Disclaimer: This article is for informational purposes only. It is not intended to replace medical advice offered by physicians. We recommend that all caregivers consult with and review the information with your physician and/or dietitian before providing a thickened fluid for the person you are caring for.

“Dysphagia,” or difficulty in swallowing can be a challenge affecting many seniors, particularly those with dementia. Caregivers may observe “choking” reactions, especially in consuming liquids. If remained unchecked, this can lead to dehydration or even “malnutrition” in dementia.”  This is why the use of thickeners has been used as a management strategy in dementia care.

Dementia & Dysphagia

The causal link between dementia and difficulties with swallowing, also known as “dysphagia,” stems from the neurological effects of dementia, as well as the general impact of the aging process.

As the body ages, so do the muscles of the pharynx and esophagus that facilitate swallowing. The risk of dysphagia among the elderly can also increase due to the development of illnesses that further impede the mechanics of swallowing.

Individuals living with symptoms of dementia experience both cognitive and functional decline which can include a decline in their ability to swallow food. This is in turn, can result in aspiration, where the food or liquid goes down the windpipe causing choking, coughing and, in severe cases, even infection and pneumonia.

What are Liquid Thickeners?

Liquid thickeners are exactly how it sounds. These are natural or synthetic substances we can add to food and liquids that make them thicker or more viscous in consistency. The goal is to make it easier for someone to swallow fluids and food. It reduces dehydration and risk for malnutrition; and make mealtimes less “frightening” and more enjoyable for the patient.

There are 3 general levels of consistency: mild (with a nectar/cream type consistency), moderate (honey type consistency), and extreme (pudding type consistency).

The use of thickeners may not always work as some patients may simply not like the thickened food. However, caregivers can try different types of both natural and synthetic food thickeners to test if any of these would work for the person they are caring for.

Alzheimer’s and Hydration

“Aspiration” occurs when the liquid or food goes down the windpipe causing the person to cough or have a choking reaction. With specific guidance from a physician or Nutritionist-Dietitian, thickeners are generally safe. However, when a client is experiencing dysphagia, the most important thing to watch out for is the patient’s weight and hydration level.

There are other reasons that may cause someone with dementia to not want to eat other than dysphagia. This can be tooth problems or loss of teeth which can affect swallowing. Certain medications, specifically those used for sedation can also cause dysphagia. Therefore, it is important to work with your client’s care team to explore the other causes. The “reason for the behavior,” and asking the important question of “why” the client is not eating or drinking.

A Person-Centred Approach to Using Thickeners

Knowing your client’s likes and dislikes, as well as the particular difficulties they face during mealtimes and with swallowing, is key to deciding whether a thickener can be useful. Best to consult with a professional to provide you guidance.  They can assist you with how best to use it, and which type would be of most beneficial to the person you are caring for.

Mealtime difficulties can sometimes be a matter of “meal confusion.” For example, presenting your client with several options to choose from can be particularly difficult and frustrating experience for someone living with dementia. Therefore, as caregivers, we need to try and understand the person we are caring for and explore several creative approaches to make meal time less of a struggle and a bit more enjoyable. This is what a person-centered approach is all about and why it’s a great strategy to help enhance the overall well-being of the person you are caring for.