Dinner is a nightmare

ErikaK

Last few weeks Dad has been challenging at meals.  We keep reminding him to take a bite and swallow before taking another.  He says ok and literally takes another bite while still chewing and staring at me while doing so.  We've tried hard not to get upset but it is not keeping him sason was fe if he chokes.  Then he says he'll just go home.  He's been living with us since 2020.  I am at a loss on what to do.  I guess just feed him earlier than my husband and I eat, like we did when our son was little? Any advice?

M1

Hi Erika. His doc can order a swallowing study if needed, where an occupational/speech therapist observes him and a radiologist can use fluoroscopy to watch him swallow. Not sure you're needing that but you might ask. He may need his food cut up for him and supervision, which it sounds like you are doing. For your own sanity feeding him separately may help.

SunnyAB

I've dealt with the exact same problem and we've had some frightening choking incidents. The cues to slow down have not helped one bit. In our case, it makes it worse - I think because he resents being told what to do and deliberately does the opposite. But besides that, it's definitely a cognitive issue because even when my family member was actually choking he tried to put more food in his mouth and I literally had to grab his wrist to stop him. I've heard advice to give him a spoon instead of a fork, or anything to make it more time consuming for him to get the food to his mouth. That's kind of like the special dog food bowls they make for this same problem in dogs. I haven't experimented with that but I have been able to greatly reduce the choking and also reduce how much food is in his mouth at one time by changing what he eats. I stopped pizza, sandwiches, and anything hard, dry, thick, or crumbly. He's not a meat eater, but if he was, I would have eliminated anything except ground meat with sauce and soft moist fish. What I serve is all soft and slick/slippery and moist and tends to be cohesive. For instance, pasta with lots of butter and well cooked veggies. Sauces, gravies, and butter etc. on everything. No sandwiches except something like a grilled cheese that's not too thick. These soft/slick/cohesive foods leave the mouth faster than other foods that require more chewing, moving around, and "gathering of pieces". They also slide down the throat easier. So as he keeps shoveling more in, at least what is already there is moving out quicker.  Both age and dementia reduce the speed and efficiency of the swallow (including what takes place in the mouth before the actual swallow) so my goal here is to help that along. It doesn't fix the issue of simply eating too fast but it has helped lower the risk for us. Eating is one of his last remaining pleasures and it's important to me that he continues to enjoy food. Luckily, he really likes all the stuff I give him and he isn't aware of the changes.

ErikaK

Thanks, yeah I have tried to modify what he eats too.  Sometimes we are having something different which confuses the issue.  I think he tries to mirror what we so when eating.

harshedbuzz

ErikaK-

I agree with M1, this is an urgent issue. I would reach out to his doctor on Monday and ask about a swallow study and/or SLP feeding consult. This would pinpoint what is happening and help you plan to feed dad safely. The risk of aspiration is real and can arise sooner than you might anticipate although often the physical manifestation of choking occurs first with liquids like water.

When dad was evaluated the SLP explained to me that there are 2 ways eating can go sideways and that sometimes both occur. A PWD sometimes forgets the steps to the process in the same way they do other ADLs like showering requiring you to prompt and eventually take over. The big risk here is that he could allow food to hang out in the back of his mouth without swallowing and aspirate. Since the brain controls everything, as the disease progresses, the process of digestion can become sluggish or impaired. Sometimes the epiglottis doesn't close off quickly enough to close off the windpipe to food (or even saliva) setting up aspiration pneumonia. 

Some tips we were given to feed dad safely:

Make sure he's sitting up. You have dad at the table which is great.

Avoid foods with mixed textures- cereal and milk, soup with chunks

Avoid offering water to wash food down during meals

Avoid straws and sports spouts that can wash liquid to the back of the throat too quickly for the epiglottis to react


Good luck.

HB

​fesk

We are dealing with this too. 

We believe my mother is aspirating but not showing any signs. We had a speech therapist come to the home and observe her eating on several occasions and will be going for a swallow study in the hospital soon. The speech therapist in the home could not identify any issues and didn't place many restrictions. 

My mother is a fast eater too. We give her food a bite/piece at a time to be safe. I suggest you do the same and get the swallow study as recommended.

Michael Ellenbogen

 Hope all of you folks know CPR Technique for choking. It may be handy. They also make devices for that just in case you do not know how.