28: Nutrition

This program will

  • Discuss some basic principles of proper nutrition and hydration for the elderly
  • Indentify the challenges with eating and drinking that often develop in the later stages of dementia
  • Provide some guidelines and strategies for supporting good nutrition and hydration
  • There are no easy answer when its comes to the care of another
  • Our hope is to offer you useful information and guidelines for caring for someone with dementia
  • These guidelines will need to be adjusted to suit your own individual needs
  • Nutrition-dense foods
  • Well-balanced diet of fruits, vegetables, dairy, meats and whole grains
  • Allow for allergies and other dietary restrictions
  • DASH diet
  • Prepared and served to match the person’s level of functioning and needs
  • Soft or pureed foods
  • Thickened soups and liquids

For more information on the DASH Eating Plan, click on the website link below:

http://www.nhlbi.nih.gov/health/public/heart/

  • Brain healthy foods
  • Fruits, vegetables, nuts, seeds, olive oil and fish
  • Adequate vitamins and minerals
  • Magnesium, zinc, iron, vitamin D, calcium, and selenium
  • Antioxidants: polyphenols
  • Folate
  • Vitamins B6 and B12
  • Unsaturated fatty acids: omega-3 fatty acid
  • Fruits (blueberry), vegetables (spinach), nuts (walnuts), whole grain cereals, chocolate, tea, coffee, red wine
  • Fish, olive oil
  • Antioxidant supplements
  • Vitamins E and C
  • A variety of antioxidants from a nutritious diet and supplements combined with physical, social, and cognitive enrichment can improve mental function
  • Exercise
  • Improves memory and mental function
  • Elevates mood and energy
  • Improves health
  • Nutrient-dense, well balanced meals and snacks
  • Fruits, vegetables, whole grain foods, fish, lean meats, poultry, and low fat diary products
  • Avoid foods high in fat, sugar, salt, and highly processed foods
  • Provide healthy snacks
  • Foods high in fiber prevent constipation
  • Vitamin supplements
  • Folic acid, calcium, vitamins D, B6, B12, C and E
  • Consult a physician and dietician about unhealthy weight loss
  • Elders have a high risk for dehydration
  • Swallowing problems
  • Poor food and fluid intake
  • Reluctant to drink due to toileting issues
  • Fear of falls getting out and into bed
  • Medical problems associated with dehydration
  • Urinary tract infections, constipation, confusion, dizziness, kidney and heart problems
  • Recommend 1 mL of water for each calorie of food
  • 64 to 80 oz of water a day for average adults
  • Includes water from food
  • Offer every 2 hours
  • Set a daily schedule for drinking
  • Incorporate into activities
  • Drink with every meal
  • Alternate fluid between meals
  • Sit down and have a nourishing drink together
  • Have water available
  • Honor preferences for fluids, but encourage water as best source of fluid
  • Limit caffeine intake
  • Offer a small cookie or cracker as an incentive to drink
  • Add new flavors
  • Fruit juice, a lemon slice, or sliced cucumber in water
  • Decaffeinated tea
  • Fruit ices, popsicles, and gelatin desserts
  • Milk shake or root beer float
  • WHO drink for preventing dehydration
  • 3/4 teaspoon table salt
  • 1 teaspoon baking powder
  • 4 tablespoons sugar
  • 1 cup orange juice in
  • 1 quart or liter of water
  • Check person’s weight at least weekly
  • Look for signs of dehydration
  • Dry mouth, nose, and skin, light-headedness, low energy, fainting, and low blood pressure
  • Consult a physician about difficulty drinking or swallowing
  • Use encouragement, patience and cueing

What was wrong with Mary’s approach to assisting Robert with his meal?

  • A. Mary failed to get Robert’s attention and engage him.
  • B. Mary failed to notice that Robert was not aware of his surroundings and not focused on the task of eating.
  • C. Mary wrongly assumed that Robert had the abilities to chew and swallow.
  • D. Mary endangered Robert by not staying with him to make sure that he did not choke on the piece of chicken.
  • E. All of the above.

Choice A: Mary failed to get Robert’s attention and engage him, is a good choice.

  • In the later stages of dementia, caregivers will need to make considerable effort to focus their care recipients on tasks such as eating
  • Mary needs to sit near him, get close, make eye contact, and say his name, and maybe take his hand

Choice B: Mary failed to notice that Robert was not aware of his surroundings and not focused on the task of eating, is also a good choice.

  • Carefully observing people’s facial expressions, gestures, posture, and state of dress can give much information about their emotional and mental states
  • By the late stages of Alzheimer’s, the usual signals that tell people that they are hungry or thirsty are not working properly

Choice C: Mary wrongly assumed that Robert had the abilities to chew and swallow, is another good choice.

  • In the later stages of dementia, the abilities to chew and swallow diminish and are eventually lost

Choice D: Mary endangered Robert by not staying with him to make sure that he did not choke on the piece of chicken, is a good observation.

  • Older people with dementia are at greater risk for choking
  • Choking
  • If someone choking and coughing, encourage the person to cough and clear the airway
  • If the person is unable to clear the airway, perform the Heimlich Maneuver®

Choice E: All of the above, is the best answer

  • A choking person needs your help immediately
  • Follow these steps to help someone who is choking
  • From behind, wrap your arms around the person’s waist
  • Make a fist and place the thumb side of your fist against the person’s upper abdomen, below the ribcage and above the navel
  • Grasp your fist with your other hand and press into the person’s upper abdomen with a quick, upward thrust
  • Do not squeeze the ribcage; confine the force of the thrust to your hands
  • Repeat until object is expelled.
  • Feeding apraxia
  • Principles and techniques for assisting someone to eat in the later stages of dementia
  • Recognizing the person’s autonomy
  • Simplifying the task
  • Cueing
  • Positioning
  • Assisting with chewing and swallowing
  • Methods of food preparation
  • Assistive devices
  • Prepare yourself physically and mentally to share an important and sometimes challenging activity
  • Sit down and engage with the person, making it a social experience
  • Tell the person what is on the plate and what is on the spoon
  • Give time between spoonfuls
  • Offer a beverage regularly
  • Come to the table with everything you need
  • Sit on the person’s dominant or preferred side
  • Position yourself at a 90 degree angle
  • Tell the person what is on the plate
  • Ask if the person wants a particular food from the plate
  • Place a small portion on a spoon and say what you are serving
  • Raise the spoon so the person can see it
  • Give time between bites to chew and swallow
  • Offer drinks regularly to wash down food and to hydrate
  • If able, encourage or help the person to wipe the lips
  • Do not mix foods unless you know that the person prefers it that way
  • Do not place too much food on the spoon
  • Do not scrape excess food from person’s lips
  • Do not use a bib unless necessary
  • Do not ignore or exclude the person from conversations
  • If you have to step away from the meal or are distracted, excuse yourself
  • Use proper manners and show respect
  • Autonomy and Independence
  • Allow as much “self feeding” as the persons can manage
  • Feeding someone is a bonding interaction
  • Love and Respect
  • Simplify the task
    • Set out only necessary utensils
    • Provide cup that is easy to hold, filled only part-way
    • Present one food item on the plate
    • Use same utensil throughout the meal

Strategies for Assisting with Eating (continued)

  • Equipment
    • Lightweight, plastic glass
    • Cup with a large handle
    • Soup served in mugs with handles
    • Spoon with a padded handle

Strategies for Assisting with Eating (cont’d)

  • Communication strategies
    • Verbal and non-verbal message
    • Engage
    • Present a calm, pleasant demeanor
    • Use simple language, repeat and rephrase as needed, and say the important words last
  • Graded helping
  • Mirroring: showing by example
  • Cueing: giving someone a signal to start or resume an activity
  • Guiding: providing hand-over-hand guidance
  • Sequencing: maintaining a logical, consistent pattern of activities
  • Positioning: helping the person into an optimal body position for the activity
    • Chairs
      • Best to sit in chairs with their hips at a 90% angle
      • Sit back so that their thighs are supported to within 2 inches of the backs of the knees
      • Even distribution of weight,
      • Body about 4 inches from the table
    • Wheelchairs
      • Firm seat
      • Armrests should support their elbows without causing their shoulders to hike up
      • Best to sit at a table
    • Bed
      • As upright as possible
      • Support under the knees
      • Slight forward tilt of the head
      • A pillow or hand behind the head
      • Caregiver should sit on the person’s dominant or preferred side
  • Holding food in mouth
  • Biting spoon
  • Spitting food out
  • Choking
  • Caregivers may be able to help by placing their hand under the jaw and gently moving it up and down

Chewing & Swallowing Assistance (continued)

  • Pocketing & choking
  • Holding food in mouth
  • Choking risk
  • Offer small amounts of food
  • Small, easy-to-chew pieces
  • Offer a drink after each bite

Chewing & Swallowing Assistance (continued)

  • Swallowing
    • Signs of swallowing difficulty:
      • Frequent throat clearing
      • “Gurgling” sound to their voice
      • Delay in swallowing
      • Swallowing several times with one bite
      • Food still in their mouth after swallowing
      • Coughing during or after a meal
      • Fatigue
      • Weight loss
    • Consult a healthcare professional
    • Pureed food and thickened liquids
    • Position the head by tucking the chin

Chewing & Swallowing Assistance (continued)

  • Verbal cueing
  • Position the head and chin to promote swallowing

Chewing & Swallowing Assistance (continued)

  • Biting the spoon (bruxism)
  • Spoons with a soft coating
  • A common plastic spoon should not be used
  • Use a slight downward pressure to the lower lip as a cue not to bite on it
  • Remove the spoon from the mouth as soon as the food has left the spoon
  • Rocker knife
  • Plate guard
  • Universal cuff
  • Small washcloth around a spoon handle
  • Provide a well-balanced diet consisting of nutrient-dense foods
  • To prevent dehydration, offer liquids throughout a meal and at least every 2 hours during the day
  • Weight loss, feeding apraxia, and choking become serious issues during the later stages
    • Engage
    • Simplify tasks
    • Provide graded helping using mirroring, cueing, and hands-on guiding
    • Position properly for meals
    • Use assistive devices
  • Follow the guiding principles of promoting independence, love, and respect

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

27: Managing Incontinence

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion

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