Coughing every time she drinks or eats?
So my grandma eats and drinks unnecessarily fast and basically just keeps shoving the food or drink in her mouth without really swallowing first. She ends up looking like a greedy chipmunk at every meal. I didn’t think much of it until last week when she actually choked on something and the caregiver had to do abdominal thrusts to save her. Traumatic (probably more for me than her honestly). So I've been watching more closely now and I’ve noticed her coughing like the liquid goes down the wrong pipe or she’s got too much food in her mouth she can’t even chew it. So at first I thought she just needs to be monitored and reminded while eating (I have to like stop her arm from stuffing more food and say “first, chew”). But then she nearly choked on a calcium tablet. Granted they are big, but she never had a problem before. I started breaking them in half the last two days. I’m very worried about aspiration, but she seems very far from the stages of dementia where that’s usually a concern. Ideas? Tips? I cut her food small and don’t give her huge glasses of liquids, but it doesn’t seem to help much.
33 Answers
Popular Questions
Related Questions
- My 93 year mother with Alzheimer’s and dementia has trouble swallowing. Is this normal?
- How can I protect our dog from my husband's obsession of feeding him?
- What to do when my 96 year old mother with dementia keeps asking to go home? She is living in her home of 50 years with 24/7 care.
- My mother in law keeps calling the doctor, her hairdresser, the grocery store. How do I get her to stop without taking away the phone?
My Dad use to cough when he ate, but it got worse as he aged. Test were run when he went to the hospital at the recommendation of Dad's aide at Assisted Living. Turned out Dad had aspiration pneumonia.
Choking and coughing, as well as inadvertent "pouching" of food in the pockets outside the teeth can occur. As FF states, a videoscopic swallow study should be done to determine if this is the issue.
In our experience, my father's pulmonary doctor was the one who ordered swallow studies, as did a speech therapist at rehab and a speech pathologist at a hospital.
It's an easy test. The individual is given little bits of liquids to swallow and food to eat. The pathologist monitors the intake and path flow to determine if "frank" aspiration is occurring.
A modified diet is then prescribed, based on the level of dysphagia. As Inlaw mentions, modifications such as chin tucking, slower eating and more processing time before the next bite, and exercises can be recommended, depending on the severity of the condition.
Several of us here have been through that, pureeing foods for our dysphagic relative.
A search of other dysphagia posts here brought up a lot of hits, which you can read to familiarize yourself with the issues.
https://www.agingcare.com/search.aspx?searchterm=dysphagia
If dysphagia is diagnosed, then you move to the next step of acquiring a food processor or something similar to puree the food, buying Thik-it or other brand to thicken the liquids.
Be aware that if the condition is severe, a feeding tube might be recommended. Think seriously if it gets this far, as that would typically mean an NPO status - no foods or liquids by mouth. That's a drastic and emotionally challenging step.
These are all good ideas so far, I’ll check in with her doctors about it. It just seems so out of place for dementia symptoms. My grandma still walks (not well and with a walker) and talks coherently (even though she uses wrong words and mixes up stories) and generally has no other health issues. She was in an psych unit about a month ago for two weeks and I don’t think they saw this at that time but I think she did get all the therapies daily. What’s happening now had happened occasionally before (happens to me too, like I don’t know how to breathe and eat at the same time, haha) but it’s been a lot more frequent and noticeable the last two weeks...
Saying several “K” and “G” words and saying Grrrrrrr loudly were her exercises.
The therapy was covered when ordered by the Dr. Your Grandma is eating like a 2 yr. old the way it sounds. They make yummy chewable calcium pills.
You’re a wonderful Granddaughter!
Best of luck to you and your grandmother!
I've also been told by medical pros that dysphagia can be a side effect of a stroke.
There are two levels of fluid thickening: nectar and honey thick, just as there are differences between "mechanical soft" and "pureed" food. This is why a swallow study is mandatory, to determine which level she's at, and use the correct level of dysphagia diet if she does have dysphagia.
The exercises that Connie's mother did were similar to those my father did. Making guttural sounds when consonants are used together (as in some of the European languages) helped strengthen the swallow muscles, as did "sit ups" for the throat (those were harder).
W/o challenging anyone's advice, ONLY a qualified speech pathologist or therapist can make determinations on what level of diet and which exercises are appropriate.
In fact, I used to do the speech exercises with my father so he wouldn't feel awkward about doing them. His speech therapist at the time advised me NOT to do them. She said they could harm the vocal chords of someone who didn't have dysphagia.
For soda, Hormel Thick & Easy works better. I used the Honey consistency and it thickened half a 16 oz bottle of soda without killing all the carbonation. (Carbonation will kill the Thick-It, no idea why, but it would get thinned out again very quickly.) I just split the soda between 2 bottles and then added the packet of Hormel Thick & Easy to each bottle. It kept DH happy for 6 months as he could go back to drinking his Coke. At 96, I was told to give him what he wanted.
Treatment was 14 days of Diflucan - which interacts with Coumadin and raised her INR dangerously high (therapeutic range is 2.5-3.5 and she was at 7.9, meaning her blood was REALLY thin), but we got that fixed with no ill effects, though I really wanted to wrap her in bubble wrap til her INR was down to therapeutic range!
Just wanted to give you another possibility - when she mentioned her dysphagia my mind went to aspiration or esophageal stricture (her mother and sister both had to have surgery to dilate their esophagus), but it turned out to be something completely different that could be fixed fairly easily.
The caregiver should be right there (if this in home-care) while your Mother eats; not doing anything but watching over your Mother.
My Mother is in an assisted living group home; the caregivers are in the dining room for every single meal just for this reason.
Have the calcium tablet grounded and mixed into her food or give her a calcium liquid, these are flavored so she will think she is drinking orange juice.
Test to see if she does better using a straw (bending one). Smaller sips are better than her trying to 'gulp'.
Cut her food into toddler size pieces or even mash things like vegetables. It's a horrible thing to see or have to do, but your Mother has become a child again.
Swallowing reflex requires adaptation
2. Begin putting most foods into a blender, avoid chunky or "dry" foods like sandwiches, crackers. Serve more soups and stews. Cut up all foods into very small bites and supervise as they are eating. It was explained that due to the dementia, the signals from the brain to the muscles in the tongue are delayed creating the problems with swallowing and that exacerbates the choking and coughing.
They told us do not let her drink while she eats and to make sure all food is out of her mouth before she drinks. She shouldn't lie down for 30 minutes to an hour after she's eaten. We also had to puree and use thickening agent for the food. I hope this helps.
My Father failed his test and had a feeding tube put in, which he promptly pulled out (Alzheimer’s). My adopted Papa (Parkinson’s) is now having trouble swallowing, but his doctor knows he doesn’t want a feeding tube, so he is going with quality of life over quantity, since food is one of Papa’s few enjoyments left. We have eliminated some foods and cut others into very small pieces, but he won’t use thickeners at all.
I wish you calm during this journey.
"I am once again amazed that so many folks are experiencing the same issues and that this is yet another common symptom. Why are there so few hospitals and doctors who can prepare us for these things??"
It has been my experience that nobody ever prepared me for any of it; the doctors treated the symptom of the moment and social worker pushed the idea of a facility and the home care company sent me workers who had no clue how to manage or were seniors themselves and shouldn't have been undertaking heavy physical care. I've had to educate myself, that's how I found AgingCare.
KayDoubleU said
"It is pretty tragic and that’s basically I guess they end up starving to death slowly.?"
It's a lot more complicated than that but I guess it is essentially true, my mom has no desire for anything and barely eats now, I'm amazed that she keeps hanging on. I prefer to think of it as fading away....