· responding to the mood of the other person
· too many demands placed upon person from staff or other resident
· being asked to many questions
· anxiety from not being able to convey needs
· upset from change in a routine
· feeling rushed by others
· depression
· boredom

ENVIRONMENTAL FACTORS

· too much happening in the environment
· nothing which looks familiar, people or place
· sudden noises or movements
· too many people in one area
· temperature not comfortable
· not enough stimulation in the environment
· does not like to look for smell of the food

INTERVENTION STRATEGIES

· perform a behavioral assessment profile
· perform a Dental workout
· perform a physical evaluation
· evaluate for Depression
· check vision and hearing
· setup food out of sight of the person
· evaluate atmosphere in the dining room
· play music which might be relaxing
· have potpourri or spices in dining room to encourage eating
· keeping a regular meal time schedule
· allow enough time for meals
· redirect to plate or moved when necessary
· offer beverages but avoiding caffeine

MAKING EATING SIMPLE

· used bowls and cops that a larger than the portion of the food
· use bowls rather than plates
· set place with only utensils needed
· use bowls or plates that are different in color from the placemat to help the person more easily locate the plate
· used brightly colored placemats
· place a damp wash cloth under the plate to keep it from sliding
· don't use plastic utensils-they are to light to manipulate easily and may break in the persons mouth
· try bendable straws or cups with lids and spouts for liquids
use mugs for soup and stews. Be sure to get mugs with big enough handles for easy holding.
·use assistive devices, such as large handle silver plates with suction cups on bottom, plates with rims. Or buy white plastic tubing, which can be cut and fit on utensils
· serve the finger foods such as french fries, cheese, small sandwiches, chicken or pork kebabs, fried chicken, fresh fruits or vegetables. Even very impaired people often manage finger foods well.
PUT A BITE OF THE FOOD TO LIPS AS STIMULUS TO OPEN MOUTH.

FOR CHEWING PROBLEMS

· try light pressure on lips or under the chin to get started
· give verbal instructions such "chew now". And "now swallow"
· demonstrate chewing
· make sure person is in a comfortable position
· avoid sticky even foods such as bananas, peanut butter, white bread
· avoid foods that fall apart or have tough skins, such as nuts
· moisten food with sauces, gravy, water. Recognize that some medications such as antipsychotic, cause dryness of the mouth.
· Serve chopped soft foods
· offer small bites, one at a time

FOR SWALLOWING PROBLEMS

· remind to swallow with each bite
· stroke the throat gently
· check mouth periodically for food stored in cheek
· omit foods that are hard to chew and swallow, such as popcorn, nuts, raw vegetables
· offer small bites, one at a time
· allow plenty of time between each bite
· keep liquid at room temperature
· moisten foods

FOR CHOKING PROBLEMS WITH LIQUIDS

· try thicker liquids, such as apricot juice, milk shakes, Egg nogs
· make cooked cereal with milk or water to help hydration
· keep liquids at room temperature
· notify your doctor of this problem

FOR CHOKING PROBLEMS WITH SOLID FOODS

· try soft cooked foods, such a scrambled eggs, canned food, cottage cheese, frozen yogurt, Jell-O made with orange juice and fruits, chopped chicken, mashed potatoes, apple sauce
· notify your doctor of this problem

FOR SWEET CRAVINGS

· have medications checked. Some antidepressant medications cause a craving for sweets
· offer gum
· try nutritious milk shakes or Egg nogs

FOR OVEREATING OR INSATIABLE HUNGER

· try 5 to 6 small meals a day
· have a tray of low-calorie snacks available, such as apples, carrots,
· consider whether activities, walks or other exercise might distract the person
· lock some foods in cupboards, if necessary, particularly if the person is overweight or on a special diet

FOR UNDEREATING

· try glass of juice, wine, sherry - assuming alcohol is permitted
· offer Ice cream, milk shakes, or Egg nogs
· make sure the person is getting enough exercise to stimulate appetite
· try to prepare familiar foods in familiar ways, especially foods that were favorites
· consult doctor about using supplemental drinks, such as Carnation instant breakfast, Plus, Ensure
· check with doctor about using vitamin supplements
· consult with doctor if there is a significant weight loss, such as five pounds in six weeks
· try feeding all or most of one food before moving onto the next. Some people become confused when the taste and textures change rapidly
· sit directly in front of the person if peripheral vision is not good. Show each spoon full to help orient
· mix pudding store ice cream with other courses to sweeten, as this encourages person to eat.
· Allow the person to eat when hungry.

Adapted from: Understanding Difficult Behaviors: Some Practical Suggestions for Coping with Alzheimers Disease and Related Illness edited by Robinson, Spencer and white. Geriatric Education Center of Michigan 1988.

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