As a physical therapist who has worked in many care settings, I have had the honor and pleasure of working alongside countless talented and experienced speech-language pathologists. I can speak firsthand to how valuable they are, not only in helping people regain or maintain communication skills, but also in guiding safe, dignified care when swallowing becomes difficult. Their expertise in assessing, managing, and adapting mealtime routines is truly life-changing for the people they serve and for the caregivers who support them.
Caring for someone with dementia means adapting to many changes, some you can prepare for and some that appear suddenly. One of the most concerning changes is when eating and drinking become difficult. You might notice coughing during meals, food lingering in the mouth, or a reluctance to eat. These can be signs of dysphagia, a swallowing disorder that is common in later stages of dementia.
Dysphagia is not just frustrating. It is a serious safety concern. Without proper management, it can lead to choking, aspiration pneumonia, dehydration, and malnutrition. The good news is that with early recognition and professional guidance, you can help the person you care for continue to eat and drink in a safer, more comfortable way.
Why Swallowing Becomes Difficult in Dementia
Swallowing is a complex action involving muscles, nerves, and reflexes that dementia can gradually affect. As the brain changes, it can disrupt:
• Coordination of chewing and swallowing
• Awareness of food in the mouth
• Timing of the swallow reflex
• Control of breathing while eating
The result is that food or liquids may go “down the wrong way” into the airway instead of the esophagus. Sometimes the person may not even cough to alert you, a phenomenon called silent aspiration.
The Role of a Speech-Language Pathologist (SLP)
When swallowing issues appear, a speech-language pathologist is one of your most important allies. Despite the name, SLPs do far more than help with speech. They are specially trained to assess and treat swallowing disorders.
Here is what an SLP can do for the person you care for:
• Conduct a thorough swallowing assessment, which may include a Modified Barium Swallow Study or Fiberoptic Endoscopic Evaluation of Swallowing
• Recommend the safest food and liquid consistencies
• Teach you strategies to reduce choking risk
• Provide exercises to strengthen swallowing muscles if appropriate
• Work with you to create a mealtime environment that supports safe eating
Signs It’s Time to Seek Speech Therapy Help
If you notice any of these, ask the doctor for a referral to an SLP:
• Frequent coughing or throat clearing while eating or drinking
• Wet or gurgly-sounding voice after swallowing
• Food or drink leaking from the mouth
• Difficulty chewing or keeping food in the mouth
• Unexplained weight loss or dehydration
• Recurrent chest infections or pneumonia
Early intervention can make a big difference in comfort and safety.
Adjusting Food and Liquid Consistency
One of the most effective ways to prevent choking and aspiration is to change the texture of foods and thickness of liquids. The International Dysphagia Diet Standardisation Initiative (IDDSI) provides global guidelines for this.
Your SLP may recommend:
• Pureed foods that are smooth and lump-free
• Soft and bite-sized foods for those who can chew but need minimal effort
• Thickened liquids in nectar, honey, or pudding consistencies
Balancing Safety with Dignity and Pleasure
When swallowing becomes difficult, it is natural to focus on safety above all else. No caregiver wants to see their loved one choke or develop aspiration pneumonia. But safety is not the only value that matters. For many people, food is joy, memory, and connection, and in dementia care, those moments can be just as important as medical safety.
Some families choose to follow strict dietary modifications, keeping all foods within the safest consistency range recommended by the SLP. Others, after thoughtful discussion with healthcare providers, may decide to allow certain favorite foods or drinks, even if they carry a degree of risk. This approach is sometimes called risk feeding or comfort feeding.
If you are navigating this choice, here are some guiding considerations:
• Talk about values, not just risks. What brings the person joy? What memories are tied to certain foods?
• Modify when possible. Favorite dishes can often be pureed, softened, or thickened without losing all flavor and enjoyment.
• Make pleasure part of the plan. If ice cream is their favorite, serve it when they are most alert and able to swallow more effectively, and in small, manageable spoonfuls.
• Collaborate with professionals. An SLP and doctor can help you understand the real level of risk and how to minimize it.
• Give dignity in the details. Serve meals attractively, even if they are modified. Offer choices, use pleasant dishware, and maintain mealtime rituals.
There is no one-size-fits-all answer. Your decision should reflect both the medical guidance you have been given and the life your loved one wishes to live. As one SLP told me, “Sometimes, the safest swallow is not the most meaningful bite, and we have to weigh both with compassion.”
Practical Tips for Safer Mealtimes
• Encourage upright seating at 90 degrees during and at least 30 minutes after eating
• Offer smaller, slower bites and sips
• Use adaptive utensils to promote independence and reduce fatigue
• Maintain a calm, unhurried atmosphere without distractions
• Gently cue the person to swallow before offering the next bite
• Keep emergency choking procedures in mind and accessible
Helpful Products for Safer Eating and Drinking
Texture Modification
SimplyThick Easy Mix Food & Beverage Thickener – blends smoothly into hot and cold liquids buy on amazon
Resource ThickenUp Clear – maintains clarity for better presentation and tastem
Ninja Mega Kitchen System – perfect for pureeing foods to a safe consistency buy it on amazon
Adaptive Drinkware
Provale Cup – delivers a small, measured amount of liquid with each sip
Nosey Cup – allows drinking without tilting the head back
Adaptive Utensils and Plates
Weighted utensils – reduce tremors and improve control
Plate guards – prevent food from spilling over the edge
These items can make mealtimes safer and more dignified, especially when paired with professional swallowing strategies.
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Closing Thoughts
Caring for someone with dementia and swallowing difficulties can feel overwhelming at times, but you are not alone in this journey. By partnering with skilled professionals like speech-language pathologists, using thoughtful adaptive tools, and making intentional choices about safety and dignity, you are giving the person you care for both protection and comfort. Every small adjustment you make at mealtimes is an act of love, and those moments at the table, no matter how simple, can still hold joy, connection, and meaning.
Notes
1. American Speech-Language-Hearing Association. Adult Dysphagia. Retrieved from https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/
2. National Foundation of Swallowing Disorders. Understanding Dysphagia. Retrieved from https://swallowingdisorderfoundation.com/
3. International Dysphagia Diet Standardisation Initiative (IDDSI). Framework and Testing Methods. Retrieved from https://iddsi.org/
4. Alzheimer’s Association. Eating and Swallowing. Retrieved from https://www.alz.org/help-support/caregiving/daily-care/food-eating
5.Cichero, J. A. Y., et al. (2013). Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: The IDDSI Framework. Dysphagia, 28(2), 132–152. https://doi.org/10.1007/s00455-013-9489-2
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Disclaimer
The information provided in this blog is for educational purposes only and should not be considered medical advice. Always consult with a doctor or a licensed physical therapist before starting any new exercise routine, using assistive devices, or following the recommendations mentioned. Every individual’s needs are different, and professional guidance is essential to ensure safety and appropriateness of care.
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