Tips for getting Alzheimer's patients to eat and drink ...

Tips for getting Alzheimer's patients to eat and drink

Many caregivers become frustrated, trying to ensure that their loved ones drink enough fluids, and maintain their weight. I've found many suggestions on how to deal with these problems on the discussion forums.


GETTING ENOUGH FLUIDS

Alzheimer's patients tend to have problems with dehydration at almost any stage, which can have serious consequences. It can increase confusion and muscle weakness and cause nausea. Nausea, in turn, will prevent the person from wanting to eat, thereby causing more dehydration.

Often, they get dehydrated simply because they won't drink enough, and there are a lot of tricks for getting fluids into them -- such as offering high-liquid fruits such as watermelon, popsicles, ice cream, thickened soups, jello (sometimes with fruit in it), or a Boost protein shake with evening medicines. Serve beverages at room temperature. Avoid caffeine, which may cause frequent urination and dehydration.

Alzheimer's patients may have difficulty swallowing (this is called "dysphagia"), especially in the later stages. Use a child's sippy cup or "nosey cups" (plastic cups with a cutout for the nose if your loved one keeps his/her head tilted down somewhat when drinking) to make it easier to drink. If that doesn't work, thicken drinks, soups, and other liquids, to make them easier to swallow. There are products especially developed for this; for example, see the Nestle Nutrition Store products at:

http://www.nestlenutritionstore.com/dysphagia.asp

60% Pear nectar/honey and cranberry thickened with honey are favorites, since our loved ones often prefer sweet tastes. Drug stores also sell products such as "Thick-It". Although these are over-the-counter, they may be shelved behind the pharmacy desk, so ask.

But you don't have to stick with special products. Use baby cereals such as rice or oatmeal to thicken drinks. Pureed fruits can be added to fruit juices. Yogurt, ice cream, or powdered milk can be added to milk. Thicken soups and shakes with small pastas, rice, instant potato flakes, or oatmeal.

Conversely, solid foods may have to be cut into tiny pieces, or even pureed, to make them easier to swallow.


GETTING ENOUGH NUTRITION

When a loved one refuses to eat, or is eating but still losing weight, there are many ways to encourage them to eat, and to pack each mouthful with calories.

First, be sure to have a doctor check to make sure your loved one isn't suffering from an infection (urinary tract infections are all too common!) or another problem, such as a bowel obstruction, that is making your loved one too uncomfortable to eat

Check the possible side effects of any medications your loved one is taking, especially those recently prescribed. Cholinesterase inhibitors such as Aricept, Razadyne (galantamine), and Exelon, for example, may cause nausea, stomach cramps, bloating, diarrhea, or anorexia. Be sure to have your loved one take such medicines on a full stomach. It may be necessary to decrease the dosage, or even switch to a different medicine, if the symptoms don't go away in a few days.

Or perhaps your loved one is suffering from depression, and an antidepressant, or a medication which stimulates the appetite (such as Megace or Megesterol), may help.


Let your loved one eat wherever s/he is comfortable. Some become agitated at the dinner table, but are happy eating on a TV tray, or even standing by a counter in the kitchen. Your loved one might prefer to dine alone, or may crave the company of family members or a close friend. Minimize distractions, such as a noisy TV or radio.

Put food on a brightly-colored plate. For example, use a bright red or yellow plate -- those seem to be the ones that work best. The color often fascinates Alzheimer's patients, and they will get closer and closer, and eventually start eating. When your loved one begins to get used to one color, switch to another.

Another thing that can help is to cook with color. Use red, yellow, orange or green peppers, sweet potatoes instead of white potatoes (which add sweetness, too), grapes, carrots, tomatoes, spinach ... lots of contrasting pretty colors! Keep some dried or frozen blueberries or a frozen berry medley on hand, and add to pears or peaches, pudding or yogurt, or ice cream, to add color and flavor and fiber.

Most taste sensations start to fade over time in Alzheimer's patients. Usually, the taste of sweet and the taste of strong spice (such as curries or Carribbean flavors) are the last to go. So try to punch up the meal with very flavorful spices and herbs, (but not much salt!) To add a sweet taste, top foods with jelly, honey, or a berry medley, or serve small cakes with the meal. Don't worry if you don't find a concoction appealing ... if your loved one likes it, that's all that matters!

Try apple salads with chopped apples, maybe some celery, dried fruit (blueberries, cranberries, raisins), and chopped nuts. Sprinkle with sugar and just a little lemon juice ... and if you want a little creamier dressing, add a tablespoon of whipped cream. Or try cubed tomatoes, avocado and mozzarella cheese dressed with a bit of honey mustard dressing. Cooking with fruit is a great way to get in both fiber and sweet. Any time you cook a fruit, it intensifies the sugars in the fruit. So cook chicken with apples, a fruit salsa over chicken or fish, or grilled fruit as a side dish.

Offer high-calorie, nutritious foods -- such as almond butter and peanut butter; pudding; protein shakes frozen just to the thickness that they'll stay on the spoon; or mashed potatoes (perhaps mashed with other foods your loved one might like, such as cheese, sour cream, onions or scallions, etc)

Think of ways to add calories and nutrients to everything your loved one eats. Make milkshakes with real ice cream plus Carnation Instant Breakfast or protein powder to add nutrients. Try using a high-calorie supplement such as Boost shakes or Ensure Plus, perhaps blended with ice cream. Blend anything you can with bananas and protein power. Make a "breakfast pudding" of bananas, protein powder, wheat germ, heavy cream and a flavored extract, thickened with baby oatmeal dry cereal if it's too runny, or sweetened with seedless "Simply Fruit".

Make foods easier and/or more fun to eat.

For example, as discussed above, thickening drinks and soups, or pureeing solid foods, may make them easier to swallow.

Melted cheese holds the bread together in sandwiches and so does peanut butter. Eating is easier if crusts are removed and the sandwiches are cut into smaller pieces. Scrambled eggs hold together better if you add a little cheese when you cook them... for example, with a low sodium cheese such as lacy swiss.

Serve small portions. For example, cut a sandwich into four pieces. Give your loved one a single piece. When s/he eats it, act as if s/he hasn't had a meal yet, and offer another piece. Serve several small meals and snacks scattered throughout the day.

Try offering finger foods, which may be more "fun" to eat, easier to handle, or appear to be smaller servings. For example, offer tiny individually wrapped cheeses (monterey jack, string, and cheddar) served with fruit as a snack, or ice cream sandwiches cut into small pieces.

Try to have something sweet to end the meal, such as a favorite fruit, fresh or frozen. Or, start the meal with something sweet. Once the "pump has been primed", the loved one will often go on to eat everything else that is offered.

Use something your loved one likes as a bribe to get him/her to eat -- taking a nap, going for a walk, playing a game, whatever. Tell your loved one s/he can do "x" when finished eating.