Archive for the ‘Eating Problems’ Category

Posted on September 14, 2011 - by Nurse Virginia

SUPPORTING EATING AND NUTRITION – FOR THE ELDER WITH ALZHEIMER’S DISEASE

• Make the mealtime experience as simple as possible for the caregiver as well as the elder with dementia. The activity of eating is the most important activity of the day. And it is certainly true that when cooking, everyone can be right “in the moment” with the person with Alzheimer’s disease. So cooking and eating are wonderful activities for everyone. However, if the caregiver is over whelmed, making a meal or baking something that is involved, time consuming as well as involves a major clean up effort, this may just be too much to attempt successfully.
• If the elder with Alzheimer’s disease no longer remembers they have just had something to eat and so wants to continually eat – you will have to plan for this. Remove sweets since sugar can stimulate the appetite. Realize that you probably will not be able to satisfy the elder’s urge to eat, but you can make sure what he eats is nutritious. Rice cakes, apples, carrot sticks, celery sticks are some of the quick and easy things a person can grab. Be aware that the person with cravings may eat very fast as well and forget to chew. Always have someone there to remind the confused elder to slow down eating and to chew.
• If the elder starts off eating well, but then just stops eating – gently remind them to continue. The elder may have just forgotten that he was eating. A few words of encouragement may be needed periodically to keep him eating.
• If the elder seems to playing with their food more than eating the food, they may have a problem with using the silverware. Try making their meals into finger foods – almost anything can be put into a pocket pita
• Occasionally an elder with Alzheimer’s disease may not be able to sit down long enough to eat. Once again putting food in a pocket pita and letting the elder eat on the go will be more effective than having the elder sit in a chair that keeps them from standing and creates agitation.
• Elders may start mixing their foods, if so – serve them one item at a time and limit the availability of condiments.
• Only serve food and beverages at moderate temperatures, the elder with Alzheimer’s will not wait for hot food to cool down enough to eat.
• Unless the doctor has recommended cutting back on liquids, offer the elder two beverages with each meal. Don’t fill glasses or cups too full – use equipment that is easy for the elder to handle.

Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on October 13, 2010 - by Nurse Virginia

JUST IMAGINE GROWING OLD AND EATING ALL YOUR MEALS IN A NURSING HOME

My name is Marge and I used to be a good – no a great cook.

During my life of 88 years, I’ve enjoyed many meals. Meals I have cooked served and shared as well as meals that have been cooked and served by others.  They have been happy, rowdy meals with the whole family. As well as quiet, intimate meals with just my husband, Fred. I have eaten lobster at fine restaurants and chicken with my fingers at fast food restaurants.

I have sat around the kitchen table with my family and didn’t even realize how wonderful that was because then I just took things like that for granted.

After Fred died I just didn’t feel like making big meals anymore. There was something about brining a hot meal to the table and having Fred say “Ah,” that I missed. Once in a while I liked having a sandwich on my own when reading a book, but eating alone all the time was no fun.

My children said they started to notice I was losing weight and thought I wasn’t eating well. So one day they brought me to this nursing home, and this is where I now eat all my meals. Sometimes it is nice having people around, only I don’t seem to have much in common with the people at my table in the dining room.

I’m not that good at conversation these days, so I just eat and look at my plate.  If someone does say something to me, I usually can’t hear them because of the noise in the dining room.

What kind of a place is this anyway?  Is it a cafeteria? Why are all the meals on trays? And why when the meal is over does everyone just leave, no one cleans up or pays. I wouldn’t mind helping out a little, but I don’t think it would be allowed  There are so many things on the tray they give me, that I don’t know where to start. Most of the time the food given to me looks strange, everything seems to be beige.  Is this all for me or are am I expected to share? The tables seem so high or am I shrinking?

They say my blood pressure has been up, so there is no salt, but don’t they have mustard, garlic, oregano?  The other day there were so many things on the tray I couldn’t find my fork in all that stuff, so I put my hand in my mashed potatoes by mistake. Then my hand was sticky so I wiped my hand on my dress. So, here I sit in my dirty dress.

But I remember when they said I was a good cook, no a great cook.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on June 18, 2010 - by Nurse Virginia

HOW TO HELP THE ELDER WITH ALZHEIMER’S DISEASE OR A RELATED DEMENTIA EAT SAFELY

Whether it is eating non-food items, using utensils incorrectly or having difficult behaviors during meals, solving mealtime problems for the elder can be challenging.

CODE IS AS FOLLOWS: Problem is stated and suggested correction follows in bold type.

PROBLEMS WITH USING DINING EQUIPMENT

• Uses knife/fork/spoon incorrectly   – Using hand-over-hand, demonstrate use of utensil, if unsuccessful remove.
• Eating non-finger foods with hands – Wash elder’s hands before the meal, and cut food in bite size pieces.
• Elder is using cup or glass incorrectly – First demonstrate by using hand-over-hand – if unsuccessful remove.

PROBLEMS WITH FOOD

• Elder mixes inappropriate foods together – If the elder eats less than 50% of the food – start serving just one item at a time.
• Elder eats pieces of food that are too large for safe intake – Cut the food into bite size pieces before serving.
• Elder just wants to eat sweets or deserts and neglects other foods – Don’t have anything sweet in sight, and just bring deserts out after the meal has been eaten.
• Elder will only eat certain food groups or only liquids – Remove that food group – and serve at the end of the meal.
• Elder eats too fast for safety – Keep reminding elder to slow down and chew (don’t leave unattended while eating) give the elder only small amounts of food at a time.
• Elder eats everything and anything – even non-food items – Give the elder small meals more frequently (6 times a day) check the elder’s living area for unsafe items that may be ingested.

PROBLEMS WITH DINING BEHAVIORS

• Impatient behavior before meal is served – Bring the elder to the table when the food is ready to be served.
• Impatient behavior during the meal (fidgeting) – Take the elder to the bathroom immediately prior to the meal.
• The elder stares without eating – Touch the elder’s arm, say the elder’s name, put a utensil in the elder’s hand and do some hand-over-hand to get them started.
• Elder routinely gets up from the table and walks away without eating enough – Experiment with finger foods that can be eaten “on the run.” Many food items can be eaten rolled up in a piece of soft bread, pita pocket – anything that can hold food items.
• Elder is always searching for food – Keep on hand small food items – individual jello containers, pudding containers or protein shakes.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on January 20, 2010 - by Nurse Virginia

Caregiver Tips: When the Elderly with Alzheimer’s Disease are too distracted to eat

Restaurant might be first time elder appears too distracted to eat

Many families have told me that they started seeing problems with their loved one, when they would go out to eat.. When you have a distraction problem, the noisy environment of a restaurant is often too much for the person with Alzheimer’s disease. It might be too loud, dishes and utensils clattering, people talking, music playing and people walking around.

Persons who wear hearing aids often turn down the volume on their aid while in a restaurant because of the increase in background noise. Background noise is very easy for the elderly with dementia to be distracted by.

Six ways to help the elder focus better while eating:

• The person with Alzheimer’s disease might just need a rest time before a meal so that they can be more attentive during the meal.
• Mealtime should in a quiet calm environment – this wouldn’t be the time to have the TV on.
• A regular routine – eating at the same time, sitting in the same place so that everything looks the same.
• Have the elder come to the table when everything is ready so the person can see the food and know it is time to eat.
• Sitting poorly and too far from the table may cause a distraction – especially for the elder in a wheelchair. Whenever possible transfer the elder to a regular chair for meals.
• Conversation is good if pleasant, this wouldn’t be the time for tablemates to discuss problems or have loud angry conversations.

Most of all a person with Alzheimer’s disease needs someone who is interested in them and paying attention to them.

Make sure everything is ready and available so the caregiver doesn’t have to get up and down. Having the caregiver getting up and down causes a distraction, right when the elder needs the total attention of the caregiver.

Virginia Garberding, R.N.

Director of education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on July 21, 2009 - by Nurse Virginia

Caregiver Tips: Sitting correctly, so important when the confused elderly are eating

Mom always said to sit up straight.

Sitting up straight is so important when the confused elderly are eating. There is an old saying in health care, that the amount of food on the floor is a reflection of how well a person is sitting. When the elder is not sitting correctly, you will probably see food on the floor.

8 – Suggestions for helping the confused elder sit up straight while eating:
• If the elder uses a wheelchair, transfer them into a regular dining chair if at all possible.
• The table surface should be between waist and mid-chest area to help the elder physically as well as visually see their food.
• The elder should be no more than 12 inches from the plate; this is why it is important to sit in a dining chair because it is difficult to get a wheelchair close enough to a table.
• If the elder needs to sit in a wheelchair look into special cushions for the seat and back of the wheelchair to help with sitting straight.
• Shoulders should be back.
• Elbows should be supported on the chair or table surface, not hanging off the sides of the chair.
• The elder’s hips should be at a 90 degree angle as well as knees and ankles.
• Feet should be well supported on the floor or foot rests not dangling.

Eating is certainly the most important activity of any elder’s day. Take the time to help the elder sit up straight and make the most of this part of their day.

Posted on April 13, 2009 - by Nurse Virginia

Caregiver Tips: All swallowing problems, when you have Alzheimer’s disease, need to be investigated by a Speech Therapist

The person with Alzheimer’s disease, as they go through this disease process will at some point develop swallowing problems. The caregiver and anyone involved with a mealtime needs to be made aware of how those problems will look or sound like.

Things to look for when someone who has Alzheimer’s disease is eating:

• the person complaints of a feeling that something is stuck in their throat.
• the person is breathing differently during or after eating.
• the person coughs during eating or drinking.
• you have already seen the person choke on – medication, food, drink or even just saliva.
• food falls out of the person’s mouth when they eat.
• the person holds food in the side of their mouth – between teeth and cheek.
• the person keeps clearing their throat when the eat or drink.
• the person chews and chews for a very long time- or has trouble chewing.
• after the person eats or drinks their voice quality sounds “wet” or “gurgles” when they speak.
• when the person eats their swallow reflex seems gone or late.
• the person has behaviors where they are eating too fast or too much on a spoon full or fork full at a time.

Needless to say – eating problems are very serious and can lead to serious consequences.

Anyone of these problems needs to be communicated to the doctor for a referral for a Speech Evaluation. Time is always of the essence when it is a swallowing problem, because the next meal is coming.

Posted on February 18, 2009 - by Nurse Virginia

Caregiver Tips: Eating and Drinking not only an Activity for the elderly with Alzheimer’s disease but an Activity of Consequence

Consequences of not eating or drinking happen fast.

 
Eating and dinking are always the most important activity of any day for a person with Alzheimer’s disease. If the individual doesn’t bathe when planned one day – the bath can be accomplished at another time. If the person is agitated and won’t change clothes no harm is done. But for eating the next meal comes in a few hours, and the consequences of not eating and drinking happen quickly.

Starvation happens over a period of time depending on the condition the person started out in. Fat is lost first and then muscle is lost as a person starves, how much fat or muscle they have plus any disease processes determines how long a person can last.

Dehydration can occur over a period of time when a person loses more fluid than they take in. As a person becomes dehydrated their urine becomes darker and more concentrated. People can last several days without fluid but once again, as with the person who stops eating; this is determined by what condition they were in previously.

Because there are such serious consequences for the person with Alzheimer’s disease if they stop eating or drinking. It remains very important to monitor how much a person eats and take their weight regularly – at least once a month. (Always weigh a person on the same scale and at the same time of day) And offer them a beverage frequently through out the day.

Posted on January 30, 2009 - by Nurse Virginia

Caregiver Tips: When the Confused Elder Stops Eating, or Starts Losing Weight.

It’s Not Always The Alzheimer’s Disease

Even if an elder is diagnosed with Alzheimer’s disease, every problem or symptom an elderly person has shouldn’t be automatically blamed on the disease. Especially in the case of eating. When any elderly person stops eating or starts to lose weight every possible cause needs to be investigated. The big difference involving elders with Alzheimer’s disease, is that it will take more effort on the part of the caregiver to discover the problem.

Because the person with Alzheimer’s may not be able to verbally communicate or express a problem, behavior can become a way of communicating feelings or needs.

8 Possible reasons the confused elder stops eating:

• If the individual wears dentures, do they fit well? Dentures have to be re-lined when needed as well as the use of denture products for cleaning and adhesives when appropriate.
• The person who wears dentures needs to have their gums checked to make sure there aren’t any sore areas.
• The condition of teeth and gums need to be regularly monitored by a dental professional.
• Lack of interest in eating may indicate illness.
• Any pain might distract a person from eating.
• Being uncomfortable in wet incontinent products may distract a person.
• Change in medications.
• Vision problems – especially if the person has had a stroke and may have a limited vision field.

People with Alzheimer’s disease may have lost some of their sense of taste. They might also be only able to express likes or dislikes by pushing food away, making negative vocal noises or refusing to open their mouth.