Continuous Chewing While Eating in Dementia Patients

Food, eating, and mealtimes are important parts of life. Food gives us life-sustaining nourishment and contributes to good health, eating satisfies our hunger and stimulates our senses, and mealtimes can be important sharing and social times with family and friends. Many of our favourite experiences and memories—preparing and sharing holiday dinners with family members, celebrating birthdays and other life events with special meals, and getting together with friends for lunch or dinner, for example—involve eating and food.

When a person has Alzheimer's disease or another type of dementia, though, the ability to prepare meals and eat independently may diminish, and mealtimes can become challenging, frustrating encounters for both the individual and the caregiver. Often, too, the person with dementia may be experiencing changes, such as decreased appetite, that are part of normal aging. Combined, these changes can lead to malnourishment and dehydration, increasing the risk of infections, poor wound healing, abnormally low blood pressure, and other problems.

Good nutrition cannot always prevent weight loss in people with Alzheimer's disease, nor will it slow the progression of dementia. However, continuing to eat a healthful diet can promote overall health, improve the person's ability to cope, help prevent some physical and behavioral problems, and most of all, contribute to higher quality of life. Family members and paid caregivers of people with AD play an important role in both encouraging eating and identifying eating-related problems that could be resolved. This article discusses some of the eating-related challenges associated with the middle stages of AD and related dementias, and suggests mealtime strategies and tips for at-home caregivers.

Understand the Challenges

As people age, their interest in eating and mealtime enjoyment can change. Some older adults find that their senses of taste or smell decrease, making food seem less appealing than it did in the past. Others eat less because of difficulties chewing or digesting as they get older. Medicines can also affect appetite, and constipation may increase with age or medication use. When a person has AD or other dementia, these problems can become more pronounced, and mood, behavioral, and physical functioning problems may affect eating as the disease progresses.

"When the brain is involved, as in dementia, any part of seeing, thinking, or moving can be affected—from problems seeing the food clearly to difficulty planning the movement of scooping with a utensil and bringing food to one's mouth. These problems can take the pleasure out of eating," explains Sue Coppola, MS, OTR/L, BCG, clinical associate professor of occupational therapy and core interdisciplinary team member with the Program on Aging at the University of North Carolina at Chapel Hill.

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.

Tips for Making Mealtimes Easier and More Enjoyable

• View mealtimes as opportunities for social interaction and success for yourself and the person with dementia. A warm and happy tone of voice can set the mood.
• Try to make mealtimes calm, comfortable, and reassuring. Be patient, avoid rushing through meals, and give the person enough time to finish the meal.
• Be sensitive to possible frustration, confusion, and anxiety during mealtimes and look for ways to reduce these feelings.
• Maintain familiar routines and rituals, but be flexible and adapt to the person's changing needs.
• Minimize distractions during mealtimes. For example, turn off the television or radio, and eliminate unneeded items from the table.
• Offer appealing foods that have familiar flavors, varied textures, and different colors, and give the person opportunities to make choices.
• Make nutritious finger foods and nutrient-rich homemade shakes or shake products (unless the person is lactose intolerant) available throughout the day.
• In the earlier stages of dementia, be aware of the possibility of overeating. If this occurs, provide a balanced diet, limit snacks, and offer engaging activities as alternatives to eating.
• If the person is on a reduced-sodium or sugar-restricted diet because of hypertension, diabetes, or another medical condition, keep foods with high salt or sugar content out of reach or in a locked cabinet.
• Help the person drink plenty of fluids throughout the day—dehydration can lead to problems such as increased constipation, confusion, and dizziness.
• Use adaptive eating tools as needed. Talk with an occupational therapist about which tools might be helpful, as well as other strategies to make eating and mealtime routines more successful.
• Identify and work to resolve issues such as depression, forgetting to wear glasses or hearing aids, wearing poorly fitting dentures, and use of appetite-suppressing medications, which may impair the person's ability or desire to eat.
• Maintain routine dental checkups and daily oral health care.
• Be alert to and address potential safety issues, such as the person forgetting to turn off the stove after cooking and the increased risk of choking because of chewing and swallowing problems that may arise as the disease progresses.

And finally: Remember to take care of yourself to reduce the stress of caring for others. Whenever you have questions or worries, get help from your health care provider, friends, and family.

Source: National Institute on Aging, Alzheimer's Disease Education and Referral Center http://www.nia.nih.gov/alzheimers/features/encouraging-eating-advice-hom…

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Source: https://lewybodydementia.home.blog/2018/10/30/lewy-body-dementia-eating-difficulties-eating-disorder/

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