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Residents with dementia who are holding food in their mouth or chewing for prolonged periods of time

Advice for care homes.

Speech and language therapy get lots of referrals from care homes about residents who are holding food in their mouth or chewing for protracted periods of time before swallowing.

Unfortunately, this can be a common behaviour in people who have dementia.

If you have a resident who is having these difficulties we would suggest that you try the
strategies below:

Strategies

  • Reduce distractions at mealtimes to facilitate concentration and awareness (clear clutter from the table, ensure the atmosphere is calm, avoid unnecessary interruptions)
  • Use verbal prompts to remind the person to swallow
  • Allow plenty of time for meals. Consider the use of insulated containers to maintain the temperature of food for those people whose mealtimes may be prolonged.
  • Try offering more intensely or highly flavoured food and drinks as these can sometimes stimulate a more effective swallowing reflex.
  • Offer an empty spoon or fork towards the mouth to remind the person they need to
    swallow
  • Try ‘hand under hand’ or ‘hand over hand’ feeding techniques, monitor effectiveness
    and note the person with dementia’s preference for technique.
  • Try alternating temperature within a meal – for example try interspersing a hot meal with a chilled drink or vice versa.
  • Ensure the mouth is clean and free from residue at the end of the meal. Encourage a
    ‘clearing swallow’ or ‘saliva swallow’ to assist in clearing residue from the mouth.
  • Cleaning teeth and the mouth at intervals during the day is advocated.

Warning

If your resident is experiencing any of the following symptoms, you should refer them to speech and language therapy without delay:

  • Coughing and/or choking during or after food or fluids
  • Showing other signs of risk of aspiration (food or fluid particles going the wrong way
    into the lungs) such as a hoarse, wet-sounding or gurgly voice
  • Recurrent chest infections where aspiration may be the cause

If you still have concerns, or wish to discuss any of the above please contact the adult
speech and language therapy service on 01642 854497.