When a client is unable to accurately process information, this can lead to problems with food and fluid intake. They may not understand the process any longer, or they may not be able to follow the commands of opening their mouth, chewing, or swallowing. General considerations for promoting food and fluid intake are discussed in the Chapter 5.7, “Assisting With Nutrition and Fluid Needs” section, and the Chapter 6.2, “Nutrition and Fluid Needs” section also discusses assisting individuals with dementia, developmental disorders, or mental health disorders. The therapeutic techniques of using good communication, displaying empathy, keeping a routine, and reapproaching can also be utilized.
Aspiration risk also increases as dementia worsens, so individuals with advanced dementia may require thickened liquids and mechanical soft or pureed texture diet orders to prevent aspiration risk. Tube feeding may be initiated according to the client’s preferences or at the discretion of their appointed power of attorney for health care.
There are several actions a nursing assistant can take to promote food intake. If the patient has difficulty with the motor skills of eating or drinking, determine if sensory deficits may be the issue. If the dining area is noisy, try moving them to a quieter area where it may be easier to hear prompts. Bringing the person near the area where food is prepared can increase their appetite by smelling the aromas of the meal. After the food is served, position the food in the client’s direct line of vision. Put a small amount of food on a spoon and hold it gently to the lips, allowing ample time for them to process the feeling and open their mouth. Multitextured foods like cereal in milk can contribute to confusion over whether to chew or swallow. It may take a long time for the person to swallow, or they may have difficulty swallowing. Remind the person to tuck their chin towards their chest to reduce aspiration risk and aid in swallowing. If the person is holding the food in their mouth, gently rub their neck over their throat because this often prompts them to swallow. People with dementia and some with developmental disabilities may “pocket” their food, meaning they keep it in their cheeks and don’t swallow it. You may have to use an oral swab after meals to be certain that there is no food left in their mouth.
It can be difficult to tell when a person is full if they have dementia or other communication deficits. When they stop taking in food during a meal and seem full, a good practice is to hold each type of food to their lips one more time to be sure they have had all they want to eat of each food choice. Do the same with fluids.
Documenting food and fluid intake is the same as is required for any resident, but if intake is very minimal, report this to the nurse. When a person exhibits changes in their appetite, is coughing or clearing their throat more frequently, or has trouble managing utensils, report these changes to the nurse so that a speech or occupational therapist can assess the resident. Check the dietary card or care plan so any assistive feeding devices can be utilized to keep the resident as independent as possible and interested in meals.
The act of keeping food or medications in one’s cheeks and not swallowing it.