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Introduction

The brain is extraordinarily complex. It is made up of several distinct parts, each with its own function. While these parts are separate, they must work together to complete the simplest task. As Alzheimer Disease affects each area of the brain, certain functions or abilities can be lost. One link in the chain of events may be missing and the person will need help or a coping mechanism to complete the task. It is important for caregivers to remember that changes in a person’s behaviour may be related to the disease process.

The ritual of eating

Eating plays an important role in our lives. It is often a social event, a time shared with family and friends. It can provide structure to the day. Each household has its day-to-day eating habits and patterns, the “table manners” which family members come to expect and enjoy. Alzheimer Disease affects these patterns because the skills needed for eating are lost and awareness of social etiquette is forgotten. It then becomes important for the caregiver to ensure that the person with Alzheimer Disease is getting enough to eat and drink.

Where to begin

Usually we do not assess our eating habits and routines, which have developed over a lifetime. The following suggestions may be helpful to reduce problems and make meal time more pleasant.

Consider the person

• Is the person’s mouth free from sores? Do dentures fit properly or are teeth worn down or missing?
• Are there medications or other conditions (such as heart condition, diabetes, constipation or depression) that may lead to loss of appetite?
• Can the person visually distinguish food, plates, etc.?
• Can the person recognize food as something to eat?
• Does the person know how to use table items, such as utensils, condiments?
• Is the person agitated or restless?
• Is there confusion about meal times or whether a meal has been eaten?
• Is food less appealing because the person’s sense of taste and smell has lessened?

Consider the setting

• Is there too much noise, too many people or other distractions?
• Is the table too cluttered?
• Is the lighting adequate?
• Is there a need to rush? Are other people impatient?

What to try

Whether a specific reason for the problem is determined or not, there are strategies that can be tried to make eating easier and more pleasant.

The table

• Provide a calm and unhurried atmosphere, minimizing distractions, loud noises and abrupt movements.
• Simplify the table and the setting. Omit unnecessary utensils and condiments. Give only one food item at a time. Reduce sharp knives or fragile china.
• Provide a sharp colour contrast between table or place mat and the plate, but avoid strong patterns as they cause confusion.
• Choose cutlery and dishes that are easy to hold.
• Ensure plates are stable - with mats or even a wet cloth underneath to prevent slipping.

The food

• Provide finger foods: foods that have the same taste and nutritional content as a regular menu, but are in a form that can be picked up and eaten easily. This provides nourishment when it is difficult to use utensils.
• Provide nutritious foods that can be taken from a cup or a mug: the ability to hold a mug and to drink is often retained until late in the disease. Milkshakes or liquid food supplements can sometimes take the place of a full-course meal.
• Offer frequent small meals or snacks rather than three large meals in a day.
• Provide food that is colourful and easily distinguishable on the plate.
• Provide the person’s favourite food. Food that tastes and smells good may also serve as reminders of happier times.
• Cut food into manageable bite-sized pieces. If there is a concern about choking or swallowing, consult your physician.
• Check the temperature of the food to ensure it is not too hot or too cold.
• Cue the person with words or actions. The person might be able to mimic your motions for eating.

Day to day

Elegant dining may not always fit the realities of Alzheimer Disease. By adapting some of our eating rituals, a person with the disease can be encouraged to eat, often with independence and pleasure. However, what works one day may not work on another. It is important to remember that you are doing the best you can.

In addition...

We are learning more about Alzheimer Disease and its care everyday – much of it from caregivers like yourself who find solutions to problems and share them with others. You can call your local Alzheimer Society to find resources in your community. You can also exchange ideas by visiting The Care Exchange and Caregiver Forum on the Alzheimer Society of Canada Web site, www.alzheimer.ca. There is information. There is help. You are not alone.

Resources:
The Alzheimer Journey, Module 4, “Understanding Alzheimer Disease: The link between brain and behaviour”, video and workbook series, Alzheimer Society of Canada, 2002.

Related information: Food for Thought: Practical Tips about Eating, Feeding and Nutrition

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