealing with dysphagia now or in the future. Here we are sharing the short answers to some common questions about dysphagia and dementia and where to go to learn more.

What is dysphagia?

Dysphagia is the medical term for swallowing difficulty. It is categorized according to where along the way the difficulties arise. For example, oral dysphagia refers to issues moving the food/liquid within the mouth, oropharyngeal dysphagia refers to issues moving the food/liquid into the back of the throat or pharynx, and esophageal dysphagia refers to issues moving the food/liquid down the esophagus to the stomach. Licensed medical professionals known as speech-language pathologists or speech therapists are specially trained to assess and treat swallowing disorders.

What causes dysphagia for someone with dementia?

Dysphagia can be caused by changes that occur in the brain as well as environmental factors, such as background noise, distractions, etc. While dysphagia tends to be more apparent in the later stages of dementia, it may be present to one degree or another at any stage of dementia.

What are signs that someone with dementia has dysphagia?

Potential signs or symptoms may include difficulty chewing, food left in the mouth, coughing during eating/drinking, reduced intake, taking longer to eat, avoiding certain foods, and weight loss. This brief questionnaire can help identify a possible swallowing disorder.

What are the risks of dysphagia?

Perhaps the most well-known risk is choking, which happens when food goes “down the wrong pipe” and obstructs breathing. Making a vocal sound like coughing is a good indicator that a person is not choking since airflow is needed for making sounds like coughing, talking, etc. Refer to the American Red Cross website for more information on how to recognize and respond to a choking event.

Lesser-known risks associated with dysphagia include malnutrition and dehydration as well as a serious condition called aspiration pneumonia, when aspirated material (i.e., food/liquid that enters the airway) becomes infected in the lungs.

How can I prevent aspiration pneumonia?

Routine oral care limits the bacterial load in the mouth and, therefore, limits the bacteria in any consumed food/liquid that may take a wrong turn and enter the lungs. So, proper oral hygiene is one way to help prevent this type of pneumonia.

Another way is to try to prevent aspiration (material entering the airway) in the first place. If you are noticing signs and symptoms of dysphagia, talk to your doctor about seeing a speech-language pathologist who can assess and come up with an individualized treatment plan. Part of the plan may include mealtime modifications, such as head posturing. Such modifications can be more effective at preventing aspiration and aspiration pneumonia than thickened liquids, a dietary modification that is also associated with an increased risk for dehydration. While feeding tubes are an option, research suggests that they do not prevent aspiration/aspiration pneumonia (what is being fed through the tube can come up and enter the airway), nor do they prolong life.

How do I help someone with dementia get the nutrition they need?

Maximizing sensory cues associated with eating (e.g., flavors, temperatures, textures) can improve meal engagement and nutritional intake among individuals with dementia. People with dementia may also prefer to eat multiple small meals and/or “finger foods” that can easily be eaten using hands instead of utensils. Setting up meals to suit these preferences, and any others you’ve identified, such as softer foods, familiar foods, etc., can lead to greater intake throughout the day.

To learn more about dysphagia and access dysphagia-related caregiver resources, visit the National Foundation of Swallowing Disorder website.

Holiday Conversation Tips for Friends and Family of People with Dementia

If you are a friend or family member of someone with dementia, you may be thinking about ways to enjoy the upcoming holidays with them. Below are a few strategic adjustments you can make to the environment and your own communication to help promote meaningful connections this holiday season.

Setting the Scene 

If you are the care partner, consider hosting or attending the festive event in the morning or whenever cognition is at its best for the person with dementia (PWD). Additionally, putting out pleasing sights, sounds, or smells associated with the holiday can help trigger fond memories and bring to mind what the day is about. For example, setting out a familiar decoration, playing a song you commonly sing around the holidays, baking fresh rolls so the smell wafts from the oven. These elements offer not only a positive atmosphere; but also, they have the potential to leverage the PWD’s intact long-term memory and can be a jumping off point for conversation. Keep in mind, you do not have to do it all. Whatever ideas you come up with, pick what seems the most simple and pleasant to put into practice.

Supporting Conversation and Connection 

If you have noticed a change in the PWD’s conversation abilities, adjusting how you express yourself can help to meet them where they are. That may mean simplifying and slowing how you speak (e.g., using short sentences, asking yes/no questions, waiting patiently for a response). It may also mean enhancing your message with sensory-rich language (e.g., the spice of the hot cider, warmth of the fireplace) and/or supporting it with visual cues (e.g., gestures, written words). Noticing and acknowledging nonverbal forms of expression, such as sounds and facial expressions that convey feelings, is another valuable way to create a sense of shared connection. In the end, engaging in a conversation topic that is familiar and meaningful to the PWD, such as reminiscing about a past, personal event, can help encourage meaningful discussion and social participation. As mentioned, if you have concrete elements in the environment (e.g., a photo album) to help introduce and facilitate the recall, even better.

We hope everyone has a happy holiday season!  

If you try (or have tried) any of these tips or others, please feel free to share your experiences in the comments below.

Dining Health – A Person-Centered Approach to Improving the Eating Experience

Dr. Shune and Dr. Barewel present a webinar focusing on improving the eating experience through a person-centered approach. An additional look into how transitional foods can be therapeutic, providing additional sensory stimulation, and yet still fit under IDDSI food safety guidelines.

 

Links to the webinar recording, handouts, and samples for the Savorease crisps can be found here.

Another year of successful capstone projects

A big congratulations to Claire Malany, Hayley Neptune, and Magda van Leeuwen on the successful completion of their master’s capstone projects. The projects they completed through the O-SEE Lab were all extremely meaningful and clinically relevant – and have great potential to impact the field of speech-language pathology. The titles of their projects were:

Mealtime management of culturally and linguistically differing (CLD) populations: A qualitative study (Claire Malany and Hayley Neptune)

Implications of snacking on nutrition and quality of life in nursing home residents (Magda van Leeuwen)

 

Check out the great handouts they prepared with some of the key take-aways from their talks!

Cultural Responsivity and Dysphagia

Implications of Snacking on Nutrition and Quality of Life in Nursing Home Residents

Introducing Dr. Ting-fen Lin

Allow us to introduce the recently minted Dr. Ting-fen Lin!

Ting-fen successfully defended her dissertation entitled, “Understanding breathing and swallowing in chronic obstructive pulmonary disease via a holistic lens.” The purpose of her project was to evaluate the feasibility, acceptability, and effectiveness of a breathing-based yoga program among individuals with COPD. Her entire committee was unanimously enthusiastic about the implications of her important work, including the identification of an accepted and effective intervention to target the physical and psycho-emotional correlates of COPD-related dyspnea. You would not have known that her project required a complete pivot in scope, modality, and methods as a result of the COVID pandemic! She will be starting a faculty position this fall in the Fresno State Department of Communicative Sciences and Deaf Studies.
Congratulations, Ting-fen!

(CARES) screening tool

Brand new publication hot off the press. Authored by Samantha E. Shune, Barbara Resnick, Steven H. Zarit, and Ashwini M. Namasivayam-MacDonald.

Dysphagia is a debilitating condition with widespread consequences. Previous research has revealed dysphagia to be an independent predictor of caregiver burden. However, there is currently no systematic method of screening for or identifying dysphagia-related caregiver burden. The aim of this study was to develop a set of questions for a dysphagia related caregiver burden screening tool, the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) and pilot the tool to establish preliminary validity and reliability.

Click here to read more.

Elderly woman with adult child

CARES tool presented and ESSD Award

Our very own CARES tool was presented at the European Society for Swallowing Disorders. Dr. Shune presented on behalf of our collaborators (Drs. Ashwini Namasivayam-MacDonald, Barb Resnick, and Steve Zarit). The presentation was designed as a poster of merit and it went over so well that Dr. Shune received the Best First Presentation Award. This was a wonderful unexpected outcome!

award poster