What is an important step to take when you are feeding an individual with Alzheimers disease?

How dementia can impact meal time habits and routines

Healthy eating is important for all of us. Sharing meal times with family and friends can provide structure to the day and increase the enjoyment of food.

When caring for someone with dementia, however, meal times can become stressful and frustrating. The caregiver has a lot to consider making sure that the person with dementia eats a well-balanced diet and is properly hydrated, but also ensuring that meal times are an experience associated with pleasure and enjoyment.

Our eating habits and routines develop over a lifetime. Understanding the eating habits of someone with dementia can help you understand changes in behaviour, such as refusing to eat. The following information may help you make meal times pleasant.

Questions to ask about the person

• Is her mouth free from sores? Does she have a dry mouth? Do dentures fit properly or are teeth worn down or missing?
• Is he on any medications that may cause loss of appetite?
• Does she have a condition (such as heart condition, diabetes, constipation or depression) that may lead to loss of appetite?
• Could he be feeling ill, from an infection?
• Can she visually distinguish food, plates, and other items on the table?
• Can he recognize food as something to eat?
• Does she know how to use table items, such as utensils and condiments or does she have physical difficulty using them?
• Is he agitated or restless?
• Is there confusion about meal times or whether a meal has been eaten?
• Is food less appealing because her sense of taste and smell has lessened?

Questions to ask about the setting

• Is there too much noise, too many people or other distractions?
• Is the table too cluttered?
• Is the lighting adequate?
• Does the person sense a need to rush? Are other people impatient?

How to handle decreased eating

• The person with dementia may lose weight because of a loss of appetite or difficulty eating. Try the suggestions below and, if the person continues to lose weight, ask your physician for a referral to a dietitian.

Tips for improving meal times

Whether or not it’s possible to determine a specific reason for the problem, use these tips to make meal times easier and more pleasant.

The atmosphere

• Minimize distractions, such as by turning off the radio or television.
• Provide a calm and unhurried atmosphere.
• Avoid loud noises and abrupt movements.
• Make sure the lighting is adequate.
• Try to serve meals at a time when she is calm and alert.
• Make meal times social by eating together.
• Keep in mind that he may not remember when he last ate.

The table

• Simplify the table and the setting. Omit unnecessary utensils and condiments. Give only one food item at a time.
• Avoid using sharp knives.
• Provide a sharp colour contrast between table or placemat and her plate, but avoid strong patterns as they may cause confusion.
• Choose cutlery and dishes that are easy to hold.
• Ensure that plates are stable, using a non-slip mat or a wet cloth underneath to prevent slipping.

The food

• When possible, involve him in the food preparation.
• Provide finger foods: foods that have the same taste and nutritional content as a regular menu, but are in a form that can be picked up and eaten easily without utensils.
• Provide nutritious foods that can be taken from a cup or a mug: the ability to hold a mug and to drink is often retained until late in the disease.
• Healthy shakes or liquid food supplements can sometimes take the place of a full-course meal. Consult with a health-care provider to understand more about liquid supplements.
• Offer frequent small meals or snacks rather than three large meals in a day.
• Use food that is colourful and easily distinguishable on the plate.
• Provide her favourite foods. Food that tastes and smells good may also serve as reminders of happier times.
• If he is having difficulty chewing, grind or mash foods, or cut them into manageable bite-sized pieces. Choose soft foods such as eggs and cheese, and avoid hard foods such as nuts and raw carrots.
• If there is a concern about choking or difficulty swallowing, consult a physician. Learn the Heimlich manoeuvre if you do not know how to perform it.
• Check the temperature of the food to ensure that it is not too hot or too cold.

Giving instructions

• Cue her with words or actions. She may be able to mimic your motions for eating.
• Use simple one-step instructions, and break them into small steps.
• Speak with a calm, soothing tone.
• If necessary, use hand-over-hand guidance to help initiate eating.
• Tell him with dementia what food you are giving him.
• Avoid commenting on spilled food, which could cause embarrassment.
• Do not rush her.
• Encourage her to feed herself, even if she may not be neat.
• If he refuses to eat, try taking a break and distracting him with another activity. Perhaps he will agree to return to eating later.
• If she is restless or on the go, offer nutritious finger foods. You may not be able to encourage her to sit down for a full meal.
• Use adult approaches and avoid the use of bibs or other items associated with children. Consider inviting her to wear an apron, made from a fabric she likes, especially if she is used to wearing one.

Day to day

It can be difficult to determine the problem, especially if he is unable to explain it. As the caregiver for a person with dementia, try to keep in mind that she is not trying to be difficult; the changes in behaviour are not personal. By adapting some eating rituals, he can be encouraged to eat, often with independence and pleasure. What works one day may not work on another. Remember that you are doing the best you can.

References

Cassolato, C. A., Keller, H. H., Dupuis, S. L., Schindel Martin, L., Edward, H. G. & Genoe, R. M. (2010). Meaning and experience of “eating out” for families living with dementia. Leisure/Loisir, (34)2, 107-125. DOI: 10.1080/14927713.2010.481107

Edwoba, A-K., Keller, H. H., Daly, K. (2011). The food-related role shift experiences of spousal male care partners and their wives with dementia. Journal of Aging Studies, 25(3), 305-315. https://doi.org/10.1016/j.jaging.2010.11.002

Genoe, R. M., Keller, H. H., Schindel Martin, L. & Dupuis, S. L. (2012). Adjusting to Mealtime Change within the Context of Dementia. Canadian Journal on Aging, 31(2) 173-194. DOI: 10.1353/cja.2012.0023

Genoe, R., Dupuis, S. L., Keller, H. H., Schindel Martin, L., Cassolato, C. & Edward, G. 2010. Honouring identity through mealtimes in families living with dementia. Journal of Aging Studies, 24(3), 181–193. doi:10.1016/j.jaging.2010.02.001

Keller, H. H., Smith, D., Kasdorf, C., Dupuis, S., Schindel Martin, L., Edward, G., Cook, C. & Genoe, R. (2008). Nutrition Education Needs and Resources for Dementia Care in the Community. American Journal of Alzheimer’s Disease & Other Dementias, 23(1), 13-22. DOI: 10.1177/1533317507312805

Keller, H. H., Schindel Martin, L., Dupuis, S. L., Genoe, R., Edward, H. G. & Cassolato, C. (2010). Mealtimes and being connected in the community based dementia context. Dementia, 9(2), 191–213. DOI: 10.1177/1471301210364451

Keller, H. H., Schindel Martin, L., Dupuis, S. L., Reimer, H., & Genoe, R. (2015). Strategies to support engagement and continuity of activity during mealtimes for families living with dementia: a qualitative study. BMC Geriatrics, 15, 119. DOI 10.1186/s12877-015-0120-2

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