By the late middle to end stages of Alzheimer’s disease, many loved ones have trouble eating and drinking. This is in part because of a lack of interest in food or missing hunger pangs, and also because choking becomes a constant potential hazard. As the power of the mind to send messages to systems that used to work automatically, adequate chewing and the loss of the swallowing reflex create frightening moments.
Meals also become confusing. While your loved one knows that something goes on pancakes but doesn’t remember what, orange juice instead of syrup may seem like the perfect answer. Breakfast is now a soppy mess.
At best, you smile and watch her down the deluge with growing tears in your eyes. At worst your uncontrollable outburst, “What are you doing?!?” transforms your loved one into sobs. She may connect and recognize the precise error that was made or she may simply have that fleeting moment of lucidity when she knows something is terribly wrong.
To help, always bring the plate to the table already prepared, pancakes buttered, doused with syrup, and cut into small bites, cereal with milk previously added of less sloppy choices like oatmeal or cream of wheat, or meat and potatoes sliced into small, bite-sized bits. I always tried to do this preparation out of sight or on the sly so that my sister Carole would not see that instead of receiving an “adult” plate, she was being treated like a child. Even if she didn’t notice it, it bothered me if I did not try to keep her dignity in tact. Sometimes I observe well-meaning caregivers dining in a restaurant placing a bib over her loved one and slicing without asking. It feels embarrassing, to me, but I also accept that we must find our own ways to cope.
As long as your loved one with Alzheimer’s disease can use knife, fork, and spoon permit him to do so. You want to allow independence while also keeping a wary eye alert for a possible problem. Spooning soup is far more difficult than spooning most cereals so it may prove to be a good meal option or put the soup in a cup; forking up broccoli is easier than trying the same method with peas. In meal preparation you will learn to be clever at creating enticing delights while being careful to avoid spills and frustration.
My sister loved to walk. She trundled through her home for miles and miles every day. Up the stairs and then back down, through the kitchen and family room, and then her return so that she could circle again. She did the same at her day care and it got to the point that she could not or would not sit down, even to eat. Trying to force her into a chair only brought on agony as she became rigid and unbendable. One solution was finger food. As she circled by she would be handed a small square of peanut butter and jelly sandwich or a piece of banana. An eye was kept on her as she circled to be sure she was chewing and swallowing and when she finished one bite another was offered on the next round.
Carole was far less interested in drinking liquids and that meant more perseverance to get some gulps down. The sippy cup method worked when she could still remember to hang on to it; an offered drink with a straw worked better later on.
Cups tend to spill as the disease progresses so you will want ones with handles and less tippy with easy-grasp handles. Cups with lids and sipping spouts will help you as will the use of straws. Somehow sucking through a straw makes more sense to many with dementia. It also controls fluid intake where a glass may cause a mess.
Eventually you may have to move to a pureed or liquid diet. Both are unappetizing in appearance and often in odor. On some days this did not bother me; on others it wrenched at my heart. Just know that everything you do to keep love and dignity alight, you are making a significance difference to your loved one and to your soul.