Aegis Therapies explains how therapists and caregivers can help residents retain their sense of control over eating and drinking.

By Susan Saldibar

Feeding ourselves is one of the first things we learn as toddlers. If you have children, you may remember they started with their fingers. Popping things into their mouths. Then there was the first time he or she was able to put that spoon to mouth, open, close, chew and swallow. Less spaghetti on the fingers (and walls), more in their mouths, right?

As you know, feeding ourselves is also one of the last things we are able to do as dementia and other progressive cognitive impairments disrupt our ability to perform our activities of daily living. So it stands to reason it’s something worth hanging on to as long as possible.

Angela Edney, Occupational Therapist and National Clinical Director, and Susan Almon-Matangos, Speech-Language Pathologist and National Clinical Director, for Aegis Therapies, a Senior Housing Forum partner, know how important preserving that last critical activity of daily living is.  

We talked recently about the subject and about how therapists and caregivers can help residents retain their sense of control over eating and drinking.

Is it a cognitive problem, or a physical problem?

First, Susan points out, it’s important to assess feeding issues properly. Why is Mr. Jones not eating? Does he not remember how to hold a fork? Or can he not swallow properly and he’s afraid he might choke? Depending on the cognitive level — Aegis recommends using the Allen Cognitive Scale — a reluctance to eat can be a symptom of many underlying issues.

Caregivers need to be attuned to the different needs of the residents. “It’s so important to set up their environment to give them the best chance of success,” says Susan. Here are some common feeding issues along with the techniques Aegis uses to move beyond them and keep residents feeding themselves for as long as possible.

Forgetting to Use Utensils

    • Place your hand over the patient’s hand and gently guide hand to mouth in a slow, rhythmic manner. “It may be as simple as letting them feed themselves at the beginning,” Angela says. “Then you take over. Hand over hand. They swallow better because they are participating in the process. That’s important.”

    • Serve finger foods (fruit, sandwiches, etc.). This can work for those residents who don’t want to sit down to eat, according to Angela. “Let them stroll, while munching a finger food.”

Decreased Appetite, Refusal to Eat, or Leaving Dining Area

    • Provide pleasant, calm surroundings. According to Susan, it’s important that you seat compatible residents together. Try to match to their cognitive level. And get creative. Sometimes putting someone with a slightly higher cognitive level at their table can help encourage others.

    • Offer favorite, familiar foods. Unfamiliar foods can cause fear, paranoia, and disinterest.

    • Try varying the texture of the food.

    • Enhance food with spices. Sense of smell declines with age.

    • Serve the food with the highest nutritional value at the beginning of the meal, while the resident is more alert.

    • Present one food and one utensil at a time.

    • Allow the resident to dine at their most alert time of day.

    • Try serving several small meals instead of three large ones.

    • Place nutritious snacks on a table in a visible area for residents who tend to wander.

    • Place chairs near snacks so that residents may sit to eat.

    • “Some residents may only be able to take in liquids,” says Susan. “It’s not easy, because liquid food isn’t very interesting. But don’t give up! You can get creative with liquids.”

Putting Too Much Food into the Mouth at One Time

    • Remind the resident to chew and swallow.

    • Cut the food into small pieces.

    • Present only small amounts of food at one time.

    • Check the mouth to be sure there is no pocketed food at the end of the meal.

Not Opening Mouth to Receive Food

    • Try light pressure downward on the chin.

Not Initiating Chewing with Food in the Mouth

    • Apply light pressure on the underside of the chin to push up the tongue.

    • Apply light pressure on the lips.

    • Verbally remind the resident to swallow.

And there are many more tips. Aegis Therapies has comprehensive resources to help residents feed themselves. You can visit the Aegis website for more information.

The bottom line, as Angela points out, is to take an active role in keeping residents independent for as long as possible. “Feeding oneself is a very high value activity,” says Angela. “Don’t take it away from them if it’s not necessary.”

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