By Sylvia Foley, AJN senior editor
The fork and the spoon, by Jordan Fischer via Flickr
Feeding difficulties in people with dementia are common, but the way such difficulties manifest can vary widely, and there is no single, one-size-fits-all solution. Nurse researchers Chia-Chi Chang and Beverly L. Roberts open their April CE article, “Strategies for Feeding Patients with Dementia,” with some disturbing statistics that make clear the scope of the problem:
People with dementia constitute roughly 25% of hospital patients ages 65 and older and 47% of nursing home residents. And more than half of them lose some ability to feed themselves, which puts them at high risk for inadequate food intake and malnutrition. Patients who are unable to eat independently must rely on caregivers to assist them . . . Unfortunately, caregivers may be unable to identify the various types of feeding problems that accompany dementia or unaware of the feeding practices required to address them.
In an earlier literature review published in the Journal of Clinical Nursing, Chang and Roberts evaluated three tools used to assess feeding difficulties in people with dementia, then created a conceptual model depicting such difficulties, contributing factors, and outcomes. Now, in this CE article, the authors take their work a step further. They describe a range of assessment and intervention practices, matched to specific feeding difficulties and observed behaviors, that caregivers can try. For example:
- if a patient refuses or displays an aversion toward food, as evidenced by pushing the feeder or the food away, spitting out food, or refusing to open her or his mouth,
- then strategies might include feeding the patient at another time, seeking help from another nurse or nursing assistant, offering verbal encouragement, sitting down and making eye contact with the patient, and offering familiar foods.
A table breaks the information down for readers by type of feeding difficulty, listing associated observed behaviors and suggested multidisciplinary and nursing strategies. The literature is cited where applicable. “Although these strategies haven’t been validated in randomized clinical trials,” the authors explain, “they’ve repeatedly been endorsed by expert opinion and described as effective in observational and case studies, survey research, and literature reviews.” Suggestions on how facilities can best allocate personnel and on areas for further research are also provided.
As one expert said in a news article on the overuse of feeding tubes that ran in AJN last May, “Feeding a patient with dementia—or any patient at the end of life—is a true art.” Have you had success with any of these strategies?
I have been taking care of my father who does not open his mouth I keep talking to him and also give toys with music and light to wake him up .I try and give him tasty food but soft even sweets that are easily digestable in small quantity .I also give him massage in palms and feet with little olive oil ,he instantly wakes up and respond .a care giver should be very patient and loving and caring and try to understand small signs that they give and respond.eating will take long time it should be given in small pieces or in soup or liquid form .holding hands and showing them that we care ,gives them lots of confidence
This article is very interesting becuase currently I work in a geriatric psychiatric floor and this is so true. Feeding patients with dementia can be very difficult. Due to the fact that the elderly have a decreased sense of taste, food is not as enticing as it used to be. Also, many of the cardiac diets- low salt, low flat make the food very bland. The elderly also have a decreased sense of thirst. I’ve noticed that by keeping the elderly well hydrated they also become hungrier. I also try to take notice of patients individual eating patterns. Some patients wake up hungry in the morning, some in the middle of the night and some in the late evening. Everyone is so unique. It is interesting to note the article mentions that 25% of the hospitalized elderly population have dementia. Thus, feeding the elderly with dementia is not something that only psyche nurses are exposed to but, rather, all the medical floors might be. The suggestions offered by the article are also good. Sitting and talking with the patient, offering encouragment and sweetening or salting the food whenever possible helps. I find that most patients enjoy ice cream and I try to combine the meal with bites of ice cream in between. Patients with dementia seem to like the sensations created by the differences in taste and temperature. My name is Patricia Tondo. Thank you, for allowing me to offer my input.