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COPING STRATEGIES
PROBLEMS WITH EATING
Good nutrition is essential for stamina and energy and for resisting infection. Yet, as Alzheimer's Disease progresses, ensuring good nutrition can become difficult. A decreased ability to taste and smell foods can lead to a lack interest in food. Some simply forget to eat. Some lose the ability to know when to stop eating or put too much in their mouth at once. Some develop a liking for one type of food only - sweets for instance. Of particular concern is the loss of ability to to recognize thirst . The lack of thirst does not mean a lack of need for fluid. Everyone needs 6 to 8 glasses of water a day. One of the carer's challenges is to ensure good levels of nutrition and to avoid malnutrition and/or dehydration in a person who does not actively seek food or drink. Eating problems may be further complicated by a loss of basic abilities, such as coordinated chewing and swallowing or knowing how to use eating utensils.
Here are some strategies that can help, but be prepared for mealtimes to take up a lot of time.
Reduce distractions
- avoid excess noise - no radio or television
- in a large family, let the person eat alone and join the family later socially
- avoid patterned tablecloths or placemats
- remove all unecessary items from the table
- serve one food at a time, if necessary
Make eating simple and tasty
- eat at regular times
- use bowls rather than plates
- use bowls or plates that are a different colour from the placemat to make the plate more visible
- place a damp washer under the bowl to prevent movement
- serve finger foods which do not require the use of utensils
- use bendable staws or cups with spouts for liquids
- serve food that looks good and smells appetising
- serve small amounts at a time
- offer limited, but healthy choices with varied textures, colours and spices.
- avoid confusion by feeding all of one food before moving on to a different taste or texture
If the problem is undereating
- try a glass of juice, wine or sherry (if medications permit alcohol use) to stimulate appetite
- serve icecream, milk shakes or egg nogs at intervals throughout the day
- try to prepare favourite foods
- consider vitamin supplements or supplement drinks (consult doctor first)
- make sure that the person is sufficiently active
- consult doctor about the possibility of depression
- sit directly in front of person if assisting with feeding
- make sure that the person is sitting in a comfortable upright position
- if necessary, co-ordinate medications with mealtimes to reduce agitation
- verbally guide the person through the meal, if necessary
If the problem is overeating or cravings
- have the doctor check medications
- try five or six small meals a day
- have a tray of low calorie snacks available
- consider activities - walks or exercise - to distract the person
- lock up some foods - especially if the person is on a special diet or obese
If there are chewing problems
- make sure that the person is sitting in a comfortable upright position
- choose easy to chew foods
- consider cooking food longer so it becomes softer, mashing food with the back of a fork, or liquidising it in a blender.
- avoid sticky foods such as banana, peanut butter or white bread
- avoid hard to chew food or foods with tough skins such as nuts
- moisten food with sauces or water
- offer small bites one at a time
- try light pressure on the lips or under the chin to encourage the person to start chewing
- guide the person by telling them to "chew now" and "now swallow".
- demonstrate chewing
If there are swallowing problems
Indicators of swallowing problems may include
- being unaware of food when it arrives
- failing to do anything with food in the mouth, just holding it there
- difficulty chewing and/or difficulty moving food to the back of the mouth
- spitting lumps of food out
- eating very fast or putting too much into the mouth
- eating insufficient amounts or refusing food and/or drink
- talking with food or drink in the mouth and forgetting to swallow causing coughing
- coughing/choking on food and /or liquids
- complaints of food not going down or getting stuck in their throat
- a 'wet' or 'gurgly' voice after swallowing
- difficulty swallowing tablets
- dribbling
- chronic chestiness or recurring chest infections
Foods that may present difficulty for someone with a swallowing problem include
- mixed textures eg food in a lot of fluids like minestrone soup, or cornflakes and milk;
- stringy textures eg bacon, cabbage, runner beans
- floppy textures eg lettuce, cucumber
- small, hard textures such as peanuts, peas, sweet corn and broad beans
Useful strategies include
- Make sure that the person is sitting in a comfortable upright position. If you put your head back to drink, you are opening up the airway more, making the swallow reflex slow. It is easier for food and drink to go down the wrong way.
- Remind the person to swallow with each bite.
- Gently stroke the throat to encourage swallowing.
- Avoid the use of drinking vessels that encourage the head to tip back (eg feeder beakers). Feed small sips of drink, perhaps from a teaspoon.
- Alternate food and drink to help clear the mouth of food.
- Try encouraging the swallowing of each mouthful twice to clear any food or drink that may remain in the mouth or in the throat after the first swallow. If the person has not swallowed what is in their mouth, sometimes it helps to present an empty teaspoon rather than more food.
- Offer small small mouthfuls of food and allow time between each bite.
- Consider cooking food longer so it becomes softer, mashing food with the back of a fork, or liquidising it in a blender.
- Keep food moist.
- Thickening fluids to yoghurt or sometimes porridge consistency may help if swallowing liquids is a problem.
- Crushing tablets or using a syrup form may be easier for someone with a swallowing problem but seek advice from a doctor as some tablets need to be taken whole.
- Specially designed cutlery, plates, non slip mats and cups which allow drinking whilst keeping the chin down are available. An occupational therapist can advise you on this.
Sometimes these strategies may be insufficient to ensure an adequate dietary intake. After discussion with your doctor it may be decided to feed via a tube directly into the stomach. This is called a gastrostomy, and it can be used in conjunction with eating small amounts orally, or can be used alone.
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