Among the many challenges people with Alzheimer’s disease pose, one is the most critical of all. They have to eat.
But often they don’t. They may no longer recognize the foods on their plate, have poor fitting dentures (making eating painful), take medications that change appetite, not get enough physical activity, or have a decreased sense of smell and taste, says the Alzheimer’s Association (AA).
As a caregiver you can find this frustrating and difficult to overcome, but there are ways to encourage eating that focus on limiting distractions and choices, while adjusting for changes in perception.
Those include serving meals in quiet settings, away from television and other distractions, keeping the table setting simple, distinguishing the food from the plate (which compensates for a loss of spatial abilities), checking the food temperature, serving only one or two foods at a time, being flexible to food preferences that can change, and giving the person plenty of time to eat.
It also helps to eat together, making meals a social event that a person with Alzheimer’s looks forward to. Research suggests that people eat better when they are in the company of others.
You also have to remember that the person you’re taking care of may not remember when or if he ate. “If the person continues to ask about eating breakfast, consider serving several breakfasts — juice, followed by toast, followed by cereal,” says the AA.
It’s also important to make eye contact with the person you’re caring for, sitting directly in front of him and smiling frequently, while waiting for him to smile back at you. You start eating first, but keep quiet to limit distractions.
“Did I say keep your mouth shut?” says Bob DeMarco of the Alzheimer’s Reading Room. “Trying to convince a person living with Alzheimer's, if they are at the point of not eating, that they must eat is counterproductive to your effort.”
The proper mindset is learning to be a guide. A good guide demonstrates how to eat each and every time (like it is the first time, every time). The good guide does this with a smile on their face, he says.
If you are going to talk, he adds, praise the food. Not with a long explanation, but a simple one such as “yum, this is delicious.” Good positive reinforcement can be helpful, too, DeMarco says. You might praise your patient for eating also.
Create a positive atmosphere. “For example, while I had Dotty sitting at the kitchen table, and I was preparing the food, I would start singing one of her favorite songs, like `Shine on Harvest Moon,’” Demarco says. “Or, I would just make up some song to get her attention and get her to interact with me. Singing always put Dotty in a good mood.”
As dementia progresses, swallowing difficulties (called dysphagia) are more common, although they can vary from person to person. If a person is having difficulty with swallowing, a referral to a speech and language therapist can help, says the Alzheimer’s Society.
“Difficulties can include holding food in the mouth, continuous chewing, and leaving harder-to-chew foods (such as hard vegetables) on the plate. Weight loss, malnutrition, and dehydration can also be consequences of swallowing difficulties.”
Perhaps most important, it helps to remember that patience is a virtue in general, and a necessity for people with Alzheimer’s.
Their world may be completely unlike yours, with a different sense of time and space. That means allowing plenty of time to eat without chastising or blaming for not eating, says Age Space.
“They would eat if they could, so resist the temptation to get all stressed and negative,” DeMarco adds. “Try to think how you would like to be treated if you were having problems eating through no fault of your own.”
July 13, 2016
Janet O’Dell, RN