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Dysphagia and Thickener.......We have tried different things told to us by hospice and others but just having to figure out how to get my husband to drink and eat. The consistency of everything is HUGE. He can chew and swallow but everything hangs up in his esophagus. It is heart breaking to watch him cough and choke. My caregiver saved his life twice because food was hung up. Any tips from anyone.....

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Small meals more often with tiny spoonfuls, and slowly. And as Grandma1954 said, play around with the consistency, in his case perhaps thinner might be better than pudding thick. But do understand that his wanting to stop eating may be in the future and that its okay to allow that, just continue to offer the things he likes if he wants them and stop when he has had enough.
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cwillie Jun 19, 2024
I want to add to my post - having food get "hung up" in the esophagus makes me think he is getting a second, third and fourth bite before he has managed to completely swallow the first one, he shouldn't get another bite until you have observed him actually swallow the first.
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I can only guess that perhaps you are making his drinks too thick, thus why it's coating his throat.
Have you tried making his drinks a little less thick so he's better able to swallow it? If not please try that. (I used the product Thick It with my late husband)
Also I would only be feeding him pureed foods, and nothing but pureed foods. That way he will be less likely to choke on any of it, and there won't be anything to get hung up on his esophagus.
Best wishes.
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It worries me how in your profile you say your husband is 10 yrs into AD and declining swiftly, but "physically he's in good shape". A swallowing disorder that goes with AD and dementia is a huge sign that your dh is not physically in good shape anymore either. With hospice on board, it may be time to stop feeding him now. Has this been discussed? If not, now is the time to have that talk.

I'm sorry you're both going thru such an ordeal.
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I had to "play" with the thickness of liquids I was thickening for my Husband.
Towards the end the lemonade, iced tea and other drinks were thickened so they were like thick pudding.
You might have to do the same thing and see what ratio of thickener to liquid is best.
AND you might also want to try a variety of temperatures.
It might be that a hot or cold food might go down easier because the throat recognizes that there is something there to swallow. Where a room temperature liquid might just sit there because his body does not know to activate the muscles to swallow.
This is just a thought....
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Reply to Grandma1954
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Only a swallow eval with imaging would give you the picture of what is happening . It sounds as if his esophagus may no longer work properly and it is getting worse which can happen with Alz/dementia.

Since he is on hospice and it is determined a short life expectancy , this swallowing problem getting worse is not rare .

I’m sorry this is difficult .
(((hugs)))
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Reply to waytomisery
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I have not experienced this, but I think I would find it very scary!

Is the esophagus not working to push food down to the stomach? Please see his doctor, or the doctor may make a referral to a speech therapist. They can do swallow test imaging and determine what you need to do for safe eating.

If it is simply a consistency issue, I have tried several thickeners sold in drugstores, and many are essentially cornstarch, and create a pasty consistency. Yuck!
I use something called "Thicken Up" made by Nestle. Or Thick & Clear, which is a hormel product. I only use it to thicken liquids. You probably don't need to use a thickener in foods. Just make sure foods are the consistency of pudding, applesauce, or pureed with a little liquid to help it slide down the throat better.

Depending on his overall condition and life expectancy, you could ask the doctor for a referral to a gastroenterologist, who can place a feeding tube directly into the stomach. This requires x-rays, surgery, and fasting before and after tube insertion. So, if he is already nutrient deficient, consider whether it is worth it. With a feeding tube, you can administer a high protein formula directly to the stomach to give his body what it needs to be strong.

You say hospice has given advice. If he is near end of life, then not eating is normal, and is your first clue the end is coming.
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Grandma1954 Jun 19, 2024
Patient on Hospice. No therapy or referral to a doctor unless the family wants to withdraw from Hospice then come back on. My feeling is if the patient is on Hospice they will not be able to participate in any therapy
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Also this WARNING:

If this is end of life care and these thickeners being added and food forced then this is going to be a good deal quicker (if not more pleasant) final exit.
This food is going to get stuck with this stickener, unable to move and either cut off the airway or going to go into the bowel where it will turn to a cement like obstruction that will have more and more fluid removed from it by the bowel, making it harder and harder to move. The result will be killing the person.

You may be making one deadly cocktail her for the person you love. Discuss with Hospice. Stop trying to push foods and fluids, thickened or not.
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waytomisery Jun 19, 2024
Exactly , ask hospice , it may be time to stop food and fluids .

My step mother in law with dementia and significant problems swallowing refused puree foods. She insisted on eating sandwiches . She was in the hospital for the seventh time in less than a year for aspiration pneumonia . While in the hospital her daughter brought her the sandwich she requested and the mother proceeded to choke to death .
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You need to be very careful with this stuff just as with metamucil or citrucel. People can die of it being too thick and sticking in throat. Also it can rarely cause abdominal obstructions, building into a bank of it stuck in the intestines.

Speak with the doctor. Follow the directions. Don't give if the person cannot handle it. You would then have to make the choice whether to move to tube or not.

Even using thickeners is VERY DANGEROUS FOR SOMEONE WHO HAS SWALLOW deficit.
Talk to the MD before proceeding.
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I appreciate everyone's thoughts. We are using 1 packet of #2 thickener for 16 0z of water and it still coats his mouth and throat after a couple of days....it takes a few days and then we use suction. Of course we cannot get into the throat where it must be terribly thick. He eats pureed foods just fine it is only the thickened water.
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funkygrandma59 Jul 6, 2024
phoward51, have you ever tried the thickener called Thick-It? That is what I used for my late husband after he almost died from aspiration pneumonia, and you can thicken his drinks as much or as little as necessary. And he never had an issue with it.
I'm not familiar with what you call #2 thickener that comes in packets, but if that doesn't seem to work well, I would suggest trying something else.
I find it hard to believe that hospice hasn't been more helpful with this issue as I'm sure it's something that they deal with all the time.
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There are several formulas on the market. The thick it is made from corn starch.

There are a couple with xantham gums that my dietician friend recommended.

Try several formulas. Read the ingredients.
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