Dementia and dysphagia – SLTs have a vital role

It is important that people affected by dysphagia, difficulty in swallowing, receive professional support as soon as possible.

Patients following a stroke, those who have motor neurone disease, Parkinsons, Multiple Sclerosis, and people with dementia, can experience swallowing difficulties, as well as other symptoms.

Dysphagia can vary in its severity. When mild, people report a feeling of food taking longer to pass through the oesophagus. This can be painless and liquids may well cause no problem.

When severe, it can mean both solids and liquids do not pass at all down the oesophagus.

Difficulties with eating, drinking and swallowing are a recognised challenge for people with dementia, particularly in the later stages. Steele et al (1997) found 68 per cent of those with dementia in care homes to have dysphagia.

The Royal College of Speech and Language Therapists (RCSLT) is running the Giving Voice for People with Dementia campaign to improve the quality of care received by people with dementia, their families and their carers. People with dementia and their carers have a range of needs in communication, safe eating and drinking which should be met by individuals with the appropriate clinical expertise or those who have been trained by people with that expertise

The RCSLT calls upon Governments, commissioners, budget holders and care providers to:

• Recognise the communication and eating, drinking and swallowing needs of people with dementia

• Ensure people with dementia have access to the speech and language therapy services they need in hospitals, care homes and in their own homes

• Set the highest standards for the education and training of health professionals, residential and home care staff to understand the communication difficulties experienced by people with dementia and their carers, and to ensure they have the professional speech and language therapy support they need

• Provide education, support and training for health professionals, care home and agency staff to identify the early signs of eating, drinking and swallowing difficulties, and meet the nutritional needs of people with dementia.

Working closely with people with dementia speech and language therapists (SLTs) work with people with dementia who have difficulty with everyday conversations and eating, drinking and swallowing difficulties to:

● Assess a person’s communication and their eating, drinking and swallowing abilities and needs

● Provide 1-1 or group therapy to help the person and their carers maintain the best possible communication

● Provide personalised eating and drinking plans to help the person and their family make the most of mealtimes

● Provide training and practical resources to help communication and / or eating and drinking to anyone living with, working for or providing a service to the person and their family.

SLTs provide services in a wide range of settings, including a person’s home, day care, hospitals, local authority and private care homes – wherever the person requires speech and language therapy support. Some SLTs work in Community Mental Health Teams or Psychiatry of Old Age Teams.

Supporting individuals:

Margaret was coughing when drinking and was embarrassed to attend the local Dementia Café. Following an SLT assessment:

● Margaret was given a thickening powder to add to drinks and was shown how to change her head position to reduce coughing

● Staff at the Dementia Café were given training and advice on how they could prevent Margaret from coughing while drinking

● Margaret was happy to return to the café to meet friends and get all the other benefits available there.

Managing symptoms

Billy kept getting chest infections. GP referral to a SLT:

● Revealed Billy had difficulty swallowing

quickly for drinking

● Led to Billy getting thickening powder for his drinks

● Four weeks later, Billy had no further chest

infections.

Nancy’s GP was concerned she was losing weight and struggling to take her medication. An SLT assessment showed Nancy had difficulties chewing and as a result was eating a lot less.

● The SLT gave Nancy advice on changing her diet to softer foods and asked the doctor for medication in syrup form.

● Nancy was able to eat more normally, regained weight and benefited from her medication.

For more information visit the RCSLT website www.rcslt.org