What causes problems with swallowing?

Difficulty swallowing is common for people with cognitive or thinking changes. These changes may be a result of dementia, stroke, brain injury or Parkinson’s disease. The difficulty with swallowing may be a change in how the person responds to food or drink at first, for example, changes in taste preference, not responding normally to food or drink because of reduced sense of smell and reduced feeling of food or drink in the mouth. Later on, there can be physical changes making it difficult to chew and swallow well.

A speech and language therapist can assess swallowing by observing the person eat and drink. They can make recommendations to support the person to maintain normal eating habits for as long as possible.

What problems can this cause?

If the person you care for is having difficulty swallowing, it is important to get help to avoid the risk of:

• dehydration or malnutrition
• choking
• aspiration pneumonia – a chest infection caused by food or fluid going down the wrong way and getting into the lungs.

People with cognitive changes may:

• not recognise the food in front of them
• struggle using a knife and fork
• not react by opening their mouth as food comes towards them
• have difficulty chewing or swallowing food
• over-chew the food they have in their mouth
• over-fill their mouth with food
• spit out pieces of food or medication from their mouth
• lose their ability to judge temperature.

How can family and carers help?

At mealtimes please:

• check the person is wearing their hearing aid, glasses or dentures (if required)
• seat the person near other people who are eating
• stay away from noisy, distracting environments, for example turn the television down or off
• allow plenty of time to enjoy the meal without rushing
• do not mix foods together on the plate
• be flexible – food preferences and ability (for example to self-feed) may change from day-to-day. Be prepared to offer meals at different times or preferred snacks throughout the day. If a person prefers dessert, offer more than one of these (unless against dietetic recommendations).

When eating, it is important for the person to be:

• awake, alert and engaged with eating or drinking
• comfortable
• seated upright (it is unsafe to swallow when lying back).

The person helping should:

• sit where the person can see and hear them
• talk about the tastes and flavours of the food being offered
• prompt the person to use cutlery by guiding their hand to their mouth – it is best to support people to self-feed for as long as possible as we tend to swallow better when we feed ourselves
• provide a teaspoon to eat with if the person is rushing or over-filling their mouth
• offer foods that can be eaten without cutlery, such as finger foods (depending on swallowing recommendations made by your speech and language therapist)
• offer foods and drinks with interesting tastes, textures (depending on speech and language therapy recommendations) and temperatures, for example an icy lemon drink
• take care with hot drinks
• watch and check that the person has swallowed before offering another bite (go at their pace)
• stop and give them time to recover if they cough
• check for any food left in the person’s mouth after swallowing and remove this if the person is not attempting or able to swallow again
• stop feeding the person if they are frequently coughing or are very short of breath
• offer mouth care after the meal to remove any residue and to avoid the build-up of bacteria in the mouth, as this can increase the risk of aspiration pneumonia.

If you have concerns about swallowing:

• check their swallowing recommendations if they have seen a speech and language therapist before
• supervise while the person is eating and drinking
• make sure there are no foods or drinks of unsafe consistencies (depending on recommendations) left in the person’s reach
• consult the person’s GP for a medication review
• refer to speech and language therapy for a swallowing assessment if they haven’t been seen before or if they need to be seen again.

More information

• alzheimers.org.uk – factsheet on eating and drinking
• dementia.uk.org
• carers.org