Dehydration occurs when a person is either not getting enough liquids
(about six cups) daily or excreting too much urine. The body's
ability to detect thirst diminishes with age. Illness and
medication can also cause dehydration. A dehydrated person
may need help drinking from a cup or glass and have trouble
Signs and symptoms of dehydration
- Headache the most common symptom
- Dry mouth and tongue
- Cracked lips
- Dry skin
- Sunken eyes
- Nausea, vomiting, diarrhea
- Dark, strong smelling urine
- Weight loss
- Fast heart beat
- Low blood pressure
- Confusion, light-headedness
Use ice chips, popsicles, juice bars, gelatin, ice
cream, sherbet, soup, broth, fruit and vegetable juices,
lemonade and flavoured water to incorporate liquids
into the diet.
Chewing and swallowing problems
Chewing and swallowing problems (also called dysphagia) can
be life threatening for elderly people and people with diseases
such as stroke, cerebral palsy, Parkinson's disease, muscular
dystrophy, multiple sclerosis and dementia. The muscles of
the mouth and throat may no longer be working properly, so
bits of food and liquid will be aspirated or drawn into the
lungs. Other factors contributing to dysphasia could be level
of consciousness, medications, distractions and eating patters.
As the lungs' airways become blocked, the person will begin
to choke. For frail, elderly people, a choking fit can be
fatal. The aspiration of food and fluid into the lungs can
also cause aspiration pneumonia, a condition that is prevalent
in people who are in the final stage of dementia. Repeated
bouts of aspiration pneumonia will weaken a person's system
and may eventually cause death.
Chewing problems, specifically, may be related to missing
teeth and poor fitting dentures. Better dentures, proper oral
hygiene before and after meals, and regular dentist visits
may help minimize the problem.
of chewing and swallowing problems
- Extra effort chewing or swallowing
- Eating very slowly
- Packing food into the cheeks
- Swallowing several times for a single mouthful of food
- Shortness of breath during eating
- Coughing or choking while eating or drinking
- Fluid leaking from the nose after swallowing
- A wet-sounding voice after eating
- Increased congestion in the chest after eating
- Repeated bouts of pneumonia
If a parent is coughing or choking too often when eating and you are getting worried, ask the following questions:
- What type of food or fluid was he eating when the choking occurred?
- If the person wears dentures, were they in at the time?
- Was the person walking around with food in his mouth?
- Was he laughing or talking?
Record this information for a visit to the doctor.
How to assist someone
to eat and improve nutritional intake
- Ensure that foods are neither too hot nor too cold
- Feed attractive, tasty, pleasant-smelling foods to enhance appetite
- Use finger foods to encourage independence and safety
- Make sure he is ready to eat i.e. the dentures, eyeglasses and hearing aid are in place
- Try to make the eating environment quiet and inviting with as few distractions as possible.
Try playing some quiet music.
- Make sure he is seated correctly i.e. as close to 90 degrees as possible
- Try to tuck the chin under so it points to the chest (if necessary have the person in a
chair offering head support)
- Sit at eye level as you assist the person with eating
- Use a teaspoon to avoid putting too much food in the mouth at once
- Remind the person to chew each mouthful thoroughly
- Touch the person's lower lip to stimulate opening the mouth
- Massage the throat to stimulate the swallow reflex
- Take as much time as necessary to help the person enjoy the meal
- Ensure the person remains sitting in an upright position for at least 30 minutes after each meal
- Clean out the mouth after each meal
Feed small amounts of food first, then gradually increase
the amount as the ability to swallow increases.
If the person is not swallowing between spoonfuls,
put an empty spoon into the mouth to trigger the swallowing
Use wide, shallow glasses instead of tall, narrow
Never feed someone lying down if at all possible and
do not tilt the head back. If the person must be fed
in bed, prop up with pillows
Watch for foods that have a double consistency i.e.
anything with a skin such as peas, grapes. These may
be difficult to manage.
Do not wash food down with a liquid.
Do not use straws for chewing and swallowing problems.
Straws increase air swallowing and add to the number
of steps required for drinking.
If choking and drooling become excessive, contact a speech pathologist
or speech therapist to arrange for a swallowing test through
your physician or home care. The test is called a Videofluoroscopic
Swallow Study. While the person swallows liquids of varying
amounts and consistencies, the therapist watches a screen
showing which liquids proceed to the stomach and which are
aspirated into the lungs. If the test has to be done at home,
a therapist will observe the person eating and drinking without
the equipment. The therapist will then recommend appropriate
changes, such as changing the size of the spoon, placing food
on a specific area of the tongue and positioning the person
at a certain angle during or immediately after eating. The
therapist may also recommend a special diet.
Special diets may be recommended following a swallowing test.
- Minced diet
In a minced diet, all food is minced for easier chewing
- Pureed diet
A pureed diet may be the only alternative for a person with
dementia or severe eating and swallowing problems. Use a
blender or food processor to puree foods to the consistency
of baby food. Soft and smooth foods, such as applesauce,
puddings and eggs can be served in their normal form.
Thickened fluids may be recommended as a remedy to chewing
and swallowing problems. Natural thickeners include tapioca,
flour, instant potato flakes, oats and matzo meal. Thickeners
can be used in hot or cold fluids. Add the thickener gradually
until the fluid reaches the desired consistency.
Nutrition drinks and liquid supplements, such as Ensure,
can be used to supplement the diets of people who are having
trouble eating and drinking and not getting enough nutrients.
Fortified nutritional drinks such as Carnation Instant
Breakfast are a good source of nutrition and may be
cheaper than liquid supplements. Powdered protein
can also be used to make a high protein drink.
- Tube feeding
Tube feeding bypasses a person's swallowing mechanism and
delivers food and liquids directly into the stomach. The
tube may be inserted into the nose, for short-term use,
for instance, after surgery. Or the tube may be inserted
into the stomach for long-term or permanent use. In the
late stage of dementia, when swallowing difficulties and
loss of interest in eating become extreme, caregivers may
be asked to make a decision about tube feeding.
In making the decision to tube feed or not to tube feed,
caregivers may want to consider what the sick person would
have wanted if he or she were capable of making the decision.
Also, ask about the implications of tube feeding: Can
the body make use of the nutrition that is being provided
through the tube? Will tube feeding prevent aspiration
pneumonia? Will it lessen or increase the person's suffering?
Will it prolong the person's life? Is there an alternative
to tube feeding?
Complications associated with tube feeding
- Nausea, vomiting, diarrhea
- Constipation and cramping
- A swollen stomach
- Coughing, wet breathing, a feeling of having something caught in the throat
- Infection at the site where the feeding tube enters the body
- Clogged tubes
- Tubes pulled out by the person with dementia
- Aspiration pneumonia