Managing Dysphagia Diets at Home

Dysphagia is commonly defined as difficulty in swallowing or chewing. It can be harmful because it frequently makes it challenging to take in enough calories and fluids to nourish the body. Dysphagia can be especially difficult for a person with dementia when eating enough can already be a problem.

Some common signs of dysphagia include:

• coughing during or right after eating or drinking
• wet/gurgly voice during or after eating or drinking
• extra effort or time needed to chew or swallow
• food or liquid leaking from the mouth or getting stuck in the mouth
• recurring pneumonia or chest congestion
• weight loss or dehydration from not being able to eat enough

If you suspect dysphagia, get a referral to see a speech-language pathologist who can test and treat swallowing disorders. A dysphagia diet, food and/or fluid modified in texture and consistency, may be recommended to prevent aspiration or choking for patients with dementia.

The dyspahgia diet is divided into four categories:

1. Regular Diet
Any solid textures are allowed.

2. Chopped Diet
Solid or semisolid foods, with a variety of textures and consistencies. Foods are well-cooked, soft, and hold
together in the mouth.

3. Ground/Minced Diet
Foods are modified to a soufflé, moist ground or moist minced texture. Some semisolid and soft foods are allowed, including plain bread and cakes, mashable soft cooked vegetables and fruit. Foods may have more than one texture. Peanut butter and hard breads should be avoided.

4. Pureed Diet
Foods are modified to a single thick puree texture. No solid or semisolid foods are allowed. Examples include mashed and baby foods. Bread should be avoided.

There are different consistencies for liquids:

Thin Liquids
Water, coffee, tea, juices, milk, soda, alcohol, broth, bouillon, instant breakfast drinks

Nectar Thick Liquids
Vegetable juice, fruit nectars, milkshakes, malts, eggnog, buttermilk, blenderized or cream soups, honey

It is preferable to use commercial thickeners or preprepared thickened products for these consistencies.

Here are some basic guidelines for people with dysphagia:

Before a meal:

• Check the mouth and dentures for cleanliness to ensure that no food remains in the mouth from previous meals, and to increase sensation, allowing person to eat better, and decrease bacteria from growing in the mouth.

During the meal:

• Always sit upright; a 90-degree angle is preferable. The head should be slightly angled forward.
• Eat in a relaxed atmosphere, eliminate distractions, and avoid talking.
• Allow sufficient time for eating—don’t hurry! Manageable bites of food and liquid should be taken. Allow enough time between swallows to clear food from mouth and throat.
• Alternate solid and liquid food; i.e. eat meat or starch and after that bite is swallowed, drink fluid to help the food go down.
• Discontinue any individual item if individual coughs and/or chokes.

After you eat:

• Continue to sit upright for at least 30 minutes after eating to allow for adequate swallow function. Again, check that the mouth and dentures are clean, ensuring that no food remains in the mouth after the meal.
• Commercially available instant thickening agents may be added to hot or cold thin liquids.

— Linnea Matulat, MS, RD, CDN
Nutritionist
God’s Love We Deliver

The following companies can be contacted for home delivery:

Walgreens:
www.resource.walgreens.com,
800-828-9194 for Thick-It, Dairy Thick

Precision Foods:
www.thickitretail.com,
800-333-0003 for Thick-It &Thick-It Purees

Hormel HealthLabs:
www.hormelhealthlabs.com,
800-866-7757 for thickened drinks, thickeners, & thickened foods

SimplyThick, LLC:
www.simplythick.com,
800-205-7115 for SimplyThick thickening gel that thickens most liquids

For helpful recipes, please refer to the following cookbooks:

The Dysphagia Cookbook,
Elaine Achilles, Ed.D

I-Can’t-Chew Cookbook,
J. RandyWilson

Some useful Web sites to consult:

National Institute on Deafness and other Communication Disorders,
www.nidcd.nih.gov

American Speech-Language- Hearing Association,
www.asha.org

References sited:

National Institute on Deafness and other Communication Disorders,
www.nidcd.nih.gov

American Speech-Language- Hearing Association,
www.asha.org

This is the 7th in a series of articles on the nutritional and feeding needs of persons with AD.

Linnea Matulat is a Nutritionist at GLWD, a non-profit agency in NYC that provides meals to men, women and children affected by HIV/AIDS, Cancer, AD and many other serious illnesses who are unable to shop or prepare meals for themselves. The agency’s team of experienced nutritionists also provides nutrition education, information and counseling in individual and group sessions to clients, their caregivers and other service providers. In partnership with GLWD, the NYC Chapter is pleased to offer this service to persons with dementia and their families. For information, please call the Chapter's 24-hour Helpline at 800-272-3900.

To obtain more individualized nutrition information, the nutrition department of GLWD can be reached at 212-294-8103 or 1-800-747-2023 or by visiting www.glwd.org.

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