When we educate those in the health care profession on dementia, it is vital we instruct everyone. This includes even the nutritional support team. It needs to be understood that by placing a tray of food in front of people living with dementia that are in the latter part of their disease, this is only the step one, especially if they’re in a settings such as in a hospital where their confusion levels may be extremely high.
Sometimes they may just need a little assistance to get started. They may actually forget how to use utensils. By removing all lids and placing forks in their hands may be all they need to start digging in. The same goes for placing the straw in the drinking cup. We don’t just place the meal down and walk away!
During the latter stages of dementia-related diseases, our loved ones will need more and more assistance at the dinner table. The first problem I ran into with my father was getting him just to eat . . . period.
After several fruitless attempts, I soon discovered that the only way I could get Dad to finish a meal was if I sat at the table and ate with him. The upside of this, of course, was that we enjoyed our dinner time together, as a family. Always, during these times, it was also helpful to keep a casual conversation going with him while we ate.
Also with my dad, keeping two family photo albums on the kitchen table at all times became a perfect redirectional tool. This gave me time to do the cooking while he was content to sit nearby flipping through the pages of his past memories. Sliding an album directly in front of him proved to keep his anxiety under control, while also preventing him from becoming impatient. When he finished eating, I would remove his plates and place those old photographs right back in front of him again, giving me time to clean up and finish my chores. (In a hospital setting, this is where a direct observer would come in handy.)
As his disease progressed, I began to become of aware of other dilemmas surrounding dad. For instance, he would only eat the food on the right side of his plate. I learned to rotate his plate 180 degrees and this immediately solved the problem.
In general, we caregivers also need to pay close attention to the colors and designs of table settings. We shouldn’t serve meals on white plates on top of a white tablecloth. We’re better off using colored plates and brightly enhanced glassware. The intention is to offset the color to help their vision. Think contrast.
Have you noticed your loved one, living with dementia having problems with using the silverware? Good news! There are specially designed utensils available. One product that comes highly recommended is called a “Knork.” It’s basically a fork and knife built into one piece, naturally curved to fit the hands better. Then again, finger foods can easily and efficiently be offered—these were also another big winner at our table.
Unfortunately, difficulty with swallowing will most likely become a problem towards the end of the disease. Keep a close eye on this. If you notice any light coughing or choking: It could be one reason why these folks are not eating what you are serving on their plates. PLease notify their physician of these changes. Be prepared to adapt—changes may come frequently and sometimes suddenly.
Also be prepared: you are going to hear from every so-called expert telling you that you must provide only nutritional foods. Well, I am here to tell you that I got to the point where, if my dad wanted ice cream for dinner or even a bowl of cereal, I was thrilled to death to get even those foods inside of him.
If you’re worried about dehydration, a bowl of soup, jello or fruit may be the perfect answer. Use your own judgment and maybe a little imagination. Concentrate on keeping these folks hydrated with something in their bellies.
Ideally, by now and along the same lines as feeding, there has been a discussion about the end-of-life decisions between them and their families or advocates. If not, this should be addressed a.s.a.p. It’s horrifying if not arranged beforehand to have to make end-of-life decisions suddenly—such as having feeding tubes inserted and resorting to other drastic measures of putting off the inevitable. Personally, when that time arrived, I took one look at my dad and I knew he had fought long and hard enough.
Favorably, the family has already made a concerted effort to get all these hard choices out of the way early so everyone can enjoy as many long and pleasant times—and those dinners—as possible. I truly treasured those times I had at the dinner table with Dad. They’re some of my fondest memories.
Gary Joseph LeBlanc
Director of Education
Dementia Spotlight Foundation