1–4 cups
1–2.5 cups
3–10 ounce-equivalents
2–3 cups
2–7 ounce-equivalents
Gravies and sauces can be served in a side dish for dipping
Table 12.2 Suggested Menu Plan for Finger Food Diet
| Breakfast |
| 1 orange, divided into sections 1 hard boiled egg, firm ½ c. bite-size shredded wheat 1 slice whole wheat toast, quartered 1 tsp. jelly 1 tsp. soft margarine 1 c. nonfat milk Hot beverage Sugar, pepper (optional) |
| Lunch |
| 2 oz. baked chicken, cubed ½ c. boiled potato, cut up ½ c. mixed vegetables, drained 1 oz. whole wheat roll 1 tsp. soft margarine 1 c. nonfat milk Water |
| Supper |
| Tuna salad sandwich, quartered 2 tomato slices 1 c. carrot and celery sticks 1 Tbsp. salad dressing ½ c. fruit cocktail, drained 1 c. nonfat milk Water |
| Snack Ideas |
| ½ c. melon slices 3 c. popcorn 1 oz. cheese cubes |
Tips
Serving food in large bowls instead of on plates, and offering spoons instead of forks may be helpful. The use of adaptive equipment such as plate stabilizers, plate guards, weighted utensils, rocking knives, nosey cups, spouted cups, and cups or mugs with handles may be useful in certain instances.
Cutting foods such as meats, cheese, fruits, and vegetables into strips or wedges provides an easy way to grasp the foods that allows easy self-feeding. Foods cut into bite-size cubes are easy to pick up with the fingers.
An occupational therapist consultation may prove beneficial. Individuals should be assessed for the need for and ability to use adaptive equipment.
ADDITIONAL RESOURCES
Websites
Alzheimer’s Association. Eating. 2005. Available at: www.alz.org.
GUIDELINES FOR INDIVIDUALS WITH DEMENTIA
Individuals with dementia are at risk for weight loss and poor nutritional intake. (1) Feeding strategies have, therefore, been integral in the care of the dementia patient. Energy and nutrient intakes can be increased in some patients with the appropriate interventions. (2,3,4,5) Caregivers need to be flexible and allow as much time as needed at the mealtime. Patients should be encouraged to do as much for themselves as possible but also provided with adequate assistance and support to be successful. Feeding assistance should be tailored to each individual. Families can offer important information about food preferences and possible feeding strategies.
The following is a nonexclusive list of feeding guidelines to consider at mealtimes to promote safe oral intake and a positive feeding environment. It is compiled from several references. (6,7,8)
1. Maintain an upright, vertical position in a chair or wheelchair with feet supported on the floor, on foot rests, or a foot stool. The patient should ideally be sitting at a 90-degree angle with the floor or may be slightly leaned forward. If the patient must be fed in bed or Geri chair, adjust the chair or bed to achieve as close to the desired vertical position as possible. Pillows are helpful for proper alignment and positioning. An upright position should be maintained for at least 30 minutes after meals to prevent reflux. Avoid tilting of the head to lower the risk of aspiration. Caregivers should sit at eye level to promote a chin tuck swallow.
2. Provide foods that stimulate appetite by their appearance, smell, and taste. Identify the food as you give it. Make positive remarks, such as “Doesn’t this look good?!” or “That smells good!” Enhance the flavor of food with condiments and seasonings for sensory stimulation and to improve food acceptance. Try offering one food item and beverage at a time; the patient may benefit from a reduction in decision making. Try alternating warm and cold foods when feeding. Regularly provide the patient’s favorite foods. Fortified, nutrient-dense foods and supplements may be provided as appropriate.
3. Foster independence by providing finger foods, cueing, providing appropriate assistive devices (divided plate, large handle utensils, foods served in separate bowls), or practicing the hand-over-hand technique. Feeding a patient the first few bites of food may “prime” self-feeding behavior, after which the spoon can be handed to the patient.
4. Focus on the patient to keep him or her on task. Avoid inappropriate conversation and arguing. Be accepting and patient. Reality orientation may be counterproductive with advanced dementia. Limit distractions and control noise through efficient meal service, serving only one or two foods at a time on plain (no patterns) dishes of bright colors to help the patient distinguish between the food and the dish. Play only soft music or no music at all. Use the simplest of table settings. Serving smaller groups of patients at a time may help achieve a calmer dining room atmosphere. A consistent seating arrangement can provide familiarity and lessen anxiety. Eating with a group at a table can keep the patient more focused.
5. Observe and report signs of chewing and swallowing difficulties (i.e., coughing, throat clearing, gurgling, abnormal rate of eating, excessive chewing or no chewing at all, pocketing food, spilling food/liquids from the mouth, and recurring pneumonia). These may require changes in food texture or thickened liquids. Foods with combination textures—such as chunky soups or dry cereal with milk—and foods that are crumbly and fall apart easily, such as corn, peas, and rice, are the most difficult to form into a bolus and swallow safely. Offer small bites and sips, alternate liquids and solids to promote a safe swallow. Be sure food has been completely swallowed before offering a beverage. Straws should not be used unless approved by the speech or occupational therapist. For some patients, the use of a straw forcefully propels the liquid to the back of the throat before the normal swallow reflex is triggered.
6. Do not feed with a syringe. Syringe feeding rapidly forces liquefied food to the back of the throat and increases the risk of aspiration. In addition, syringe feeding does not promote dignity for the individual.
7. Allow plenty of time to eat. If a meal cannot be consumed in 30 to 45 minutes, consider serving smaller meals and adding nutritious snacks. Longer mealtimes may tire the patient leading to inadequate intake. Eating at nontraditional times and places may be necessary to maintain good nutrition and hydration.
