My relative chokes a lot. What is dysphagia and how can I help?

My mother-in-law chokes almost every meal, even with water. I've had moments of panic thinking she was going to suffocate. Is this normal with dementia, or do I need to do something about it?

Frequent choking is neither "normal" nor something to ignore — it's a warning sign that deserves attention. It's called dysphagia (difficulty swallowing) and is common in moderate to advanced stages of dementia, but there are concrete ways to make mealtimes safer.

What is dysphagia?

Dysphagia occurs when the muscles and nerves involved in swallowing no longer correctly coordinate the path of food or liquid from the mouth to the stomach. Instead of going down the oesophagus, some food may enter the airways — this causes choking and, in repeated cases, can lead to serious respiratory infections (aspiration pneumonia).

Warning signs to look out for

• Coughing during or after eating/drinking: even if it seems mild, it's an important sign.
• "Wet" or hoarse voice after swallowing: may indicate that liquid has remained near the vocal cords.
• Refusal of certain foods: often the person instinctively avoids what is most difficult for them to swallow.
• Excessive time chewing or swallowing: or holding food in the mouth without swallowing.

Practical strategies for safer mealtimes

• Correct posture: the person should be sitting at a 90-degree angle, never lying down or reclined, with their head slightly tilted forward when swallowing.
• Adapt texture: pureed or mashed foods are generally safer than dry solids or those that crumble (like biscuits).
• Thicken liquids: "plain" water is often the most difficult to control; a thickener (recommended by a speech and language therapist) makes the liquid safer to swallow.
• Small spoon, no rush: give small amounts at a time and wait for the person to swallow completely before the next spoonful.
• Keep them seated after the meal: for at least 20-30 minutes, to reduce the risk of reflux and aspiration.

"When we started thickening liquids, as the speech and language therapist advised, the choking episodes almost disappeared. I should have asked for help sooner."

What NOT to do

• Do not give thin liquids (water, juice) without guidance if there have been frequent choking episodes.
• Do not feed the person lying down or semi-reclined.
• Do not ignore persistent coughing during meals, even if it seems "mild".

When to seek professional help

Book an assessment with a speech and language therapist (swallowing specialist) as soon as you notice recurrent choking — they can determine exactly which textures and consistencies are safe. Seek urgent medical attention if there is a fever after meals (a possible sign of aspiration pneumonia), significant weight loss, or an episode where the person genuinely seems unable to breathe.