Problems with Eating, Drinking, and Chewing in Late Stage Alzheimer’s

It’s bad enough that Alzheimer’s disease robs the patient of their sense of smell, which can certainly impact the appetite; but it also affects people’s ability to realize they’re thirsty. The patient must be encouraged and reminded to drink plenty of liquids. Serving fruit and vegetable juices as well as water, soup, or yogurt at meal and snack times will certainly help. My Mom loved jello and it was a great way to keep her hydrated when she didn’t realize she was thirsty.

As the patient reaches later stages of Alzheimer’s disease, more issues arise regarding eating and swallowing their food. Often, in the final stages they may forget how to chew altogether and require tube feeding. Despite the fact that many people do remember how to chew and want to eat by themselves, there are still serious issues that can arise during the later stages of Alzheimer’s.

If the patient has difficulty chewing or swallowing, extra caution must be taken at mealtime. Agitation or rushing the patient while eating can cause them to breathe food or liquid into their airway and make them more susceptible to pneumonia. If they aren’t chewing long enough or correctly, it will be easier for them to get choked on a large piece of food.

If the patient still wears dentures, be sure the dentures are checked periodically and realigned if needed. If they require dentures but refuse to wear them, they should only eat soft or pureed foods, along with liquid or cream soups. My Mom needed a hearing aid because she was totally deaf, yet in the later stages of her disease she refused to wear the hearing aid and depended entirely on lip-reading for any conversation.

The best setting for mealtime is a simple table in a quiet area, with regular utensils that they are accustom to. Their concentration should be on feeding themselves rather than television,  loud music, conversation or a noisy room. They should sit upright while eating, rather than reclining. That will aid in swallowing and chewing. They should also remain seated and upright for a half hour or so after their meal to aid digestion.

As the patient’s disease progresses, mealtimes will last longer. It isn’t unusual for the Alzheimer’s patient to store or “pocket” food in their cheeks or under their tongue as they forget the need to swallow as they eat. They may need more encouragement and coaxing to chew and then swallow and they will tire more easily. A little patience at mealtime will prevent frustration for the patient and the caregiver alike. If they are struggling to finish an entire meal at one setting, it may be advantageous to have smaller meals at closer intervals. Many caregivers prefer to change the feeding schedule during this later stage. Often, the patient may be switched from 3 meals a day– to 5 smaller meals. And when they don’t remember to swallow, their diet is often changed to pureed food. Caution must always be taken if they are hoarding food in their cheeks or under their tongue as this makes it much easier for to get choked. Yet another good reason to switch to pureed or softer foods.

The caregiver might put more emphasis on easy-to-swallow, softer foods. The softer foods are easy to chew and swallow, such as pudding and mashed potatoes and decrease the fear of choking. Bite-size and finger foods, such as cubes of cheese with crackers, also work well. If the patient can no longer eat solid foods, try a food processor or blender. Many great tasting dishes are created with these gadgets. And with all the softer foods, you lower the risk of choking.

With good preventive measures, you should have no issues with choking. But–you never know when something might happen and– it’s better to stay prepared. Since late-stage Alzheimer’s often includes swallowing problems, coughing and choking are serious risks during meals. Learn how to do the Heimlich maneuver and be prepared for choking emergencies by having a phone nearby.

During the very last stages of Alzheimer’s your loved one may not be able to feed them self at all and have issues chewing their food. A last resort to furnish nutrition is to use a straw. Many have found that dipping the straw into pureed food, then hold your finger over the end until you put the straw in their mouth–then release your finger and the pureed food will slide into their mouth. The Alzheimer’s Speaks Blog offers a photo and instructions on this method of feeding.

Also, when they no longer want to eat or swallow, you may need to confer with their physician, he may suggest a speech or swallowing therapist. By watching the patient, they can tell if they are able to swallow and what would be the best way to feed them.

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While my Mom stayed with us, I purchased “The Bullet” as seen on TV.  I thought it would be helpful because I could make single portions without a big mess.   It worked great for Mom and the grand-kids love it too. As soon as they’re in the door we hear,  “Nana, can we have a bullet.” They want their custom made “smoothie” of choice. I can’t say enough about The Bullet. It sits on our cabinet and is used daily.

  • The grandkids like a couple scoops of ice cream, cookies, or M & M’s, or mint chocolate chips– add milk and blend for a couple seconds and you have your very own custom Blizzard.
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  • All of my children are adults now, but I recently saw a commercial where The Bullet was used as the preferred means to create custom baby food. The mother chooses which foods are used and which preservatives  eliminated from her baby’s diet.

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Comments

  1. My Dad has been “pocketing” his food for about the last 6 months. He still has a lot of strength, but is very confused most of the time. He CAN remember things from long ago, though. He also becomes fixated and obsessed with things very easily. He never eats a full meal anymore, such that it is — usually 3 different foods on a small plate! I was wondering if the “pocketing” of the food is always a part of the late stage of Alzheimer’s, or if if can appear earlier?

    • ~ Sandy says:

      Hello Anna,
      You’re a wonderful daughter to be caring for your dad. Be sure and take care of yourself also.

      There’s really no way to tell for sure what stage someone is in with Alzheimer’s or dementia. The later stages are always filled with confusion and lack of appetite but it can also occur in the earlier stages. My mom began losing weight early-on in her Alzheimer’s. She simply forgot to eat and wasn’t hungry later. So it might be earlier with your dad.

      During the very late stage, they may forget how to swallow, but that’s a different issue than what you are seeing.

      I’m glad you stopped by and wish you all the best with caring for your dad.

      ~Sandy

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