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Maintaining Nutrition
When They Can't Sit Down to Eat
By Barbara Williams, RN, BSN

It is difficult to plan for meals when the person you are feeding canít sit down and enjoy a meal. This is often the case during the hyperactive stage of dementia. It is extremely frustrating for the caregiver and patient alike.

If you stop and rethink an earlier period in your life as the mother of an active two-year-old, it may cause you to see many similarities. What may have been an easy remedy then, a high chair with a belt, is not be a solution now. Food choices, however, may be eerily similar. The finger foods that worked for the two year old will work again for this new version of ďI canít sit down.Ē Chicken fingers will seem like a godsend. Simple sandwiches that stay together, like grilled cheese, is another staple of this menu. Peanut butter sandwiches without the slippery jelly are also a good choice, although it may be a bit dry if you have difficulty getting fluids into your loved one. Sandwiches that are stacked high with lettuce, tomatoes, and other slippery fillers are not a good choice. Vegetables in finger food size such as carrot sticks, celery, cherry tomatoes, cucumber slices and the like are a good way to get more variety into this diet. Fruit in finger food portions are also easy to feed to this person who is literally on the run. Be sure to remove pits and other uneatable parts of these foods since the person you are attempting to feed probably cannot make the differentiation as to eatable or not any more. I remember one wife who used to place an apple in one hand and a pear in the other of her hyperactive, almost track starlike husband as he ran around in constant motion; problem was he would alternately eat both, seeds, stem and all.

Large roasted potato slices, especially if baked in a fragrant seasoning mix, are also easy to handle. French fries or French-fried yams are also a good choice. Rice, however, is not a good choice. Ravioli without messy sauce, tortellini, and pierogis are also easily eaten on the run. Empanadas, those tasty little meat pies, travel well too. Many of these dishes can be purchased in the freezer department of your local grocery store. Just remember, if it can be hand-held and eaten with a minimum of messiness, it is a good choice.

A quick and easy snack is slices of meat and cheese rolled up like you might find on an appetizer tray. Cheese or peanut butter crackers are good snacks as well, unless your individual has a really tight grip and is apt to crush the crackers into crumbs. Energy bars are good, but do watch for the protein/carbohydrate balance. Some are not much more than sugar. It is often trial and error to see what works best for your loved one. Just remember, if they didnít like a particular food before, they probably are not going to like it now either. Some things they just donít forget.

Probably the hardest task to handle is maintaining adequate fluids. Travel mugs or the toddler sippy cups work well for fluids such as juices, milk, and water. Travel mugs, with their larger openings, also do well for creamed soups which can be packed with a variety of nutritious foods, thanks to the invention of the blender. If your individual has a sweet tooth and not inclined to want to eat what is healthy, smoothies are the answer. Mix yogurt, fruit and fruit juice together and even the finicky eater will down them. How do you think Ensure became so popular? It has been keeping the elderly alive for years.

Feeding the individual who is constantly on the go is not easy, and the idea of three meals a day can be thrown out the window. You do need to monitor what they eat more than when. It is a good idea to keep a variety of foods available in the refrigerator or cupboard. Thanks to the microwave, you can heat something up at a momentís notice. You have to take the individual where they are at and adapt to their schedule. They are not going to accommodate yours, trust me. Make the most of any opportunity to get something nutritious into them whenever the opportunity arises. It is, however, a good idea to keep a running tally of what they have eaten during the day so you can adjust what you are offering them in order to maintain a balanced diet to the best of your ability. It is easy to fall into a pattern of only offering them something they like or that is easy for you to prepare, and this may lead to an inadequate intake. It is also easy to neglect fluids, too, since quite often they are messier or harder to get them to drink. Again, trial and error may be the only way to discover what works best in your situation.

Quite often, these individuals donít know when to sit down and can wear themselves out. If you notice them beginning to develop that forward tilt where they look like they are going to fall flat on their face, they need to be distracted and sat down for at least a short rest. In the nursing home situation, restraining them in a chair with a tray or other restrictive device is the usual answer. In the home, you need to become more creative. It usually works best if they can be sat down at a table in a sturdy chair that doesnít tip or move easily; but in front of them, on the table, needs to be some sort of distraction. This may be a good time to try getting them to eat something that may require the use of a spoon, if they are still able to negotiate getting the spoon from dish to mouth. Some food with the consistency of ice cream or pudding that is easily scooped up on a spoon and taken to the mouth is a good choice here. If the spoon to mouth idea has left them, then finger foods should get their attention while they rest their overused legs. And you thought you left the toddler phase behind.

If you can occasionally get them to sit down at the table to eat, remember that they have a great deal of trouble making decisions. They cannot decide easily what to eat first if a number of usual table items are in front of them. Distractions will get their attention quickly and they will be up and gone again before you can accomplish anything. The basic rule here is to KEEP IT SIMPLE. Remove distractions, face them towards a blank wall if possible, no TV, no flowers or other centerpiece on the table, no placemat, and one dish in front of them at a time. They will still probably need cueing to remind them to continue the eating process. Simply tapping them on the hand to pick up the utensil, and spoons work best, and tapping on the side of their mouth is usually sufficient to get them moving in the dish to mouth routine again. Speaking to them will only make them turn towards the speaker and not to the task at hand. The non-verbal cueing is a minimal purpose-driven action.

All in all, trying to maintain proper nutrition when the individual is in constant motion is one huge challenge. These are some tried and true examples of solutions, but you will need to adapt these to your individual situation, which also may be changing literally by the minute. Until you can get into a pattern of what works best for you and you can plan your activities out in advance, it is best to keep a log of what works and what doesnít, so you can evaluate what is best for your situation and know that your loved one is getting the best possible nutritional balance. Donít worry too much about overall intake; after all, that toddler managed to survive the hyperactive stage without any major nutritional deficits and your new challenger will, too. Good luck with this new adventure in your life. It certainly will make each day interesting.



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