Expert: Mary Gordon - 7/19/2010

Question
Hi Mary,
Thank you for all your advice through this difficult time with my aunt.  I tried to follow the directions regarding dysphagia with my aunt but still encountered another little obstacle.  I mentioned previously that my aunt puts her head back when she is spoonfed, now she is turning her head away and pushing my hand aside and saying "no" or "no more".  I don't want to wrestle with her, especially in front of a dining room full of nurses aides and other residents.  Any other tips on feeding her without forcefully doing so??  I tried to approach from both sides, but I don't want to hurt her.  Incidentally, the staff still tells me that she is feeding herself ( I put a spoon in her hand and she apparently didn't know what it was) and that her appetite is good. (she had a few spoonfuls of mixed vegetables, 2/3 cup of yogurt, and half of chicken pot pie.  Maybe I shouldn't go there when she's about to eat.  What would you do or am I doing something wrong? What I see and what they are saying are two polar opposite...

Answer
Hi Ellen, what we found with my mother in law is that by mid to later AD, she did better when she was fed alone on the ward at a little card table, than she did in the dining hall.

She got very distracted by the bustle and noise of the big dining hall, and she would not eat as much, as she did sitting on her own, quietly concentrating on eating. It was sad to see her by herself with just a carer, but it did help a lot, and the point was to get more food into her. She also did better with more frequent smaller meals. When she could still feed herself and could handle some texture, they put an emphasis on foods she could eat with her hands.

Later, she need pureed foods and thickened liquids.

The staff should be watching to see if there are times of the day when your aunt is more interested in food and will eat more, so the emphasis can be on getting calories into her at that meal. There is no reason why any specific types of food have to be eaten at any particular meal. If, for example, there are things she really prefer that are high in nutrition or calories - for example custards, there is no reason she shouldn't have those for breakfast or more than once a day. If she is being given a lot of juice between meals, ask to have that cut back in favor of less sugary liquids. Juice can be a real appetite killer.  

I am assuming her weight is being monitored. If she is losing weight, she should be seen by a speech therapist and the dietician and assessed for dysphagia. They really have to have a strategy to keep her weight up - and that may mean higher calorie foods and supplements, more frequent feedings and snacks, a change in consistency, trying small amounts of one food at a time on her plate so as not to confuse or overwhelm her etc.

Weight monitoring is key. If she is eating very little, but not losing weight, it may just be that her caloric needs are declining because of the illness and inactivity.

You might want to ask if she can be brought a tray and fed in a quiet spot by herself and see if that helps. Make sure she has plenty of time to eat, so she is not rushed or stressed in any way, and that the person assisting her is positive and calm. You might also want to come and observe her from a far to see if the staff observations are correct or not. If they believe she is eating her food and successfully feeding herself when you are not there, watching her without her knowing will demonstrate if they are talking through their hats or not.

Hope this helps. Your aunt is lucky to have you concerned about her well being.

Mary