Swallow Safety and
Aspiration Precautions

For persons with dementia, sometimes getting them to eat enough and consume food and liquids safely is challenging. It’s important to implement specific precautions with your loved-one to ensure safety when swallowing food, liquids and taking medications. These precautions are utilized because often, the person with dementia is at risk of having food travel into the lungs, developing pneumonia or respiratory problems, choking hazards, dehydration or malnutrition. Below are some guidelines we recommend to provide a means for safe adequate oral nutrition and hydration.

1. Positioning upright at 90 degrees for meals and medication, up in a chair is optimal.
2. Stay upright at least 30 minutes after meals.
3. Elevate the head when in bed, never lay flat.
4. Follow the recommended food texture and liquid consistency from the physician, speech pathologist or dietitian. This may include foods that are ground, chopped or pureed. In the latter stages of dementia, or disabilities with co-existing medical conditions, foods may even need to be liquefied to be taken safely. Liquids, may need to be thickened to a consistency like “nectar” in order to minimize the risk of aspiration. Always follow physician and dietitian orders for any restrictions to the diet, examples include limited salt, reduced sweets, or protein restrictions.
5. Encourage small bites and small sips, slow pace with eating.
6. Crush medication in applesauce when talking pills becomes difficult or unsafe.
7. Stop if coughing and/or difficulty with eating increases. Never offer anything by mouth with someone who is unable to “attend” to you and safely participate in the task of eating.

Other Safety Considerations:

• Supervision with eating, never eat alone if possible.
• Avoid distractions when eating, like the TV, even too much “talking.”
• Keep foods moist, avoid “dry” or “flakey,” avoid “pasty” or “sticky” foods.
• If the person develops a cough, fever, or feel like they are getting ill, contact your physician.
• Keep a food diary to make sure they are eating enough and eating the right foods, if intake is poor, use supplements and snacks to increase calories.
• Supplements include blended “smoothies,” snack size desserts, yogurts, and other commercial products. To check our recommended list, click Sources.