Dad’s inability to swallow, the final insult

I think most people probably associate Alzheimer’s with memory loss and other manifestations of mental decline. And while certainly those would be the hallmark symptoms, the physical impact of this disease cannot be forgotten.

Despite being a lifelong smoker, dad was in pretty good physical health when his mental state began to decline. Sure, he had been diagnosed with COPD and emphysema, and he was having some mild prostate issues, but he had always been a lean man who enjoyed walking as a form of exercise. Frankly, I always expected lung cancer would be what claimed my dad’s life. But it was a cardiac arrest, along with pneumonia and dementia that secured that spot on the death certificate.

Dad had been put on medication for a bladder infection and that’s supposedly what knocked him out when he was transported to the new nursing home. We will probably never know what truly happened. What was quickly determined at the hospital where he ended up was that he was having difficulty swallowing. The palliative doctor explained to us that the act of swallowing actually consists of many complex processes that the brain must execute, even though to us, it seems automatic. As anyone who has dealt with Alzheimer’s and dementia knows, difficulty swallowing can lead to aspiration pneumonia.

Before the hospital was able to conduct the swallow test, the dietary staff would still bring dad full meals, which just set there on the tray, growing cold and congealed. Turkey medallions and mashed potatoes and carrots. All things dad would have loved if he had been more lucid and able to eat properly. Instead, he was given water mixed with honey, and he struggled to suck up the sugary dredge in the straw.

I actually watched one of the swallow tests performed on dad. There was a cup of water, a cup of juice, and a small container of applesauce. Dad struggled physically to swallow, but also most importantly for rehabilitation purposes, failed to follow directions. That’s the irony for those with dementia. Some of their physical symptoms might be alleviated via rehab, but they make poor rehab candidates because they can no longer follow simple commands.

Once the ability to swallow is lost, then the discussion of the feeding tube comes. Dad had one for a short amount of time, but we then opted for the palliative approach, which was focused on hand feeding. Yes, this increases the risks of aspiration pneumonia, but if it can give the patient a moment of faint, if fleeting pleasure, then so be it in my opinion. I’m not sure if dad enjoyed the bits of scrambled eggs and other soft foods that a stranger fed to him over the last weeks of his life, but a tube would have just been prolonging the inevitable, a cruel extension of a life that had already been stolen by this terrible disease.

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