Elderly persons with chronic illness and impaired mobility may suffer from various degrees of feeding problems. It is therefore important for carers to provide appropriate assistance according to elderly persons’ individual needs. This can resume elderly’s confidence in self-feeding. Caring with patience and love are especially important for those who are totally feeding-dependent to enhance their joy of eating.

Online videos: Facilitating oral feeding of the elderly persons with swallowing and hand movement difficulty

Objectives:

• To maintain a healthy diet and balanced nutrition
• To prevent complications such as aspiration pneumonia induced by choking
• To encourage and assist elderly persons with eating problems so as to maximise 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 dining area is well-ventilated, with adequate lighting and free from distractions so as to enhance the elderly persons' concentration
• Maintain safe, comfortable, tidy and quiet environment
• Adequate time

Feeding Utensils

(Fig. 1)

• Ensure the utensils are clean. Use non-slip mat to fix utensils on the table for easier feeding. Check functions of the utensils and replace broken items promptly
• Choose appropriate feeding utensils. e.g. fork or spoon instead of chopsticks
• Use smaller spoons to control feeding amount and minimise the risk of choking
• Consult occupational therapist if necessary for advice on the choice of feeding devices, e.g. spoon and fork with enlarged handles, chopsticks adpator, scooper bowl, nosey cups (Fig. 1)

The carer

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

Choice of food

• Arrange food according to the health condition of the elderly persons and prepare meal menus in advance. Follow the recommendations of medical staff, nutritionists and speech therapists to prepare soft meals, minced meals, pureed meals, liquid meals or portion arrangements.
• Pureed meals must be ground. In order to increase the elderly persons’ appetite, it is recommended to grind meat, vegetables and grains such as rice and noodles separately and place them in different containers
• Individual's food preference, religion, culture 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 and ensure adequate nutrition
• Prepare food according to individual's chewing and swallowing abilities, e.g. puree, porridge or fluid diet. Remove the bones and skin of meat, and chop up the food / vegetables into smaller pieces for easy chewing and to prevent the risk of choking
• Avoid foods that are too hard in texture, e.g. nuts
• Avoid foods that are too slippery or sticky, e.g. jelly, fish balls, whole piece of grape, sweet/glutinous dumpling
• Avoid foods which crumble easily, e.g. egg rolls
• Avoid giving the elderly persons food or drinks that are too hot as they may scald the mouth and tongue during swallowing
• Hot tea, water and soup should be placed in a safe place to prevent the elderly persons from pouring and causing scald.

The elderly persons

• Encourage the elderly persons to eat together at the dining table or in the canteen, which can increase their appetite.
• Assist the elderly persons to sit up straight, match with dining table of appropriate height, maintaining a comfortable and correct posture
• Assist the elderly persons to put on apron, put in dentures, hearing aids, and glasses (if applicable)
• Assist the elderly persons to perform oral care before meals to increase appetite.

Safety Tips on Feeding

• Ensure that the elderly persons are fully alert during feeding
• Ensure proper positioning of the elderly persons. 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 to prevent scald
• Observe during feeding, provide assistance accordingly and do not rush
• During the feeding process, don’t give too much food or give too fast at one time. Continue to feed until the elderly persons finish chewing and swallowing the food. If they refuse to eat, try to find out the reason
• Observe for any signs of swallowing difficulties, e.g. cough, drooling, aspiration of food back into the nose, etc. or need to swallow several times
• Observe closely during feeding, in case of choking or aspiration, keep calm and handle promptly. Send the elderly to the Accident and Emergency Department if necessary
• Signs and symptoms of choking or aspiration are:
  • Continuous coughing
  • Not able to speak or with breathing difficulty
  • Hands grasp around the neck, showing signs of pain
  • Skin, fingernails or lips turning into cyanosis, even loss of consciousness in severe cases
• Ensure adequate fluid intake for those who cannot feed themselves so as to prevent dehydration

After Care

• After feeding, check the elderly’s mouth for any food debris to prevent aspiration. Assist the elderly to maintain good personal hygiene: rinse mouth, cleanse the denture or perform oral care, and to wipe the mouth with wet towel if necessary
• Remove the utensils, apron and serviettes. Let the elderly persons rest comfortably
• Avoid lying down right after feeding. Remain sitting in an upright position for at least 30 minutes to prevent aspiration
• For those who are particularly frail, observe their mental state after feeding and monitor for signs of aspiration and choking