Dysphagia - Nutritional Concerns

Sound nutrition plays a critical role in your care recipient's health and well-being. In addition to meeting basic physical needs, eating is generally a pleasant activity, and mealtimes are often opportunities for relaxation and social interaction. But if your care recipient suffers from dysphagia, eating becomes difficult, stressful and possibly even dangerous. Aside from losing pleasure in eating, your care recipient is also at risk of malnutrition, dehydration and, if the food is aspirated - it passes through the bronchial passage rather than the esophagus - choking or an infection leading to pneumonia can follow.

Dysphagia is a swallowing disorder in which the reflexes that control chewing, swallowing and guiding food and water safely and efficiently from the mouth to the stomach become disrupted. There may be any of a number of underlying causes, including injury or illness affecting the brain, such as Parkinson's disease or ALS. For people with Parkinson's disease, the condition may interfere with the normal signals of swallowing sensations, and the care recipient may be unaware that food or liquid has stuck in the throat, or gone down the wrong way.

Feeding Tips

These tips may ease the strain your care recipient experiences when eating. Please keep in mind that these are general tips only. Your care recipient's doctor or therapist will provide specific information for your situation:

• Try to keep mealtimes quiet and relaxed. Avoid serving meals when your care recipient is tired or upset.
• Keep the lighting good so that your care recipient can see all the food items.
• Your care recipient should be sitting up for all meals, snacks and drinks. A pillow or a towel placed behind the head may be helpful in keeping the head pointed down so that the chin points towards the chest. You may need to experiment to find a posture that is comfortable and that minimizes head movements.
• Do not rush the meal times. Your care recipient should swallow each bite thoroughly before taking another.
• Your care recipient should remain seated for 20 or 30 minutes following a meal or snack.
• Small meals served frequently may be easier to deal with than larger meals.
• Soft, blended or pureed foods are generally easier to swallow. Avoid dry, stringy or tough foods. Steaks, chops and other 'chewy' foods can be ground up in a blender or food processor to make them softer.
• Avoid acidic or spicy foods - they may cause pneumonia if aspirated.
• Thickened liquids may be easier for your care recipient to swallow. Commercial thickeners can be added to produce the desired consistency without affecting the taste or nutritional value of the food.
• Solid foods should be cut into very small bite sizes.
• A flexible, one-way straw may be easier for your care recipient than a cup.
• Food that is attractive in color, texture, aroma, taste and temperature will help trigger the swallow response, appealing to your care recipient's sense of pleasure and quality of life.
• Start and maintain a food diary to keep track of details such as what foods were eaten, what foods or liquids proved to be problematic, and what methods of feeding have proved successful.

Symptoms

People with Parkinson's may have problems chewing and swallowing. Have your care recipient sit upright with the chin tucked in slightly. This position makes swallowing more natural. Eat in a quiet place where your care recipient can concentrate on chewing and swallowing. Cut food into smaller pieces or process into a coarse mixture that takes less chewing and is easier to swallow. Suggest small bites and lots of fluids between bites.

Don't fill cups, glasses and bowls too full. The thermos cups that are so popular just now are perfect for people with Parkinson's. They keep beverages cold or hot and the lids prevent spills.

Try to get cutlery with easy-to-grip handles. These utensils are less tiring to hold.

In the advanced stages of Parkinson's disease a low protein diet may be required. Pay close attention to foods high in protein:

• Meat
• Poultry
• Fish