Cognitive Impairment

• Patients with dementia may have difficulty preparing food and using utensils.
• Due to reduced attention, they are easily distracted by the environment and may forget to chew and swallow food.
• Food residue left in the mouth may slip into the throat, leading to aspiration and increasing the risk of choking and aspiration pneumonia.

Physiological Factors

• Most dementia patients are elderly, with poor oral and dental function, weak swallowing muscles, and slowed swallowing reflexes.
• A history of stroke or Parkinson’s disease may further cause swallowing muscle weakness and incoordination, increasing the risk of aspiration pneumonia.

Signs of Swallowing Difficulties and Feeding Problems

• Frequent throat clearing or coughing during or after meals: Due to weakened swallowing muscles, food residue remains in the oropharynx and is aspirated.
• Food residue in the mouth after eating: Poor tongue strength and control prevent food from being completely transported to the throat, leading to oral hygiene problems and increased risk of aspiration after swallowing.
• Weight loss: Swallowing difficulties may not be obvious at first, but weight loss can be a warning sign.
• Frequent pneumonia: Food or liquids may be aspirated into the airway, and if not effectively coughed out, aspiration pneumonia may develop.

How to Help Patients with Dementia Eat More Safely

Comfort Feeding Only
In recent years, “comfort feeding” has been recommended as a suitable feeding strategy for dementia patients. Its core principles include:

• Comfort-based stopping: When patients show discomfort or resist eating, feeding can be paused and the cause assessed. Adjust food texture, feeding method, or environment to improve comfort.
• Comfort-oriented approach: Use non-invasive feeding methods, reduce stress, and make the mealtime experience comfortable and satisfactory.

Adjust the Eating Environment, Timing, and Frequency

• Create a quiet, comfortable setting with good lighting, soft background music, and minimal waiting before meals.
• Serve meals when the patient is awake and willing to eat to reduce choking risks caused by drowsiness.
• If the patient cannot focus long enough to finish a meal, avoid forcing; instead, provide smaller, more frequent meals.

Eating Posture and Techniques

• Sit upright with the upper body at a 90-degree angle, chin tucked slightly downward, and head slightly tilted forward to prevent choking.
• Use verbal or gentle tactile reminders to encourage chewing and swallowing. Provide small bites, ensuring each mouthful is swallowed before the next, to reduce choking.

Modify Food Textures and Utensils

• Avoid sticky or hard-to-chew foods such as rice cakes, glutinous rice balls, or meat with bones.
• For patients with poor oral function, offer soft or finely chopped foods such as rice porridge, oatmeal, or fruit puree.
• For patients prone to choking, add thickening agents to liquids. Note that these are often starch-based, which may increase calorie intake, and silent aspiration remains a risk.
• Consider assistive tools such as bendable spoons, fork adapters, chopstick aids, curved plates, two-handled cups, or non-slip mats.

Pay Attention to Emotional State

• Agitation or anxiety may affect eating. Identify and minimize sources of discomfort so the patient can eat calmly.

Post-Meal Precautions

• Oral hygiene: For patients with swallowing difficulties or poor oral function, use a damp swab or oral care tools to clean the mouth, reducing the risk of oral infections and aspiration pneumonia.
• Avoid lying down immediately: Keep the patient upright for 20–30 minutes after meals to reduce reflux or belching-related choking.

Swallowing Assessment for Dementia Patients

• Eating difficulties in dementia patients may stem from cognitive problems or from impaired chewing and swallowing functions. A comprehensive evaluation is recommended.
• At a rehabilitation clinic, the physician will review medical history, medications, diet, and nutrition, and perform physical and neurological examinations along with a clinical swallowing assessment.
• If necessary, a videofluoroscopic swallowing study (VFSS) may be arranged to determine the cause of swallowing difficulties and to design an appropriate feeding plan or treatment.