A couple of readers recently requested information about how to help an adult with eating and drinking. One person works in a group home caring for adults with developmental disorders, while the other works in a skilled nursing facility with adults who have dementia. Here are some general tips and suggestions for educational purposes. Please consult a medical provider in your community for medical advice.
Free DIRECT download: How to help an adult with eating and drinking (caregiver handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Outline:
- Asking for professional medical advice.
- Setting the environment.
- Preparing the food and drink.
- Readying the person you are helping.
- Providing verbal or visual cues.
- Assisting an adult with eating and drinking.
- Engaging the person you’re helping.
- The importance of oral care.
- What other problems do you notice at mealtime?
- Related Eat, Speak, & Think posts
Asking for professional medical advice
A swallowing problem may increase the risk of choking, dehydration, malnutrition, and respiratory problems such as aspiration pneumonia. A person who has a swallowing problem may also experience depression and less social interaction, which often revolves around food.
Sometimes the symptoms of a swallowing problem are obvious. For instance, a person may complain that food or drink gets stuck in their throat. Or they may cough often when they eat or drink. But sometimes the symptoms are very subtle.
One way to decide whether to seek professional guidance is to complete the EAT-10 questionnaire, which you can download or take online. A score of 3 or more indicates that a person should seek medical advice.
My advice would be to report any concerns or problems you notice to the person’s doctor, who can then order a swallow assessment, regardless of what the EAT-10 score is.
You can learn more about swallowing problems and how they’re assessed and treated. But in the absence of personal medical advice, here are some tips and strategies to make mealtime easier.
Setting the environment
A calm, pleasant environment helps set the mood for a successful meal. Consider turning off the television and turning on relaxing music, or music preferred by the person you are helping.
If you have good lighting, it makes it easier to see food items and utensils. Good lighting also helps improve communication, since we convey so much through our facial expressions and body language.
People who have a vision problem or a cognitive problem can be confused or overwhelmed by clutter. Use a place setting to delineate where the plate or bowl and utensils will go. Make sure the color of the plate contrasts with what it is resting on (the place setting, table cloth, or table), as well as the food that is on the plate.
Chicken, cauliflower, and mashed potatoes on a white plate on a white table can be hard to see.
Preparing the food and drink
The person you are helping may need food or drink that is specially prepared. For instance, a speech-language pathologist or other medical provider may recommend that food be ground or pureed, or liquids be thickened to a certain degree. It’s important to follow their recommendations.
In the absence of specific medical advice, you may want to provide foods that are easier to eat. In general, foods that are moist or tender are easier to chew and swallow than foods that are dry, tough, sticky, or crunchy.
If you cut food for someone else, consider cutting the pieces no wider than the width of a fork.
Be mindful of portion size. Some people I’ve worked with become overwhelmed when presented with too much food at once. In this case, it can be helpful to divide the food onto two plates and present smaller amounts at a time.
Readying the person you are helping
Assist the person with toileting and cleaning their hands prior to the meal.
If they own them, make sure they have their glasses, hearing aids, and dentures. All assistive devices should be in good working order.
If the dentures don’t fit properly, make an appointment with the dentist or inform the appropriate responsible party. Poorly fitting dentures can make it difficult to chew and swallow food, can cause pain on the gums, and in some cases can even be accidentally swallowed.
Pay attention to the person you are helping and engage them in conversation as you’re getting ready to start the meal. Use a calm tone of voice.
Ensure they are sitting upright, or as upright as possible. Sometimes reclining back only a few degrees can make the different between swallowing easily and having trouble.
It’s also important to make sure the person you are helping is alert and paying attention before presenting any food or liquid. We need to be alert to control what’s in our mouth. If we lose control, we could choke or aspirate.
Providing verbal or visual cues
Sometimes a person is physically able to eat or drink, but they just don’t engage in the activity normally. This may be because they aren’t feeling hungry or thirsty or because they are distracted by their environment or their thoughts.
In this case, simply asking someone to take a bite or a drink may be enough of a cue for them to do it.
Sometimes a person requires a more specific instruction. You could directly instruct them to pick up the spoon (or fork or cup).
Some people just need to be assisted with the first bite. If you hand them a sandwich or peeled banana, they may proceed to eat normally. Alternatively, you could ready the first bite with a fork or spoon and hand it to them. They may then continue eating on their own.
In some cases, if you demonstrate what you want someone to do, they may imitate you. I’ve often had someone pick up their glass for a drink if I take a drink first.
Assisting an adult with eating and drinking
If someone isn’t able to feed themselves, then here are some things to keep in mind to minimize the risk of choking or aspirating the food or drink into the airway.
Sit face-to-face so you can watch the person you are helping. This will also improve communication.
Smaller bites and sips are safer than larger bites of food or gulps of liquid.
A slower pace is safer than a faster pace.
Use a clear glass so you can judge how much fluid is going into the mouth.
Avoid dumping food or liquid into their mouth. Allow them to take liquid from the cup and food from the utensil. Gently touching their lower lip or the tip of their tongue with the food item or utensil may cue them to close their mouth to take the offered food.
Alternate between food items and also between food and beverage. This provides variety and may increase interest, and it may also help decrease any residue that may be building up in the mouth or throat.
Wait until a person has swallowed what is in their mouth before offering more. You may need to tell them to swallow. Look in their mouth before giving more food or liquid. You wouldn’t want to accidentally push food or liquid down into their throat before they’re ready to swallow.
Engaging the person you’re helping
Try to engage the person as much as possible. Our brains kick off the eating or drinking pattern as we bring our hand to our mouth. When someone else feeds us, we lose that cue to our brain. This makes it more likely that the eating or drinking process will be uncoordinated.
One way to engage the person you are helping is to narrate what you’re doing as you present different food and drink items.
Another way to engage the person is to place the food item, utensil, or cup in their hand and guide their hand to their mouth. This is called hand-over-hand assistance, as your hand is over top of their hand. This action can improve chewing and swallowing as the hand movement can trigger the eating or drinking pattern in the brain.
There’s another type of assistance called hand-under-hand assistance, developed by Teepa Snow. In this case, you hold the food item, utensil, or cup in your hand and place their hand on top of yours. This way, they don’t have to hold the item, but they still experience their hand bringing the item to their mouth.
The importance of oral care
Routine oral care is very important for reducing bacteria in the mouth that could cause aspiration pneumonia if it is carried into the lungs.
It doesn’t matter if a person has teeth or not. In general, everyone should get a toothbrush and toothpaste into their mouths at least every morning and night.
The friction of the toothbrush helps to scour away the bacteria from teeth, gums, tongue, and even the roof of the mouth.
If someone has a higher risk of aspiration pneumonia, you could lower that risk by ensuring frequent oral care. How much is frequent? Well, if I’m working someone who has a high risk with a recent history of aspiration pneumonia, I recommend before and after each meal.
What other problems do you notice at mealtime?
If you help an adult with eating or drinking, you may find it a meaningful and rewarding experience. But if problems arise, it can be frustrating or stressful for everyone involved. I’ve discussed the most common recommendations I make to caregivers helping adults with eating or drinking, but this isn’t an all-inclusive list. What other problems do you run into?
Related Eat, Speak, & Think posts
- I’m having trouble swallowing. Now what?
- 10 factors that increase risk of aspiration pneumonia.
- Take the guesswork out of thickening liquids with the IDDSI flow test.
- A practical guide to pureed food at home.
- Low vision tips: Bigger, bolder, & brighter.
Free DIRECT download: How to help an adult with eating and drinking (caregiver handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by JESHOOTS from Pexels.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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