Food, music, art, and good company are crucial to our wellbeing. This doesn’t change when we develop Alzheimer’s. FOOD BASICS As caregivers of Alzheimer’s people, we need to approach food, meals and eating routines with flexibility, imagination, and new awareness. When our care receivers are reluctant to eat, it may be because they are confused about which utensil to use. It’s not unusual for a person with advanced Alzheimer’s disease to suddenly not know HOW to hold a spoon or even recognize the spoon as a utensil. More commonly, the person may be totally overwhelmed by too much food or too many choices. So before you assume that she’s not hungry, try several of the ideas listed below. If your care receiver is very active, paces a lot or even has nervous tics, she probably requires extra caloric intake to maintain. Some people with Alzheimer’s burn up as much as 5000 calories a day. You can enhance her diet with Ensure or a similar supplement, being aware that most of these supplements are very high in sugar. You might also spread out her food intake by offering healthy snacks throughout the day. Importantly, make sure she gets lots of fluids. If she has problems chewing, you can make her “shakes” out of her meal in a blender or food-processor. Whatever you prepare for her, make sure it looks appetizing and is tasty, remembering that the sense of taste is typically diminished in the elderly, especially in people with Alzheimer’s.   Too much food at a time. If your friend or loved one consistently eats little or none of the food you present to her, even her favorites. She may not know how to use the utensil or an entire plateful of food may be too overwhelming and too many choices can be confusing. Try placing just a small portion of one type of food (finger-food, spoon-food or fork-food) at a time on the plate. Cut food into bite-sized portions. Would you know where to start? This may be how a full single plate is perceived by a person with Alzheimer's. Too many choices: finger-, fork-, and spoon-food. Foods to avoid. Nuts, popcorn, ice cubes, hard candies, chunks of carrots can get lodged in the throat and cause choking. Lettuce or greens as used in salads can stick to the roof of the mouth and block the airway (serve chopped salads instead.) Some breads have hard, sharp crusts (French bread,) which can cut tender gums. No bones. A person with Alzheimer’s has the right to assume that everything served on a plate is edible. This is especially important if her eyesight is diminished. She may not be able to tell the difference between the crispy skin of fried chicken and the small bones in a piece of breast and may try to eat the whole thing. Use boneless chicken. Shrimps should have their tails removed. When serving fish, beware of bones. (How about fish balls instead?) A current fad is crab-cake cooked in a crab-shell. Not a good idea! Some foods may be too difficult to handle: Spaghetti and other long noodles, for instance. Either cut spaghetti into small pieces or use a different kind of pasta, such as elbow macaroni, which can be eaten with a spoon. Sandwiches and Hamburgers may need to be cut into quarters, pizza into bite-sized sections. Desserts. Wait until she has finished her meal and you have removed her plate before presenting a dessert. Utensils. Too many utensils are confusing. Give her only one utensil at a time. Large-handled spoons are easier to use than forks. She may have forgotten how to lead a spoon to her mouth. Try the hand-over-hand method to steer it for her the first time. If utensils don’t work for her, serve finger-food instead. Large glasses can be too heavy to handle, so serve liquids in shorter glasses. Ice cubes can present a choking hazard. If necessary, thicken fluids to prevent choking. Try bendable straws or lidded cups. Plates. Studies have shown that people with Alzheimer's eat as much as 25 percent more when their food is served on brightly colored plates. Bright red and bright blue plates work much better than those in pastel colors. Don’t use patterned plates; the designs are distracting and may be confused with food, leading to frustration. Researchers believe it's easier to distinguish between the plate and the food when there's more visual contrast. It may be easier for the AD person to scoop up the food if you substitute a bowl for a plate. Learn how to perform the Heimlich maneuver, just in case. Don't rush. Give her plenty of time to eat. You’ll want to sit with her through the meal. Remind her to chew and swallow carefully. She may have forgotten to swallow and fill her mouth continually with yet more food, in which case you’ll have to remove some of the food from her mouth. Do this unceremoniously and without admonishment. If you are considering a care facility for your loved one with Alzheimer’s or memory impairment, you’ll want to make sure that they are aware of these concerns and adapt their food preparation and service to this special population. Before you sign the lease, eat a meal in the dining room and observe. Conversations around food. A person with Alzheimer’s often loses the sense of hunger or fullness. Half an hour after finishing a substantial meal, she asks you when lunch is served. She’s probably just bored and the first thing that’s come to her mind is food. Rather than reminding her that she’s just eaten, tell her it will be ready soon and find her a distraction. Or give her a piece of fruit “to hold her over.” On the other hand, when you tell her dinner is ready, she may protest she has just eaten. You know it’s been hours. If you insist, she may dig in her heals in protest. Instead, don’t disagree, but tell her that you’ve made a special dish and you want her to taste it. If that doesn’t work, wait a few minutes and say to her, “You told me that you’re really hungry – come let’s eat.”   One Alzheimer’s friend of mine spent most of lunchtime sorting out her food items, carefully separating everything into small piles. By the time she had finished, all was cold and unappetizing. She usually ended up eating only dessert. • Another would try to eat her soup with a fork, because it was the larger of the several utensils in front of her. • Yet another would routinely pour her juice onto her plate. I’ve been quite successful getting one of my AD friends to eat by serving them very small portions at a time on a small plate or shallow bowl. At times I have to “model” eating. I will make sure they see me when I take a spoonful and say, “Boy! Is this good – try some.” Typical Problems Poor nutrition can result in physical weakness, increasing the likelihood of falls and fractures. It can also affect the immune system, making it less able to fight off disease and heal wounds. Malnutrition and dehydration may increase confusion and stress, and reduce your loved one's ability to cope. Malnutrition and dehydration are two causes of the most easily reversible dementia. We need to keep track of intake and needs. If a person with Alzheimer's eats only a little at a time or if she has a hard time sitting still for a full meal, we can give her several small, healthy snacks throughout the day, such as bananas, fruit cups, yogurt, pudding and - yes, even ice cream. People who pace or have nervous ticks tend to burn up a lot of calories and need extra nutrition. You may want to add a supplement to make up for the loss. Some eating problems are caused by factors that can be changed. The first step is to figure out what exactly is causing the problem. Ill-fitting dentures. As a denture wearer ages, the fit of his or her false teeth tends to loosen. This can cause pinching or rubbing that can make eating painful. Make sure dentures fit properly, and regularly check the mouth for sores. Periodontal disease. People with dementia typically resist proper dental care. This should be taken into consideration when preparing food for this population. Everything should be easy to chew and gentle on the gums. It’s a good idea to chop foods, especially meats, into easy-to-swallow consistencies. This also helps people who may have lost some of their abilities to chew and swallow. Infections. Pain and infections often cause a loss of appetite. Dehydration. A big problem for many of our elders, not only people with dementia. Today many of us have become accustomed to carrying our bottled water wherever we go. However, this is a recent phenomenon and a foreign concept to many of the elderly. Dehydration aggravates dementia and can also have more serious physical repercussions, so it’s doubly important to ensure that you offer enough liquids. Many elders resist water, but may drink juices. You can make drink of half juice and half water, slightly sweetened. (My 95 year old dad thinks of water as something to wash your feet in, so he drinks lots of apple juice instead.) Lastly: Make eating a positive experience with your attitude and participation. • You can raise your glass in a toast to encourage her to drink. • You can declare that this is a special feast and thank her for suggesting that particular dish or having taught you to cook. • Sprinkle your conversation with compliments (but don’t overdo it) or a reinforcing comment, maybe something as simple as: "I always enjoy eating with you." • You may solicit the help of "baby" by placing her in front of the person having problems eating.