Carers' Corner

Feeding Skills for Carers of Frail Elderly

Elders with chronic illness and impaired mobility may suffer from various degrees of feeding problems. It is therefore important for carers of these elders to provide appropriate assistance according to the elders¡¦ individual needs.

Objectives:

• To maintain a healthy diet and balanced nutrition.
• To prevent complications such as aspiration pneumonia induced by choking.
• To encourage and assist elders with eating problems so as to maximize their independence and self care ability.
• To make eating an enjoyable experience to improve their quality of life.

Preparation before Feeding

Environment

• Ensure that the eating area is well-ventilated, with adequate lighting and free from distractions so as to enhance the elders¡¦ concentration and to prevent choking.

Feeding Utensils

• Ensure the utensils are clean. Use non-slip mat to fix utensils on the table for easier feeding. Replace any broken utensils.
• Choose appropriate feeding utensils. e.g. fork or spoon instead of chopsticks.
• Use smaller spoons to control feeding amount and minimize the risk of choking.
• Use straws or specially designed cups to control the amount and flow of fluids during drinking.
• Consult occupational therapist if necessary for advice on the choice of feeding devices, e.g. spoon and fork with enlarged handles, adapted chopsticks, a bowl with a raised curved lip which enhances scooping of the food. (Fig. 1)

The carer

• A warm and caring attitude is always important. Explain to the elder what you are doing and try to gain their cooperation.
• Good personal hygiene should be observed, wash hands thoroughly with water and soap.
• Assist the elder in hand washing before every meal. If needed, perform oral care such as rinsing the mouth before meals to stimulate appetite.
• Assess the elder¡¦s chewing and swallowing abilities. Give appropriate assistance if required.
• Communicate with the elders before feeding, e.g. discuss the menu with demented elders to enhance their cognition and stimulate their interest. For elders with visual impairment, guide them along by informing them the food types and position of the food and utensils. Ensure all the food and necessary feeding aids are within their reach.

Choice of food

• Individual¡¦s food preference, religion and health status should be taken into consideration during preparation of meals. e.g. Diabetic, low salt and vegetarian diet etc.
• Choose nutritious food which are easy and safe to swallow. Change menus regularly to stimulate appetite.
• Prepare food according to individual¡¦s chewing and swallowing abilities. e.g. purˆoe, porridge or fluid diet. Remove the bones and skin of meat to decrease the risk of choking. Chop up the food into smaller pieces for easy chewing.
• Avoid foods which are sticky and difficult to chew and swallow so as to prevent choking, e.g. glutinous dumplings.

The elder

• Assist the elder in wearing dentures if required.
• Ensure the elder is sitting comfortably in an upright position to facilitate safe swallowing. The seat should be adjusted to a suitable height.

Safety Tips on Feeding

• Ensure that the elder is fully alert during feeding.
• Ensure proper positioning of the elder. Sitting with head slightly flexed and chin down which reduces the risk of choking.
• Serve food at the right temperature, e.g. not too hot.
• Do not rush, allow plenty of time for feeding. If the elder refuses to eat, try to find out the reason and provide assistance accordingly.
• Observe for any signs of swallowing difficulties, e.g. cough, dribbling, aspiration of food back into the nose, etc. In case of choking or aspiration, keep calm and call for help at hospital.
• Signs and symptoms of aspiration are:
  • Breathing difficulty
  • Engorged face and neck veins
  • Face turning blue, loss of consciousness in severe cases.
• Ensure adequate fluid intake for elders who cannot feed themselves so as to prevent dehydration.

After Care

• After feeding, check the mouth for any food debris and apply oral care and wipe the mouth with wet towel and maintain good personal hygiene. Cleanse the dentures.
• Remove the utensils, apron and serviettes. Let the elder rest comfortably.
• Avoid lying down right after feeding. Remain sitting in an upright position for at least 20 to 30 minutes to prevent aspiration.
• For those elders who are particularly frail, observe their mental state after feeding and monitor for signs of aspiration and choking.

Related Topics
Swallowing Difficulty
Oral Health Care