By Barbara Williams, RN, BSN
It is difficult to plan for
meals when the person you are feeding canít sit down and enjoy a
meal. This is often the case during the hyperactive stage of
dementia. It is extremely frustrating for the caregiver and patient
If you stop and rethink an
earlier period in your life as the mother of an active two year old,
it may cause you to see many similarities. What may have been an
easy remedy then, a high chair with a belt, is not be a solution
now. Food choices, however, may be eerily similar. The finger foods
that worked for the two year old will work again for this new
version of ďI canít sit down.Ē Chicken fingers will seem like a
god-send. Simple sandwiches that stay together, like grilled cheese,
is another staple of this menu. Peanut butter sandwiches without the
slippery jelly are also a good choice, although it may be a bit dry
if you have difficulty getting fluids into your loved one.
Sandwiches that are stacked high with lettuce, tomatoes, and other
slippery fillers are not a good choice. Vegetables in finger food
size such as carrot sticks, celery, cherry tomatoes, cucumber slices
and the like are a good way to get more variety into this diet.
Fruit in finger food portions are also easy to feed to this person
who is literally on the run. Be sure to remove pits and other
uneatable parts of these foods since the person you are attempting
to feed probably can not make the differentiation as to eatable or
not any more. I remember one wife who used to place an apple in one
hand and a pear in the other of her hyperactive, almost track
star-like husband as he ran around in constant motion; problem was
he would alternately eat both, seeds, stem and all.
Large roasted potato slices,
especially if baked in a fragrant seasoning mix, are also easy to
handle. French fries or French-fried yams are also a good choice.
Rice, however, is not a good choice. Ravioli without messy sauce,
tortellini, and pierogis are also easily eaten on the run.
Empanadas, those tasty little meat pies, travel well too. Many of
these dishes can be purchased in the freezer department of your
local grocery store. Just remember, if it can be hand-held and eaten
with a minimum of messiness, it is a good choice.
A quick and easy snack is slices
of meat and cheese rolled up like you might find on an appetizer
tray. Cheese or peanut butter crackers are good snacks as well,
unless your individual has a really tight grip and is apt to crush
the crackers into crumbs. Energy bars are good as well, but do watch
for the protein/carbohydrate balance. Some are not much more than
sugar. It is often trial and error to see what works best for your
loved one. Just remember, if they didnít like a particular food
before, they probably are not going to like it now either. Some
things they just donít forget.
Probably the hardest task to
handle is maintaining adequate fluids. Travel mugs or the toddler
sippy cups work well for fluids such as juices, milk, and water.
Travel mugs, with their larger openings, also do well for creamed
soups which can be packed with a variety of nutritious foods, thanks
to the invention of the blender. If your individual has a sweet
tooth and not inclined to want to eat what is healthy, smoothies are
the answer. Mix yogurt, fruit and fruit juice together and even the
finicky eater will down them. How do you think Ensure became so
popular? It has been keeping the elderly alive for years.
Feeding the individual who is
constantly on the go is not easy, and the idea of three meals a day
can be thrown out the window. You do need to monitor what they eat
more than when. It is a good idea to keep a variety of foods
available in the refrigerator or cupboard. Thanks to the microwave,
you can heat something up at a momentís notice. You have to take the
individual where they are at and adapt to their schedule. They are
not going to accommodate yours, trust me. Make the most of any
opportunity to get something nutritious into them whenever the
opportunity arises. It is, however, a good idea to keep a running
tally of what they have eaten during the day so you can adjust what
you are offering them in order to maintain a balanced diet to the
best of your ability. It is easy to fall into a pattern of only
offering them something they like or that is easy for you to
prepare, and this may lead to an inadequate intake. It is also easy
to neglect fluids too, since quite often they are messier or harder
to get them to drink. Again, trial and error may be the only way to
discover what works best in your situation.
Quite often, these individuals
donít know when to sit down and can wear themselves out. If you
notice them beginning to develop that forward tilt where they look
like they are going to fall flat on their face, they need to be
distracted and sat down for at least a short rest. In the nursing
home situation, restraining them in a chair with a tray or other
restrictive device is the usual answer. In the home, you need to
become more creative. It usually works best if they can be sat down
at a table in a sturdy chair that doesnít tip or move easily, but in
front of them, on the table needs to be some sort of distraction.
This may be a good time to try getting them to eat something that
may require the use of a spoon, if they are still able to negotiate
getting the spoon from dish to mouth. Some food with the consistency
of ice cream or pudding that is easily scooped up on a spoon and
taken to the mouth is a good choice here. If the spoon to mouth idea
has left them, then finger foods should get their attention while
they rest their overused legs. And you thought you left the toddler
If you can occasionally get them
to sit down at the table to eat, remember that they have a great
deal of trouble making decisions. They cannot decide easily what to
eat first if a number of usual table items are in front of them.
Distractions will get their attention quickly and they will be up
and gone again before you can accomplish anything. The basic rule
here is to KEEP IT SIMPLE. Remove distractions, face them towards a
blank wall if possible, no TV, no flowers or other centerpiece on
the table, no placemat, and one dish in front of them at a time.
They will still probably need cueing to remind them to continue the
eating process. Simply tapping them on the hand to pick up the
utensil, and spoons work best, and tapping on the side of their
mouth is usually sufficient to get them moving in the dish to mouth
routine again. Speaking to them will only make them turn towards the
speaker and not to the task at hand. The non-verbal cueing is a
minimal purpose-driven action.
All in all, trying to maintain
proper nutrition when the individual is in constant motion is one
huge challenge. These are some tried and true examples of solutions,
but you will need to adapt these to your individual situation, which
also may be changing literally by the minute. Until you can get into
a pattern of what works best for you and you can plan your
activities out in advance, it is best to keep a log of what works
and what doesnít, so you can evaluate what is best for your
situation and know that your loved one is getting the best possible
nutritional balance. Donít worry too much about overall intake;
after all, that toddler managed to survive the hyperactive stage
without any major nutritional deficits and your new challenger will
to. Good luck with this new adventure in your life. It certainly
will make each day interesting.