This ElderCare Skill Builder™ is intended to give the eldercaregiver background information on special skills that caregivers may need on a daily basis. While these guides are primarily intended for caregivers of people with Alzheimer’s Disease, they can be used for any frail or dependent elderly person. When caring for an elderly loved one, always treat them as an adult, with dignity and respect.

You should use this guide for educational purposes and as a supplement to any professional training, guidance from a home care provider, or instructions from a qualified health care professional. As a caregiver, you will likely be the first to notice any important changes in physical attributes, eating habits or health status. Please notify a qualified health professional immediately if you notice any changes.

Things That May Cause Problems With Eating

   Surroundings

   Tips and Techniques

Planning And Preparing Meals

   Tips and Techniques

Feeding Someone Who Is Bed-Bound

   Tips and Techniques

   A Choking Emergency?

Things That May Cause Problems With Eating

• Not enough light to see the food, or glare
• An area that is too noisy or full of distractions
• Too many people around
• Too many choices of food, utensils or drink
• Unpleasant smells, such as urine or cleaning fluid
• Unappetizing appearance or smell of food
• Instructions that are too complicated
• Feelings of anxiety, or of being rushed by the caregiver

• Some type of mouth discomfort, such as sore teeth, loose dentures or dryness
• Side effects of some medications
• Inability to recognize the sensation of hunger
• Chronic or acute illness
• Constipation
• Agitation
• Depression
• Adjusting to new surroundings
• Loss of understanding about how to eat with utensils
• Forgetting to eat, even during the meal

Tips and Techniques

Dinnertime can be the best of times or the worst of times, depending on how well you are prepared. These suggestions may help:

1. Eating with one or two other people at a small table in a quiet room helps. A folding screen by the table can block distracting noise or moving people.
2. A person who is restless should be encouraged to eat with others and to have frequent nutritious snacks to maintain weight.
3. People who have trouble staying awake during mealtime should be around others who talk and encourage eating actions. Upbeat music, bright colors in the room and good lighting may help. They should be kept sitting upright for at least a half hour after eating to avoid choking on food if they fall asleep.
4. Try to determine what the actual problem is by looking for patterns, special difficulties with certain foods, chewing or swallowing problems, responses to certain people, etc.
5. Do not try to serve a person who is upset or sleepy.
6. Be organized and stay calm.
7. Use a plastic tablecloth or place mats, straws, non-spill cups, and dishes with suction cups. Do not use plastic utensils.
8. If a person has dentures, make sire they are in place. Check the gums for any sores if the dentures are loose.
9. A bib or special "mealtime" shirt will reduce the need to change and wash clothing.
10. Keep the food simple. Too much or too many choices can be confusing. Offer one item at a time.
11. Offer meals at regular times.
12. Try soft, relaxing music at mealtime.
13. Remove other distracting items from the table.
14. Encourage the serving of "finger foods."
15. Allow individuals to feed themselves as much as possible.
16. Allow enough time for the person to take each bite.
17. Pay attention to your elder as they are eating and do not interact with other people. Stay focused on helping your elder.
18. Consider a person’s former eating habits/likes/dislikes, but remember that during the progression of Alzheimer’s Disease food preferences may change.
19. Pay attention to food temperatures (may be too hot).
20. Alcohol should never be served to a person with Alzheimer’s Disease.

Planning and Preparing Meals

Tips and Techniques

Making sure a person with Alzheimer’s Disease eats enough of the right kinds of foods can be a challenge. Here are some suggestions:

1. Serve favorite foods often, especially if a person has little appetite. Variety doesn’t matter as long as the day’s intake is well-balanced and meets caloric needs. Cook food in a way he or she likes it – even though it may not be the way that you like it.
2. Make sure the dishes and the tablecloth and place mats differ in color from the food. The food, dishes and table surface should all look different from each other. Use plain dishes with no pattern.
3. Add extra nutrients to the diet of a person who eats too little; wheat germ can be added to soups, shredded carrots to tuna fish and grated lemon or cheese to salads. Add powdered skim milk to soups or milk shakes for extra protein.
4. Small frequent meals at regular intervals throughout the day may be easier to handle than three large ones.
5. Nutritional supplements may also provide extra nutrients. Ask the doctor which supplements are best.
6. If food needs cutting, cut it in the kitchen before bringing it to the table to avoid difficulty or embarrassment. Ask for the cook to do the same in a restaurant.
7. If a person is not eating, try this: get his or her attention, take a piece of food from your plate and put the food in your mouth while looking at the person. Then say, "It’s your turn." Or try yawning or asking the person to say "ah."
8. People with Alzheimer’s Disease often like sweet foods and fruit. Keep a dish of fruit available.
9. Serve foods that don’t need much chewing: soups, ground meat, mashed potatoes, applesauce, pureed vegetables. Baby foods are fine, but expensive; try a food processor or a table grinder.

Feeding Someone Who Is Bed-Bound

Tips and Techniques

Encourage a person who is bed-bound to do as much for him or herself as possible for as long as possible. To make mealtime easier, try some of these suggestions:

1. Protect sheets with a plastic cover, such as a plastic bag, placed under the food tray.
2. Elevate the person’s head with pillows.
3. Eating while lying down can lead to choking. Use a bendable straw or drinking tube for liquids. Keep the sipping end of the straw above the level of the liquid, and always support the person’s head.
4. Serve lukewarm foods that need little chewing.
5. Feed with a half-full spoon. Wait five seconds or so before offering more food.

A Choking Emergency?

Ask your physician or the Red Cross to teach you a method of clearing the airway of a choking person, such as the Heimlich Maneuver.