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Published on: June 18, 2013
by Tor Eckert for The Union:
While a person in early stages of dementia may not have particular eating problems, as Alzheimer’s disease or another dementia progresses, eating issues become increasingly common. In most cases, a spouse-caregiver would be acutely aware of even subtle eating habit changes. But sometimes, the changes suddenly jump out — such as “he/she is not eating the meat or drinking enough water. It’s been going on for two weeks now.”
Sometimes, there are simple answers such as cutting meat into smaller pieces, but there should always be awareness and concern that there might be a chewing or swallowing problem. It’s common among individuals with dementia, regardless of whether they are cared for at home or in a long-term care facility, to have eating issues. Assessing why they are not eating and obtaining an accurate diagnosis are the first steps toward maintaining adequate nutrition and body weight.
Let’s look at a list of eating issues that may be the “root” of both changes in eating habits and challenges for the caregiver.
• Has the person forgotten how to feed himself? This is most typical in mid- to late-stage dementia.
• Has the person lost appetite. It may bear looking at a change in medications. Some medications may decrease appetite or interest in eating because of nausea. Consult your health care professional if this seems to be a problem.
• Does he/she have trouble chewing or swallowing? Problems with swallowing, a natural reflex action, become more evident in mid- to late-stage dementia.
• Is he/she having problems with dentures or gums? If there is not good oral hygiene, there is the opportunity for food particles to lodge in the cavities and cause inflammation and pain. This may be difficult for the person to express this discomfort and just result in not wanting to eat.
• Is the individual having coordination problems, such as difficulty in using the silverware? There are eating utensils that are designed for people with dementia. An Internet search can bring up a number of companies that offer these utensils (including non-spill cups with double handles and bibs with pockets that catch food before it goes on the floor).
• Are there co-existing medical or psychiatric problems such as ulcers, depression or delusions that are causing loss of appetite? If you suspect this, consult your health care professional.
• Is the person fearful at meal times? For example, do they say or think that the food is poisoned? Some people with certain dementias such as Lewy Body dementia may be more prone to experience these issues.
• Are they unable to ask for food? In mid- and late-stage dementia, it’s not unusual for the person to loose some or all language skills. Often, hand signals can be used such as closing a fist to say “No” or opening the hand to signal “Yes.”
• Is there too much noise or other environmental stimuli? Most experts agree that eating is a peaceful time with maybe, soft music or simply some soft encouraging conversation.
• Are they filling up on fluids so that the person is not hungry. Appetites for older people who have little activity are generally less. A couple of glasses of decaffeinated tea or other liquid an hour or so before dinner can “spoil their appetite.
• Consult a health care professional to detect any medical causes.
• Seek a swallowing assessment from a speech therapist well trained in dealing with dementia issues if the person is regularly having trouble chewing and swallowing.
• Have the individual sit in an upright, comfortable position.
• Check that their mouth is empty, especially if they hoard food. It is not unusual for a person with dementia to keep on putting food in his or her mouth and forget to swallow. Be aware of this potential issue.
• Prompt or feed those who can’t feed themselves.
• Give the individual food he likes and adequate snacks.
• Provide nutritional supplements if there is significant weight loss. “Ensure” is one of many liquid supplements.
• Present one item at a time if the person seems confused by too much food in front of them.
• Consider moving food to a different location on the tray or table.
• Serve the drink last if the individual drinks too much and will not eat.
• Serve pre-cut or finger food if using utensils becomes difficult. In the later stages of dementia, a person being pushed to use utensils can be very frustrating to the caregiver but, far more important, frustrating to the person with dementia. Eating with fingers is OK.
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