As Alzheimer’s and other forms of dementia progress difficulty swallowing, a condition known as dysphagia, is very common, and occurs most frequently in the late stages of the disease. Not being able to swallow correctly can result

in coughing and choking, as well as aspiration, in which food and liquids enter the lungs, which can lead to life threatening pneumonia. When a person isn’t consuming enough calories or liquids because they have difficulty swallowing, dehydration and weight loss can occur.

Swallowing difficulties can be challenging for caregivers as they want to be sure that their loved one’s nutritional needs are being met, that they remain safe while eating, and that dining remains an enjoyable part of life as much as possible.

There are several ways to make meals easier and less stressful for both the caregiver and their loved one.

• Posture Matters: Ensure your loved one is in an upright position with their head slightly forward when eating, and keep them upright for about 30 minutes afterwards to aid in digestion.
• Limit Distractions: Serve meals in a quiet environment, limit the number of people your loved one is eating with, and keep the number of utensils and dishes on the table to a minimum to prevent confusion.
• Small Bites: Encourage your loved one to eat slowly, and check to be sure they have swallowed
  before taking the next bite. Periodically check to be sure that food hasn’t accumulated in their mouth. For some individuals it makes sense to present one food at a time, such as juice, followed by toast, followed by cereal. Or try mashed potatoes, followed by a steamed vegetable, followed by the main entrée.
• Allow Enough Time: It might take longer for an individual to complete a meal, but flexibility is key in ensuring that each meal remains a pleasurable experience for them. Smaller and more frequent meals throughout the day can be a sensible alternative to three main meals.
• Food Preparation: Food should be easy to manage. Over time you may have to modify your loved one’s diet to include softer foods or food in bite-sized pieces that are easier to pick up, chew and swallow. Soft food choices could include bananas, mashed avocados, applesauce, cottage cheese and scrambled eggs. Depending on your loved one’s food preferences, finger foods that are easy to grasp might include chicken nuggets, fish sticks, apple slices or orange segments, steamed broccoli, or small sandwiches. Pita bread is a convenient wrap for a sandwich as the filling is less likely to fall out.
• Visual & Verbal Cues: Use plates that contrast with the food being served, as it may be difficult for individuals with dementia to distinguish food that is served on a plate of similar color, such as white rice on a white plate. Avoid patterned plates. Verbal cues such as “chew” and “swallow” are easy to understand cues that will help your loved one complete their meal.

As your loved one’s dementia progresses, continue to help them maintain their independence by making the most of their abilities. Let them feed themselves as much as possible. Adapt dishes and utensils to make eating easier. Serve food in a bowl rather than on a plate. Offer a spoon rather than a fork, as a spoon is usually easier to manage. Let them eat with their hands if that is easier for them. Use cups and mugs with lids to prevent spills. Set bowls and plates on a non-slip surface.

Mary Bates, MS, CT, is a Certified Dementia Practitioner. She is the Assisted Living and Memory Care Director of Summit by Morrison, a senior living community offering independent living, assisted living, memory care, and respite care.

Through this column, Mary will share the experience, knowledge, and resources she and her team rely on, anticipating that it will be useful for anyone living with, caring for, or coming into contact with a person with dementia. Send your questions to Understanding Dementia at Summit, 56 Summit Drive, Whitefield, NH 03598 or email mary.bates@summitbymorrison.org. Mary will share information and answer as many questions as possible through this column.