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Encouraging Eating: Advice for
At-Home Dementia Caregivers


(Page 2 of 7)

Coppola and other dementia-care experts stress the value of caregivers not only understanding the degenerative nature of dementia but also recognizing that dementia varies from person to person. In the early stages of AD, challenges may be limited to the person skipping meals or forgetting to eat or forgetting that he or she has eaten. However, other eating-related difficulties and patterns—from not sitting down long enough for meals to spitting out food or refusing to eat—can arise in the middle and late stages.

“All of a sudden, the person might not eat, but it’s not because he or she is being difficult on purpose,” says occupational therapist Carol Bowlby Sifton, BScOT, founding editor of Alzheimer’s Care Quarterly and a care and staff training consultant at King’s Regional Rehabilitation Centre in Nova Scotia. “Caregivers need to understand that it’s the same person as before, but because of the complexity of the process of eating, the person may be confused and embarrassed, and thus refuse to participate. It might be easier for the person to withdraw from the activity than to make mistakes.”

For people with AD and related dementias, eating-related challenges can result from:

  • cognitive issues, such as inability to express one’s needs or desires, initiate or persist with eating, use utensils, remember to eat, and distinguish the food from the plate (visual-perceptual challenges);

  • behavioral and psychosocial issues, such as depression, distress, excessive pacing that may increase calorie use, and having difficulty sitting down for meals;

  • physical problems, such as inability to hold and use utensils properly or maintain appropriate posture; fatigue; tremors; vision impairment; decreased depth perception; mouth sores; gum disease; dry mouth; poorly fitting or missing dentures; chewing or swallowing problems (dysphagia), and inability to move food inside the mouth;

  • environmental issues, such as extraneous noise or confusion, too much visual stimulation, poor lighting, glare, unpleasant odors, and uncomfortable room temperature;

  • food and menu-related concerns, such as having too many food choices at one time; difficulty eating the foods that are offered; unappealing food presentation, smells, flavors, or textures; and foods that are different from the individual’s personal, cultural, or religious food preferences;

  • chronic diseases that decrease appetite, such as diabetes, intestinal, and cardiac problems;

  • decreased appetite from use of certain medications or food-medication interactions;

  • caregiver burden due to stress or lack of time, causing the caregiver to feel impatient or find it difficult to ensure that the person eats enough.

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