Choking and drinking

wos314

Hello,

I am at my wits end in helping my mom drink. She’s in the later stages of Alzheimer’s and bed bound. We have been giving her a drink from a straw with thickener in it for over a year , however just recently she seems to choke on every single drink and it’s scaring the hell out of me. Hospice is no help all they say is add more thickener which isn’t helping anything. 

Any advice would be appreciated as I am terrified and alone 

mommyandme (m&m)

That is scary! Will hospice come to you both and show you what might work, if they haven’t?

May be time for the little sponges of water that are placed in her mouth? 

Sounds terribly difficult. I’m so sorry.

jfkoc

My husband's Hospice said NO straws.

Take a look at this;

https://medilodgeofrichmond.com/announcement/choking-on-water-why-do-elderly-adults-have-difficulty-swallowing

star26

Is she able to drink without a straw, and does this help at all? Are you able to get her sitting up really well (as close to 90 degrees as possible)?  Have you tried a chin tuck? (tilting chin down as if she's looking at her lap). If anything will help at this point, it will probably be something that slows down the liquid even further since her swallow is becoming more and more delayed and disordered. Straws and gravity (head tilted back) speed things up and thinner liquids move faster than thick. In advanced stages of dementia, it's also possible that this cannot be corrected. When you say choking, is it a lot of violent coughing or do you feel her airway is actually getting blocked?  If it's not either of those two, and she can still drink without significant physical distress that scares her etc, then just let her continue to take small sips. She may get aspiration pneumonia and that is how she will pass. This is often how someone with advanced dementia dies. What you don't want is an awful choking incident which will traumatize both of you. Or pushing liquids when each sip brings on a violent fit of coughing and makes drinking very unpleasant for her. If that's what's happening, you may be looking at just keeping her mouth moist and comfortable. I am assuming that the liquids are the only intake she has at this point.

harshedbuzz

My dad was assessed by a SLP related to his sputtering and choking. He was ambulatory, but preferred to slouch in bed or on the couch. The SLP's suggestions:

1. He gets nothing by mouth unless sitting upright.

2. No straws or sports bottles, even with thickened liquids.

3. No mixed texture foods with liquids- no cereal and milk, no ice cream with fruit chunks, no soups that aren't pureed.

Alas we didn't get the assessment soon enough. Dad died from complications of aspiration pneumonia hours after we talked.

HB

dayn2nite2

My hospice said no straws too, and only eating or taking liquid in an upright position.

Jane Smith

I’d definitely get the swallow test, which is usually done by a SLP (speech and language pathologist).

Cobalt

My son with EO at age 41 has been having more trouble swallowing and drinking for the last year and it is progressively worse.  He's still allowed straws which seem to be ok, for now, but down the line I am sure straws will be out.  We've also noticed that he is taking the tiniest sips possible.  No more gulping of any type of drink.  I think this is a common progression of the disease.  Wish there were answers.

wos314

Thank you for all of this! Currently, she eats nooo problem...my mom still has her appetite. However, it doesnt sound like her airway is blocked, she drinks then coughs and then her voice is gurgled and she has 'coughing' episodes. I say 'coughing' because Alz has robbed her of the ability to truly cough as well.....but its terrifying and I do not want her to die from aspirating. Currently, we are giving her water with thickener but now with a spoon. We tried a sippy cup as per a hospice nurse, but no luck . 

harshedbuzz

wos314 wrote:

Thank you for all of this! Currently, she eats nooo problem...my mom still has her appetite.

You can get a lot of hydration in using foods. Many fruits are high in liquids- melon's a great option right now.

 However, it doesnt sound like her airway is blocked, she drinks then coughs and then her voice is gurgled and she has 'coughing' episodes. I say 'coughing' because Alz has robbed her of the ability to truly cough as well.....

The way it was described to me, is that the epiglottis becomes sluggish with later stage dementia meaning that it doesn't always close off the airway as food travels back especially if washed back with liquids. Many PWD pocket food or don't fully swallow and will have a slurry of semi-digested food hanging at the back of their throat. For this reason, it is often suggested the PWD be prompted to swallow through the day to keep their throats clear. The point of thickeners is to slow the speed at which liquid hits the back of the throat to give the epiglottis a head start in closing off the airway.

Her airway wouldn't be blocked, it would be food or liquid getting into her lungs. Even saliva can be a risk if it gets into the lungs. Sometimes aspiration occurs silently and it isn't discovered until the symptoms of pneumonia set in as my dad's was. If there is food or mucus at the back of the throat she might make a distinctive gurgling sound with breathing. 

but its terrifying and I do not want her to die from aspirating.

As I mentioned, dad died from complications of pneumonia. *I can only speak to my experience with it and not presume to speak for others.*

All things considered, it was not a horrible way to go. I had a sense that something had changed and even OK'd a hospice evaluation for the next morning.  I stopped by my mother's to suggest she visit the next day and even called my uncle to give him a heads up that his brother symptoms seemed to have progressed in the last week but I didn't think he was on the verge of actively dying. He was fine at his 8pm check and likely died in his sleep before the 10pm bed check. 

Currently, we are giving her water with thickener but now with a spoon. We tried a sippy cup as per a hospice nurse, but no luck . 

A spoon sounds like a good option. Wishing you the best.

LaurenB

I'm a 20 year geriatric SLP.  Feel free to get a consult for your LO.  Please do not recommend any swallowing techniques including chin tucks, head tilts, thickening, thinning as each of them cannot be assessed from the bedside and especially not by a trained SLP.  All of them have both the potential to make things better as well as make things considerably worse.  I do recommend only feeding a person when they are alert and are sitting up as close to 90 degrees as possible.

wos314

Hi Lauren,

Are you able to do an assessment via FaceTime or Zoom? We are still waiting on hospice to get us an SLP.