Choking & Sore Throat

TK67

My sister and I put our mother, who has late stage Alzheimers, in Memory Care two months ago.  Since her move to MC she has been choking severely and her caregivers are now giving her a pureed diet.  She doesn't like it and has lost a lot of weight.  She doesn't like the thickened liquids, either, so I don't think she is drinking as much as she needs.

Now, mom is complaining of her throat being sore.  I'm not sure she understands the difference between sore or maybe feeling like something is stuck in her throat.  I had lunch with her the other day and she got food stuck in her mouth and tried to use her fork to clear her throat.  (maybe the reason her throat is sore?) It is very scary for everyone involved!

Mom is on palliative hospice care with an aid coming once a day/5 days a week and a nurse coming to check on her one day a week.  We have not had a swallow study done because hospice won't pay for it and, frankly, we don't know what they will tell us that we don't already know......this is one of the stages?

My question is have you had experience with your LO choking? Any advice on how to help her? What should we expect in the near future (as in her not eating at all)?

Thank you!!!

Stuck in the middle

The pureed diet is how swallowing difficulty is handled.  My mother didn't like it either, but she ate enough to get by, as in she stopped eating a meal when she was no longer hungry versus when her plate was empty.  She lost weight, mostly muscle mass as she become less and less mobile and used a wheelchair.  This was in the last two years of her life.  She didn't actually stop eating until the last couple of days before her death.

As far as I know, the only further treatment beyond pureed food is a feeding tube.  One of my aunts had great difficulty swallowing after a stroke and was offered a feeding tube, but she refused it.  She was in her late 80s, had several impairments, and decided enough was enough.  

I think your mother is nearing the end of her life, and a feeding tube or other intervention would only prolong her discomfort.  Sorry.

harshedbuzz

TK67-

The choking is a common late stage development and can lead to aspiration and pneumonia which is a common cause of death. 

Dad had lost a lot of weight in the 6 months before he died. This weight loss occurred with good home cooking and supplementation of calories with as many snacks and treats as he desired. Even after he went to MC, we brought meals and treats daily and still he lost upwards of 10% of his body weight which is an ominous sign.

At the MCF, dad started to sputter and choke on food more; this had started when he was still at home. An SLP was called in to evaluate his swallowing. I happened to show up that afternoon with nuggets, fries and a milk shake from Chik-Fil-A which she used to test his swallowing. The way she described it, what was happening is that his digestive track wasn't getting signals from the brain to close off his windpipe on swallowing. This can be especially dangerous if the PWD pockets food or allows chewed food to kind of hang out in the back of their throat to be washed down with a drink.

After the evaluation, we discussed dietary changes. In light of his need for calories and his love of treats, we decided not to move to thickened liquids but allow a regular diet avoiding things like mixed textures like cereal and soup. We also talked about the need to avoid any kind of container that allowed liquid to rush to the back of the throat- so no more straw cups or sports bottles we brought to avoid spills and he had to be sitting upright to eat or drink. 

The SLP expressed surprise that dad's swallowing was as bad as it was given that he had been having a good day. He chatted with me and flirted with her during the eval and even got up to use the bathroom a couple of times. He was tired after the visit, so I talked with the DON who brought up hospice and shared that he'd ordered an X-ray and bloodwork earlier. Dad died later that evening from complications of aspiration pneumonia based on his X-ray. 

HB

Jane Smith

Definitely get a swallow test from a Speech and Language Pathologist or similar. They can evaluate the situation and advise changes to diet and feeding techniques that can help. 

Best wishes.