8.20.2016 Mary Yamin-Garone, DeMystifying Alzheimer’s
Good afternoon. Welcome to Demystifying Alzheimer’s. I’m your hostess Mary Yamin-Garone.
Today’s topic is “How to Handle Difficulties with Eating.”
People with Alzheimer’s often lose interest in food. They miss meals, forget they’ve eaten or eat whatever’s on hand. Any or all of these behaviors can make mealtime difficult. Poor nutrition also can compromise your loved one’s health and well-being.
If you’re caring for someone with Alzheimer’s, it’s important to understand what causes eating problems and how you can encourage good nutrition.
- Doesn’t eat, won’t eat
Your loved one may forget mealtimes altogether because of memory loss.
They may not eat much during meals because of:
- A short attention span
- Confusion about how to use utensils or eat the particular food served
- Something problematic about the food like temperature, flavor or lack of familiarity
- A physical impairment, such as a sore mouth, upset stomach, reaction to a new medication or poor fitting dentures
What to do
- Be sure you’re dealing with a true lack of sufficient calories and nutrition, not merely a finicky eater or a small appetite.
- Rule out physical problems by checking in with their doctor, especially if the change is sudden or they’re losing weight.
- Avoid coaxing and cajoling. It can set up a power struggle. It’s better to focus on more subtle strategies.
- Serve meals and snacks at the same time every day to establish a routine.
- Allow plenty of time for meals so your loved one doesn’t feel rushed. Serve them at their own pace.
- Help them focus on the meal. Eliminate background noise and remove clutter from the table.
- Highlight their plate and cup by putting them on a contrasting solid placemat. A study in Clinical Nutrition found someone with Alzheimer’s eats and drinks more when using high-contrast tableware.
- Avoid patterned dishes or table coverings.
- Offer matter-of-fact, gentle prompts during the meal, such as “Pick up your fork,” “Scoop up the potatoes” or “Take a bite.”
- Serve foods with protein and calcium at each meal.
- High-caloric, nutrition-dense foods, like dishes made with cheese, butter, nut butters or whole milk, are good for bird-like eaters. Casseroles are also a good choice.
- Don’t serve foods that are too hot.
- If big meals aren’t consumed, break them up into snacks and then serve at intervals. For example, eggs at breakfast, toast an hour or two later and a smoothie later still.
- Look into Meals on Wheels or other programs to deliver a hot meal each day, especially if an elderly spouse is the primary caregiver.
- Eats too much
Your loved one:
- Forgets they’ve eaten
- Loses the ability to register the sensation of fullness
What to do
- Serve food restaurant-style (brought to the table all on one plate) rather than family style (with serving dishes on the table), which invites second and third helpings.
- If your loved one is an all-day snacker, make snacks low-calorie and filling, like popcorn, apple slices and raw vegetables with yogurt dip. Make sure choking isn’t a hazard.
- Provide plenty of activities to engage in to distract them between meals.
- Keep snacks out of sight and out of reach so your loved one has to ask for them rather than help themselves.
- Don’t deny them food that you’re eating. Limit portions instead.
- Doesn’t drink enough liquid
Your loved one:
- Doesn’t know they’re thirsty
- Forgets to drink during the day or with meals
- Purposely doesn’t drink because using the bathroom afterward is a physical challenge or it’s something they don’t want to do in public.
What to do
- Offer liquids throughout the day. Don’t wait for your loved one to ask.
- Don’t just hand them a glass. Be sure they sip the drink.
- Vary the types of beverages offered, such as water, juice, milk, hot chocolate or cider. Even coffee, tea, and soda are okay in moderation (about one cup) if that’s what they prefer. A cup or two a day doesn’t pose a diuretic effect that would lead to dehydration.
- Curb caffeinated beverages if fear of getting to the bathroom on time is a problem.
- Issue mild reminders during the meal like “Have a sip of water” or “Try the iced tea.”
- Leave water bottles around the house or carry them with you during the day.
- Serve fruit, which contains a lot of water, especially watermelon, melon and citrus.
- Know the symptoms of dehydration, including, increased confusion or lethargy, complaining of headache, dry skin or mouth and feeling warm to the touch. If you can’t rehydrate your loved one by getting them to take liquids, and you don’t see a change in symptoms, call the doctor, especially if you suspect dehydration.
- Messy eating
Your loved one may have:
- Lack of fine motor control
- Lack of attentiveness
- Decreased interest in self-care and hygiene
- Any combination of the above
What to do
- Lower expectations and look the other way as much as you can. Spilled food can always be cleaned up.
- Use a vinyl tablecloth or paper placemats.
- Place a napkin in your loved one’s lap before serving food.
- Cut up foods before serving.
- Serve fewer “risky” foods, like sauces and condiments (mustard, ketchup, mayo). Season food before bringing it to the table.
- If manipulating utensils is difficult, switch to a “spork,” a combination spoon-fork often sold in camping stores. Spoons with thick handles are also easier to hold.
- Serve finger foods, such as fried chicken, chicken strips, pizza cut into bite-sized pieces, fish sticks or sandwiches, to eliminate the need for utensils. Cook eggs omelet-style and cut them into strips or squares.
- Serve soup in a mug, not a bowl. Be sure to let it cool first.
- Use unbreakable dishes or heavy ironstone that’s less likely to slide.
- Use plastic cups.
- Serve only one or two foods at a time.
- Serve liquids in a cup with a spout (available in some hospital-supply stores), or pour only a small amount at a time into a small cup.
- If you have to point out a mistake (mustard smeared on the cheek), sound casual and surprised (“Oh, that mustard is so messy. Let me help you get it off your cheek”) rather than shaming or blaming.
- Goes on food jags
Your loved one may:
- Find that familiar favorites are comfort foods. Anxiety may make these seem preferable.
What to do
- Indulge food preferences as much as possible, provided their overall diet is reasonably balanced. It’s okay to serve the same entrée day after day.
- Serve the same food more than once in a day if your loved one requests it.
- Ask your doctor about adding vitamins if their diet seems unbalanced.
- Consider preparing the food in different formats. For example, a hot chicken breast might be refused, while chicken soup or chicken salad might be eaten without complaint.
- Try to serve old favorites from your loved one’s childhood. They are often remembered and preferred.
- Doesn’t swallow or chokes
Your loved one:
- Finds it physically difficult to swallow
- Forgets to chew
- Consumes food too rapidly
What to do
- Avoid hard foods, such as popcorn, nuts, hard candy, raw vegetables (such as carrots), hot dogs (unless finely diced), grapes and apples.
- Avoid foods that require a lot of chewing, like celery, steak and chips.
- Avoid sticky foods like peanut butter.
- Mash up foods or puree them in a blender or baby-food grinder. Finely dice meat and cheese.
- Choose non-solids, such as puddings, gelatins, applesauce and small-curd cottage cheese.
- Try nutritional supplement drinks like Ensure.
- Be sure liquids aren’t too thin. They may be drunk too quickly, causing a choking hazard.
- Choose thicker soups, purees and smoothies. They’re easier for seniors with chewing and swallowing problems.
- Self-feeding has become impossible
In addition to the suggestions above:
- Be sure your loved one is sitting upright.
- Alternate solids with sips of liquids.
- Make foods more liquid as you feed. For example, add extra milk to mashed potatoes.
- Gently coach the person through feedings. “Okay, open your mouth…now close…now chew…swallow.”
- Try rubbing your loved one’s chin or cheek as a gentle way to stimulate chewing
That’s all for today. Thanks for listening. I hope this information was helpful.
Join me next time for more Demystifying Alzheimer’s.