Mealtime and Swallowing

Advancing Parkinson's frequently causes difficulty with eating and drinking because of both movement and swallowing problems. You might need to change the types of foods you serve or the utensils the person with Parkinson's uses, and you might need to help your loved one eat so he or she gets adequate nutrition.

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General Tips:

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• Schedule mealtimes when Parkinson's medications are working best

• Use adaptive utensils and cups, including curved and/or built-up forks and spoons, rocker knives, plate guards, nosey cups and covered cups

• An occupational and/or speech therapist can help determine what types of adaptive equipment might work best. Ask the doctor for a referral.

• When providing feeding assistance, give small bites, and allow adequate time for thorough chewing and a complete swallow.

• Dehydration can occur due to inadequate fluid intake. Know the symptoms, increased confusion, low blood pressure, dizziness, dark colored urine

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Mealtime Set-up

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• Choose a pleasant, quiet environment without a lot of distractions

• Use small pillows or cushions to keep posture upright

• Place the plate and cup on an elevated tray if your loved one has neck immobility or vision changes

• Protect clothing with a neck napkin, apron, or other protective garment

• Changes in vision may make it more difficult for your loved one if the color of the food is the same color as the dish. Consider using dark dishes when serving light-colored foods, and light dishes when serving dark foods

• Cut food into bite-size portions

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Types of Foods to Serve

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• Avoid tough, dry, or crumbly textures that might be difficult to swallow

• Consider foods that can be cut into smaller "finger food" portions to maximize independence

• Choose foods that are easier to chew and swallow. For example:

  • Lean hamburger or beef stew (avoid steak)​

  • Baked or broiled fish

  • Eggs ( a good way to get protein, and there are many ways to serve them)

  • Cooked vegetables

  • Soft fruits such as berries and melons

  • Rice, whole grains, and beans

  • Gravies, sauces, or butter (moisten foods for easier swallowing)

• If weight loss is a problem, see "Tips for Gaining Weight"

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Drinking

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• Make sure your loved one gets 48-64 ounces of liquid daily. This means 6 to 8 glasses of liquid per day. One easy way to increase daily liquid intake is to drink a glass of water with each Parkinson's medication dose.

• Encourage sips of liquid between solid foods

• Shorten the length of straws by cutting off part of the bottom to decrease the volume of liquid consumed through the straw at one time

• Serve foods with higher liquid contents, such as fruits, vegetables, Jell-O and ice cream

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Mealtime Fatigue

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• Serve small, frequent meals if your loved one experiences weight loss, low blood pressure, fatigue, or feels full quickly

• Maintain an upright sitting posture for 30 minutes after each meal to prevent aspiration

• Always give food or medication when your loved one is seated in an upright position, not when reclined or lying down

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Swallowing Difficulty

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• Report swallowing difficulties, coughing, or choking episodes to the doctor for evaluation

• Consider a referral to a speech language pathologist for evaluation and recommendations for changing food and liquid consistencies for safer swallowing

• Consider getting trained in the Heimlich maneuver from a Red Cross Class or have a dechoking device on hand and easily accessible should it be needed during mealtime

• Feeding tubes may be considered for those with severe swallowing problems. That is a choice that should be carefully considered with input from the person with Parkinson's, family, and the healthcare team

• Consult your doctor, nurse, or pharmacist if whole medications are not able to be swallowed.

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Sources:

Parkinson's Foundation. Page 144. Mealtime and Swallowing. Chapter 6. Advanced Parkinson's. Caring and Coping. A Care Partner's Guide to Parkinson's Disease. "Booklet."