Helping a Person Eat and Drink in Late Stage Dementia

so the first thing I'm going to do is make sure Lynne's mouth is moist because if she's at this point in the disease she isn't going to get fluid at any point other than when I'm offering her fluid and typically if we're talking about a meal it's been a while since she's had a little bit of fluid and often people are mouth breathers or even if they're no nose breathers they're marginally hydrated so what I want to do is introduce the fluid and what I'm going to do is I'm going to hold it up close my hand goes over the shoulder to create that connection and I'm going to bring up a little bit and what I'm watching for is how quick her swallow was how complete her swallow was I bring the liquid up to her lips and she puts it in so as I do that what I'm looking for is did she do a swallow right away or did she hold the fluid in her mouth so what you saw so far is lynn was swallowing right away what we're going to do now is I'm going to show you what happens when Lynn doesn't swallow right away she didn't swallow it still in her mouth I'm going to bring the cup up again like she's going to get a swallow but this time I don't give her any and she swallowed it's called a dry swallow so I actually tricked her brain into swallowing because she thought something else was coming and when it got there her brain went oh I still got something here and it got rid of it and she actually did a follow-up swallow because her brain realized it wasn't that complete so I always need to be paying attention to a someone this late in the disease not getting curious about what's happening around the room that's not my job my job is to really focus in because every swallow I put in I better know where it went because in the late stages when someone's a ruby or a pearl there's a possibility their brain gets turned off turned on and what happens is they go to swallow and they forget to swap cause they get busy doing something else and so the liquid sits there and then the brain goes I need to breathe and yet it has liquid sitting right there and so there's a very high risk for aspiration pneumonia and an aspiration pneumonia is what leads to infections leads to infections is what leads to a downward spiral and the use of antibiotics which then causes other problems so until we truly are getting to the very end where there's nothing else we can do we need to be careful that we're doing all that we can do to reduce risk they'll come a time when nothing we can do will make a difference we can thicken this we can change this the problem is not us and what we're trying to do the problem is the body is failing because the brain is failing and that's when we have to learn the art of letting go so I could have thickened liquid it won't matter at some point what I want to do is even as we're thickened when I put it up here and I go to have Lin drink it she does this and then she starts okay so I'm getting a coffee it's a weak coffee it's a little coffee okay so now this would be the time to think about do I need a speech consult do I need thicken liquids will she take thick and liquids now we try that maybe that buys us some time because maybe it's just the thin liquids they tend to be the fastest thing that causes problems we certainly want to move away from any soup that has objects in it and just use a pureed soup a thickened soup a soup that's got just one texture at a time but we thickened it it is thickened and when I do it even with thickened slow she's holding it okay I have to decide now with thicken if I keep doing this I'm increasing the risk with every swallow that some of its going into her lungs there's nothing she can do there's really nothing more I can do the question is what advance directives has she given us what kind of conversations have we had with each other so that we're getting ready to say okay this isn't working anymore I can see whether or not when that happens if we move to things that have a lot of liquid in them but they're viewed as the brain by the brain as more of something that you eat maybe that will work we can try it we want to start typically with things that have some sweet in them because sweet is what the primitive brain still recognized as ooh this could be good what I want to figure out yeah pretty good huh yeah that's tasty you're liking that yeah now notice that with each bite her swallows getting a little brisker and she's doing a pretty good job of enjoying it so now I know hmm liquids out but puree in I want to now have a conversation with everybody involved how can we get enough hydration in her puree to abandon the liquid idea and switch to total puree and that's where the liquids are going to come I've got to hydrate her through this not through fluids because it doesn't work anymore you

Channel: Pines of Sarasota

Views: 148,005

Rating: 4.9175258 out of 5

Keywords: dementia, alzheimer's, alzheimers, teepa snow, caregiver, care

Id: sNPAESrllgQ

Length: 6min 12sec (372 seconds)

Published: Mon Jun 06 2016