Mom is in stage 5-6 Alz and is living in assisted living with my dad, who is also stage 6 alz. She is starting to cough a lot while eating. Today, the nurse told me she has started vomiting about every other day. This has been a problem for a while now with Mom, but the frequency is now increasing.
I've been trying to follow-up behind the nurses to make sure Mom is getting her teeth properly brushed and flossed, as the dentist warned me about her dental hygiene and plaque. But for the last several months, brushing has been getting really hard. When I brush the back or inside of her teeth, she gags. And sometimes/many times that turns it vomiting.
Has anyone had experience with this? What do I do? Do I give up on brushing? What does everyone do when their loved one gets to this point? I've read that gum infection and poor dental hygiene can be dangerous. I'm also having a hard time not throwing up myself when this happens. But I don't want to neglect her care. Also, will she start to lose weight from all this vomiting? She already is thin and frail.
Alz caregiving is so tough.
They also have those soft disposable foam mouth swabs for comatose patients you could try . Yes Mom can lose weight from vomiting .
My late husband(who had vascular dementia)had aspiration pneumonia and his doctor said because of his dementia that his brain was forgetting to tell his throat to close when he was eating or drinking, thus allowing it all to go into his lungs and not his stomach.
And yes my husband almost died from it and developed sepsis and septic shock leaving him completely bedridden and under hospice care for the last 22 months of his life. It's nothing to mess around with.
I would make sure that all of her foods are now pureed and her drinks thickened with the product Thick-It.
And as far as the brushing of her teeth goes, I personally wouldn't worry about it at this point as I think there comes a point as the disease of dementia progresses that one has to pick their battles carefully and I don't think brushing her teeth and making her vomit is a battle worth fighting at this point. Otherwise just get her front teeth best you can.
Please have your moms doctor order a swallowing test for her ASAP.
And as the others have already pointed out she needs a swallow evaluation ASAP, she almost certainly needs a modified diet.
https://www.agingcare.com/articles/dysphagia-how-to-help-a-loved-one-eat-and-drink-safely-187010.htm
https://www.agingcare.com/articles/swallowing-disorders-tips-for-using-food-and-beverage-thickeners-208048.htm
You may be needing to make some decisions in the near future as to whether to include tube feedings for your mother, or request Hospice or Palliative care. In some cases this marks the beginning of the end with either choice as tube feedings lead to pulled tubes, infection, diarrhea, bed sores.
Swallow deficits are often checked by OT personnel and they may in some cases even make home visit.
Tam Cummings assessment tools/AD checklist
https://tala.org/wp-content/uploads/2019/04/Tam-Cummings-LLC-Handouts.pdf
Your dentist is insane. Seriously your mother has stage 6 Alz I think worrying about plaque build up is ridiculous. Skip the flossing and try and brush her teeth as best as you can without making her puke.
They are foam and very slightly ribbed so they can be used for any number of things.
Clearing food from the area between the gums and cheeks. (Many people begin "pocketing" food)
The swabs can be used to brush the teeth and the roof of the mouth. BUT if this causes her to gag and begin to vomit stop. Vomiting can lead to aspiration pneumonia.
And getting to the fact that she is vomiting...is she having problems swallowing liquids or is it food? If it is liquids they may have to be thickened. With dementia often the body can not close off the trachea when swallowing so food enters the lungs. I hope the food is being cut into pieces or possibly even pureed if needed.
I think at this point you no longer have to worry about dental hygiene.
I doubt that she would sit still or be compliant for any dental work anyway. (Heaven forbid that the dentist suggests pulling any teeth! Trying to care for mouth wounds, any wounds on someone with dementia is almost impossible without them picking, poking and doing all sorts of stuff. Not even going to get into anesthesia and dementia
But I agree!
i think it's best to brush what you can without hitting the gag reflex button and leave the rest.
My mother was vomiting quite a bit towards the end of her life in Memory Care Assisted Living too. She had very bad GERD and I had to insist her PCP switch her to Prilosec which did the trick. She had been taking some mild stomach med that was doing nothing for her situation but making it worse. I have no idea if your mom is suffering GERD or something else entirely, but if you think so, speak to her PCP. You know her history and we do not.
Mom had a bad case of pneumonia in 2019 which docs thought was aspiration pneumonia, but a swallow study showed it was not.
Wishing you the best of luck with all of this.
I'm right in the middle of The Silent Generation (YOB 1937). We were a small cohort to start with. Not many of us may see our 90th b'day. That may not be the case for millions of the Baby Boom generation, yet society is no better prepared or equipped for them to reach old-old age than it was for us Silents. Some politicians are looking for ways to CUT Social Security and Medicare. A growing number of homeless Americans are 55+. Now THAT is scary--or should be!
Give mom the toothbrush and let her do the best she can.
Can she rinse and spit? If she can do that, she can use a fluoride rinse that will help. Not as good as brushing, but better than having acidic stomach acid on your teeth.
Perhaps use a soft cloth over your finger and slowly go over the teeth to remove residue. Or, you might get creative and adapt a toothbrush to something with a wider, softer feel. Maybe by cutting a child's toothbrush bristles very short and/or putting a soft, disposable terry cloth strip around it.
If mom can adjust well to a modified "brush," then you can try slowly increasing her sensitivity levels. But at this stage in her life, maybe just going over her teeth with a gentle "swab" is the best you can do. Even using Q-tips, maybe, or larger cotton swabs, if that's what helps clean while not provoking any bad reaction.
That's just what I'm thinking here and what I might try with my own mom.
Don't they make "finger brushes" for teeth, like the ones for pets.? That could be something to try.
I love that your mom still understands and assents to having her teeth brushed. I did similar things with my grandmother, who was well into dementia when I was her caregiver, but she appreciated having her hair and nails looked after, and I did what I could for her and stopped if she showed discomfort. But mostly, she liked the "self-care," and I was happy to give her that care. I don't see teeth-brushing as so different here; it's just that the serious and problematic gag reflex must be considered and medically assessed. Flossing and rinsing are probably "out" at this stage of life. Making loved ones feel cared for and getting creative in how you handle their care is always the challenge of caregiving to elders, imo.
That being said, if she doesn't mind the attempts at tooth brushing/flossing you could try the little brushes that fit between the teeth, if you haven't already. Some of these are short handled, but I have a long handled one that you change the little brushes out on the end. I can clean behind my back teeth with it without shoving a big brush back there. I order the brush refills online from amazon as they are not avaiable here locally, but the short-handled ones seem to be everywhere. Or you say she tolerates the flossing well- just continue that and let brushing go.
Good luck finding a solution. Yes Alz care is tough and heartbreaking. My heart goes out to you all.
FOR PREVENTION: not giving foods that tend to get stuck between her teeth or adhere to her teeth
Possible culprits: cottage cheese, scrambled eggs, tuna, chicken or meat unblended fruit and vegetables chocolate peanut butter tahini. So instead of cottage cheese I give her protein yogurt and instead of omelets I make hard boiled eggs and blend them and also blend salads and soups (with meat)
Avoiding sweet foods.
FOR ORAL HYGIENE
1.Mouth swabs dipped in water or salt solution (1 tsp salt dissolved in 1 cup water) Also cleaning in the pockets between the teeth and cheek Can be purchased on line
2 Very gently cleaning between teeth and around tooth-gum interface with a rubber tipped gum massager or a very narrow toothbrush Take care not to cause bleeding
3 Gently using a children's small electric toothbrush on low setting
4 Using a mild toothpaste i.e.. children's strawberry flavor
5 If she can't rinse her mouth not using toothpaste just dipping the toothbrush in water or salt water
6 WITH CAUTION because this can be dangerous (CAUSE ASPIRATION) if she has swallowing difficulties
Use a small syringe( 1 -5ml without needle) with a cup of water to rinse teeth and pockets between gums and teeth Start with very small amounts (1 ml at a time to see if she can handle it.. This is like a very gentle, manual, water pick
and although my Mother also coughs when eating she can handle this when its done gently .
Your parents are truly blessed to have such a caring daughter
Wishing you happiness good health and fortitude and remember you can only do your best and your best is a lot!
We ignored her teeth for a few years because she was on a feeding tube so teeth slipped my mind! I eventually took her to a hospital clinic for all types of people (even children) who needed to be put under anesthesia, That's when we had major dental care to do. In the meantime, take care of the basics, without causing her discomfort. Good luck and be strong.
As others have said, Mom needs a swallow eval and it may be time for pureed foods.
To my mind it makes absolutely NO sense to prolong the existence (IMO, it's no longer "life" at some point) of old-old, very ill people approaching EOL who are more than ready for their Final Exit. I hope your situation can change for the better.
Since she is coughing a lot and having vomit - please ask the doctor to have her swallowing evaluated by a speech therapist. She may not be able to swallow well and food may be going into her airways and lungs rather than her stomach.