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Published with kind permission of The Alzheimer Resource Center Inc.


Shellie Brassler Executive Director
Alzheimer Resource Center, Inc.
Phone 1-800-330-1910

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Mealtime and the Alzheimer Patient Special Table setting for the Alzheimer Patient When Eating Becomes a Problem
Swallowing Assistance Catastrophic Reactions Sundowner's Syndrome

Mealtime and the Alzheimer Patient Index

The Alzheimer person may see food on their plate, yet fail to connect the chain of logic from hunger to food to feeding to gratification. This is often the way they perceive the world around them as well. Because of this loss of comprehension, the Alzheimer person may sit and stare at the food and while hungry, may be unable to put the steps in motion that would allow him to pick up a fork, place food on the fork and put the fork to his mouth, chew, and swallow. If the eating can be initiated, the remainder of the meal usually can be accomplished without incident. Many times the caregiver complains that the patient is being difficult or just plain obstinate. Not so, he has just lost the ability to eat normally.

Mealtime can be traumatic for the Alzheimer's person in the moderate to late stages of the illness. "Within the framework of their own personality, habits and traits, they are bewildered human beings, bound on all sides by the progressive limitations of their own body and mind, and this is not easy." (Quote from Alzheimer Society of Canada Report, Spring 1982.)

Special Table setting for the Alzheimer Patient

Forget the crystal and the china plates! Also, forget the full table setting of salad fork, dinner fork, knife and spoon! Instead--observe the person and see if he prefers a fork or spoon for lifting food to his mouth--then place only that one utensil by the plate. You eliminate choices and lessen agitation.

Instead of crystal glasses or other clear containers, purchase colored ones. The sturdy colored paper cups are also good to use. The Alzheimer's person often has limited vision due to the "messages" not being received and transferred to the brain from the eye, resulting in limitations. There will be fewer spills using colored glasses.

A soup bowl or other container with sloped sides should replace a regular flat dinner plate. With this type of plate the food is not pushed off onto the table. A damp washcloth placed under the dish will help to hold in place while the food is being placed on a spoon or fork.

Plastic eating utensils should be avoided. Alzheimer persons have been known to bite off the end of a plastic spoon or fork--not realizing it is not a part of the food. Always use metal utensils.

Large plastic aprons are helpful in keeping both the patient and the floor clean. The plastic covers used for customers in beauty salons are ideal for mealtime. These aprons can be turned up about three inches and stitched at the seams to make "pockets" that catch the food that normally would drop to the floor. If these ready make aprons are not purchased, large trash bags work well. Just cut up the back of one of the bags, open up the end with scissors, and cut oval sections from each side leaving end pieces to tie around the neck with the full plastic covering in front of the impaired person. These are 'disposable aprons'.

The table should be clear of all but essential items. It is best if salt, pepper, sugar, catsup and other condiments are left on a side table. It is not unusual for a person to put pepper in his coffee, or catsup in his glass. Also, the extra items on the table often will cause more confusion for the Alzheimer's person resulting in agitation. Also keep in mind--all poisonous liquids should be kept out of sight of the AD person. They will drink Clorox, vinegar, disinfectant, and will attempt to eat coffee grounds or other inedible items if they are in an area where the AD person normally eats food.

When Eating Becomes a Problem Index

Save your newspapers! Newspapers placed on the floor around the AD person's place will allow everybody to relax--knowing the papers can be rolled up and thrown away. No floors to mop and clean.

There comes a time when the Alzheimer's person will 'play' with his food. The food will be pushed together--pushed off the plate--or picked up and mashed between the fingers! This person is not being difficult but has forgotten what food is. One must sit at the table with this level of AD client and direct them in this way--"pick up your fork", "put some food on your fork", "put the fork in your mouth", "chew your food", "now swallow the food". DON'T FORGET TO SAY "SWALLOW". Many Alzheimer persons have been known to carry food around in their mouths for hours because someone forgot to say "swallow".

"Have a bit of this delicious custard" will get better results than "why don't you cooperate?"

It is not always easy to have the patience necessary to accomplish the meal without difficulty. Family members say that it is not unusual for each meal to take one to one and one half-hours. When it is obvious that the Alzheimer's person can no longer use the spoon or fork, he should still be encouraged to feed himself. By feeding himself (as opposed to being fed) the person will deep his self-esteem much longer. This is the time to introduce finger foods. Small crustless sandwiches of high nutrition can be placed on a plate with cheese cubes, bite size pieces of fruit, and vegetables that can be picked up with the fingers such as green beans, slices of beets, or pieces of squash. By all means eliminate the mashed potatoes and gravy at this point.

If the drinking container is overturned a lot, purchase one of the Training Cups with an opening that will not allow liquid to spill when the glass is overturned. Infants use these as they are learning to manipulate the drinking glass.

Sometimes the Alzheimer's person loses interest in the meal altogether and wants to continue his pacing or wandering behavior. Instead of three meals a day ~ place nutritious snacks near where the person rests so that a small amount of food can be eaten several times a day.

If tooth brushing is difficult to accomplish give apple slices following the meal, as they serve as a natural tooth cleaner.

Swallowing Assistance Index

As the disease progresses, the Alzheimer's patient can develop difficulty in swallowing. The following are some suggestions from the Northwest Speech and Hearing Center of Seattle:

  • Make sure the patient knows that he will be eating. A "surprise attack" may well lead to coughing or resistance. Tell him it is mealtime and let him see the utensils and food before eating.

  • To facilitate awareness and taste appreciation, let the patient smell or taste a drop of food before eating.

  • Avoid room temperature foods and liquids, which often cause choking due to lack of stimulation.

  • To reduce noise, do not provide social conversation during the meal. Give only as much verbal cueing a necessary for the patient to swallow.

  • Allow at least 40 minutes for each meal. Many patients have slow-moving or weak mechanisms. Six small meals per day or supplemental snacks may help these patients.

  • Encourage the patient to feed himself as much as possible, even if it is only one bite per meal.

  • Be sure the patient understands the purpose of your intervention: "This is to improve your eating."

Catastrophic Reactions Index

"He tried to choke me!" or "He never did that before-but he hit me!" or perhaps a husband might say "She has always been a gentle person but last night she hit me with a shoe." These are catastrophic reactions that come about (sometimes) when a person feels overwhelmed or is asked to do more than he/she is capable of doing. There are times when a catastrophic reaction comes about unprovoked.

Distraction is the best way to diffuse the violent behavior of the Alzheimer's person. You cannot reason with him as you would a rational person. One wife said that her husband held a hammer above her head and said "I'm going to kill you!"...and she responded by saying, "Why don't we have lunch first?", And he said "Okay" and put the hammer down. Sometimes it can be that simple.

One support group member said that her husband wanted to sleep in his shoes and being tired, she said, "Nobody sleeps in their shoes, so take them off!" and he came at her to hit her with one of the shoes. She hid her face and did not 'feed' the reaction, just as she had heard to do, and the outburst died instantly. However, if the catastrophic reaction is 'fed' either verbally or physically, there could be danger to those involved.

Some simple rules to remember when caring for an Alzheimer's person:

  • Never argue, as it will only create a bad situation

  • Never come up from behind and touch an Alzheimer's person as they have lost the perception to know that someone they know may be there.

  • Never take hold of the person's body (arm, for instance) without getting eye contact first. They could attempt to defend themselves if grabbed unaware.

Sundowner's Syndrome Index

People with a dementing illness have more behavior problems in the evening. The frustrations and sensory stimulation build up throughout the day and, by "sundown", they are not able to cope as well with the confusing environment around them. They may become increasingly confused, agitated, and anxious and may pace the floor, begin to wander or show other nervous behaviors.

To help minimize Sundowner's Syndrome, maintain a structured daily routine. This reduces the anxiety that decision-making can produce. Scheduled rest periods should be included in that routine. Try to keep the daily activities within the person's coping ability. Surprises, challenges or lots of new information can be very upsetting. Special occasions, outings, family visits and other changes in routine should be explained in advance and approached gently. It is best to schedule these events after quiet days. Turn lights on inside the house well before dusk to lessen disorientation.

StudyWeb Award
This page has been selected as a featured site in »Lightspan's StudyWeb« as one of the best educational resources on the Web by our researchers. It is included in the Health & PE:Nutrition & Diseases/Disorders:Alzheimer's Disease & Diet section.

Presented by Werner Saumweber, 17. Januar 2001
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