I work in a day centre for adults with LD and high support needs. We have a lady with us at the moment who is very reluctant to drink. She is no longer supporting herself as she used to and is now refusing drinks, she appears to be clamping her mouth shut tighter when offered drinks on a spoon or syringe, which she used to be happy to accept. We are becoming concerned about her refusal to drink and the obvious health implications of this, especially relating to her epilepsy.
Does anyone have any ideas how we can encourage her to drink more? There doesn’t appear to be any physical reason for this as she can and will drink, it seems to be more of a behavioural choice.
I would totally rule out mouth or teeth problems first. Then look at providing different types of drink, hot/cold etc. Also look at the environment, is there are lot of people around or a lot of noise. Maybe a referral to SALT might be helpful.
Do you know what she is like drinking at home normally?
Does the lady refuse food?
I would be looking at the obvious first. Are the drinks offered choices they would like? are they given the opportunity to indicate or express the choice? Then has there been any incidences/suggestions which may have caused the person to be afraid to drink? For example choking, positioning, distractions in the environment, which may be inducing stress or the need to display the behaviour. Incontinence or fear of becoming incontinent could be causing the behaviour to be displayed.
Are there any signs of soreness to the mouth or sensitivity to the teeth? If the person is having difficulties swallowing the liquid it’s possible that a dysphagia assessment maybe needed. Are you keeping a fluid balance chart to record and report any concerns of dehydration? If the person is still refusing drinks is it possible to offer ice lollies instead?
Is she under the supervision of a specialist speech and language therapist? If not, she may need a referral. Refusing fluids can be a sign of loss of comfort and control in swallowing; one way forward may be to get a thickener prescribed after suitable consultation. This allows greater control of the swallow process for the individual, reduced discomfort, and lessening of the choking sensation. First port of call is to ask th GP for a referral.
At the risk of reiterating what other people have said - a SaLT assessment would be the first step. There may be hidden swallowing difficulties which are causing the lady to refuse fluids. If there is no dyphagia, offering different drinks, at different times may help. Even using different coloured cups / mugs, in favourite colours or with favourite images. Are you drinking at the same time with her? A ‘cheers’ ritual (clinking glasses) once made all the difference to someone I worked with who refused to drink. As another respondent has said - ice lollies are another good way to try and encourage fluid intake - and I would add jellies. However, the most important thing is to refer for a SaLT assessment to rule out a swallowing difficulty which could be putting her health at risk.
I think its vital to find out what’s happening at home to see if this change of behaviour is a sign of distress aT the day centre or something deeper. Has there been a change of carer, has someone passed away or left. Behaviour change can be a sign of physical and emotional distress
Thank you for your replies.
We will definitely look into salt and thickening fluids.
There haven’t been any changes at home, she has always lived with her parents. But they seem to be having similar issues but to a lesser extent.
The nature of her disability and communication skills mean she is not able to communicate choices of drinks other than drinking it or not but we do give her different things.
We are not having any problems with eating. She does have foods blended and sieved but is picky about textures so Im wondering if thickener might be a problem.
Hi try yoghurts, custard, ice cream, ice lollies they can be recorded as fluid intake. Are u recording intake and output ?
We haven’t been able to find any physical reason for her not drinking. We’re getting as much fluid in through food as possible but are out of ideas. It may have started from biting her lip or tounge during a seizure but now it’s almost like it’s become a game to her.