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First noticed pocketing a half year ago. It was occasional and a reminder seemed to do the trick. Yesterday there was an escalation. For what seemed like a long 2-5 minutes we couldn't get mom to swallow. Multiple reminders and prods failed to accomplish the task. Ultimately aid brought her to the bathroom and simply removed the food from her mouth herself. Already spoke to the geriatric doctor. We're going to feed her earlier in the day and see if giving her something yummy like chocolate pudding helps. I'm not looking to fix her but wondering how long a person can go on with sub-optimal nutrition. I plan to tell the aid that if she doesn't appear responsive to food not to force it and simply wait till the next meal to start again. Given the choice between skipping a meal and asphyxiation I'd prefer t skip the meal

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That episode where she couldn't swallow for several minutes and the aide had to clear her mouth sounds frightening. You're already doing the right things by talking with her doctor and moving meals earlier with softer food.

I'm a dentist and most of my patients live with dementia, so I see pocketing often. A few mouth-side ideas that haven't come up here yet:

- Check her cheeks after every meal and before she lies down. Food tucked in the cheek can slip back later and be breathed in, so a gentle sweep with a damp gauze or soft swab is worth making routine.
- Keep her mouth clean even on days she eats very little. Mouth bacteria are what turn an aspirated bite into pneumonia, so a soft brush or swab twice a day protects her lungs too.
- Ask the care team or a dentist for a quick mouth check. A sore tooth, loose denture, or sore spot can make someone hold food instead of chewing it.

I'd also ask her doctor for a speech-language pathologist swallow evaluation. They can tell you which textures and liquid thicknesses are safest for her now. Her doctor is also the right person for the nutrition question, especially if her intake keeps dropping.

Another episode where she can't swallow or struggles to breathe, or a fever or wet, rattly cough, means same-day care.

Checking her cheeks and keeping her mouth clean after meals is real protection for her.
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Reply to aamarodds
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Whatever you do, don’t force her to eat. She may be choosing not to eat or this is simply the end of her body’s journey. I don’t think many of us would choose to live in this state. I’m sorry, I know it isn’t easy to watch.
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Reply to ShirleyDot
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You don't mention what type of foods you are offering to her. If you are not already, PLEASE modify her diet. You do mention giving her pudding, so you may already be giving only soft foods.
Everything should be minced, pureed, or soft (like pudding). And someone should be feeding her, or at least monitoring her while she eats.

My husband has dysphagia, and I make him 12 cups of thickened protein drinks every day. I use 4 Boost, 4 cups of milk, 2 cups of water, a thickening agent (Nestle Resource Thicken-Up) and I add some instant pudding and a juice to create different flavors. Orange juice and vanilla is really good; so is Strawberry Banana. Instant chocolate pudding makes a nice chocolate shake.
This makes a yummy, creamy shake which he can easily swallow. It provides all the protein, calories, carbohydrates, MCT's and vitamins he needs in a day.
I totally agree with you, as I'm sure most doctors would, that skipping a meal is not as important as swallowing safely. Please avoid giving her any liquids which are not thickened.

As her body winds down, she may stop eating all together. The body can no longer process food when the end is near.
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Reply to CaringWifeAZ
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Mom lived for several years this way. We blendered all of her foods and thickened her waters.

You are right that she consistently did better earlier in the day for breakfast and lunch.
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Reply to brandee
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Another thing that might happen is that she might begin to let food dribble from her mouth. When this happens, they seem unaware. The explanation is that the pocketing is happening because they're no longer aware of how to swallow. Or even if aware, they can't make it happen, and the food flows out where it came in. I'd describe it as their brain has a blank space where the swallow instinct used to be. I doubt if they are even aware that food has been put in their mouth. Another symptom at this stage is coughing or clearing their throats, and often they'll bring up food at that time.

When all of these things come about, they are nearing the end. I see it a lot at my husband's memory care facility.
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Reply to Fawnby
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How about ice cream? That's the only food my Dad gets excited to eat and can swallow it easily. Plus Ensure chocolate drinks.
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Reply to ConstanceS
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People who are basically well can live for shortly after 60 days with no food at all. This was proved by multiple self-starving prisoners in Northern Ireland several years ago. The time without liquid is very much shorter.
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Reply to MargaretMcKen
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If she is having trouble swallowing she may need liquids thickened. I would ask her doctor how to go about this. Not done right, she good aspirate her food and then your talking pneumonia.

In 2024 you posted you thought Mom was in her 6th or 7th stage. That was 2 yrs ago. Not being able to swallow can be the body shutting down. Food nor water should be forced at that time. The body can no longer process it. It may be time for Hospice.
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Reply to JoAnn29
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I imagine you are pureeing everything at this point? Is she self feeding or is someone feeding her? When she's pocketing the aides shouldn't introduce more food until she's swallowed the last one, if she's self feeding then less food needs to be in front of her. The fact she's pocketing tells me she's taking in food and wanting to eat but the dysphagia is preventing her. . It shouldn't be a choice between food and asphyxiation, even very compromised people can eat if proper care is taken. It's surprising how little food someone inactive can live on, my mom's doctor said to try for 1000 calories and she lived that way for several years. This is what supplements like boost and ensure were designed for, the nursing home also gave high calorie puddings. Of course you can make your own high calorie smoothies too
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Reply to cwillie
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