During the latter stages of dementia-related diseases, our loved ones will need more and more assistance and encouragement at mealtime. The first problem I ran into with my father was getting him just to eat . . . period.
After dozens of fruitless attempts, I soon discovered 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. During these times, it was extremely helpful to keep a casual conversation going with him. I made every attempt to keep everything as normal as possible. When it comes to mealtimes, I recommend all caregivers to think routine, routine, routine. Keep your mealtimes the same every day.
As the disease progressed, I quickly became aware of other issues surrounding his eating habits. For instance, he began eating only the foods on the right side of his plate. After thinking it through, I learned to rotate his plate 180 degrees halfway through his meal and, happily, this immediately solved the problem. Sometimes it takes some clever moves on a caregiver’s part to find answers.
In general, we caregivers also need to pay close attention to the colors and designs of table settings. We should not serve meals on white plates on top of a white tablecloth. We are better off using colored plates and brightly enhanced glassware. The intention in offsetting the color is to help them see the plates and glassware. Think contrast.
If you are not seeing a bowel movement at minimum every couple of days, it is time to act. It may be the medication they taking, so consult their pharmacist. Constipation itself can affect their appetite. Also, try having them eat smaller portions more often. Frequent snacks during the day may be the answer.
Unfortunately, there may be another very painful road ahead...that is with swallowing. This usually becomes a major problem toward the end stages of the disease, however for some, it can come early on.
Keep a close eye on any coughing or choking while ingesting food which could be an indication of why these folks are not eating. As soon as you can, notify his or her physician of these changes. Get yourself prepared to adapt as changes will come quickly and sometimes suddenly. Be ready to hear from every so-called expert telling you must provide only nutritional foods. Well, I am here to tell you 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 are worried about dehydration, a bowl of soup, Jell-O or fruit may be the perfect answer. Use your own judgment and maybe a little imagination. Concentrate on keeping these precious 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 that must be made. This should include families, advocates and, more certainly, the patient early on. If not, these decisions should be addressed as soon as possible as it can be horrifying if they are not arranged beforehand! Making end-of-life decisions suddenly—such as having feeding tubes inserted and resorting to other drastic measures which serve to put off the inevitable - will make your head spin.
Personally, when that time arrived for me, I took one look at my father and I knew in my heart he had fought long and hard enough.
It seems to me the best thing is for the family to make a concerted effort to get all these hard decisions out of the way 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 are some of my fondest memories.
Gary Joseph LeBlanc, CDCS
Dementia Spotlight Foundation