In Part 1 of Mealtime with Dad: Caring for Someone with Swallowing Problems, Koko Kawasaki helped us understand her very personal caregiving story. Koko, who is a former graphic designer, earned her MA in Gerontology because of her experience as a caregiver whose father suffered from multiple health issues including dysphagia.
Here in Part 2, Koko relates to us her tips on helping someone with dysphagia eat, as well as how her caregiving experience with her father ended.
Koko's Tips for Mealtimes
Please note, these are tips based on my personal experience with Dad. I don’t have professional training on how to feed someone with dysphagia, and the information I've provided may not be appropriate for everyone.
1. Maintaining positive, focused energy: From my experience, I learned that no matter how stressed or challenging my day had been, I had to be mindful of my energy. Even without speaking, Dad was sensitive to his environment and aware of whether I was relaxed, distressed, happy, or feeling negative. My energy affected his mealtime experience. Before feeding a loved one, taking a moment for deep breaths and focusing on having an enjoyable time together is crucial. Easier said than done, but well worth the effort.
2. Making sure that loved one is in an upright, supported position: My father’s stroke had paralyzed most of his body, so he needed assistance to sit upright. His body had a tendency to slouch to one side, so we needed to make sure that there were enough pillows behind him and on his side for proper support. Being upright would ensure that he would not choke on his food. Before feeding, it’s important to make sure a loved one is upright and comfortable.
3. Pleasant, calm environment: Mealtimes were the highlights for Dad, who enjoyed eating. I made sure that the environment was quiet and calm. Before rushing into dinner, I would have a brief, pleasant conversation with him so he would be relaxed. If someone had the volume high on the television or radio, I asked for it to be turned down. People were often accommodating. Loud sounds are agitating, and can distract loved ones who are focused on eating.
4. Eating slowly, taking small bites: I made sure that Dad was able to take his time eating his meals. I noticed that he had difficulties with taking larger spoons into his mouth. For safety and comfort, I fed him smaller bites using a teaspoon. It is important to not rush the eating and drinking in people with dysphagia because it can lead to choking. I gave Dad all the time he needed to swallow his food before I gave him another bite.
5. Providing the cue to eat: With the progression of Dad’s dementia, he would easily become distressed or confused if he felt rushed. When feeding him, I would sit facing him and gently say “awww…” while opening my mouth, and then bring the spoon close to his mouth. This was a helpful cue for Dad that food was coming! I would then proceed to place food in his mouth when his mouth was open wide enough. This method may not be for everyone, but it worked well with Dad.
6. Minimizing conversation: It took effort for Dad to focus on eating and swallowing his food. I made sure not to talk much because it might make him feel obliged to respond to me while trying to eat. In between, after he had swallowed his food, I would ask him if he is okay or if his food was tasty. But this is only if it was safe to do so.
7. Stopping if full or uncomfortable: Even if the plate was half full, I made sure that Dad knew it was up to him to stop eating if he wanted to. Admittedly, it can be tempting to push a loved one to finish his or her plate because of the satisfaction of watching them eat. However, finishing the plate of food should not be the goal. If the individual’s appetite is within his or her usual range most of the time, I don’t think leaving food is an issue. I don’t believe in forcing someone to eat.
I learned what worked for Dad through the process of feeding him every day. It was difficult to switch to a pureed diet because not everything tastes the same due to changes in food texture. I provided supportive comments and made sure that there was a variety of foods that he enjoyed, and requested changes if he absolutely detested certain foods. From time to time, I brought special foods from home and his favorite tea prepared to be safe and suitable for his condition.
I wasn’t able to be there at every dinner because there were times when other matters needed my attention. One day before he died, Dad had choked on food during lunchtime. The staff used a suctioning device to remove the food. I was not there, so I am unable to describe the process.
However, the procedure may possibly have been too harsh for him. When I came in the evening to visit, Dad was having difficulties breathing and was developing aspiration pneumonia. He was having a fever, shortness of breath, unable to speak, moaning with pain. It was very difficult to see Dad in this condition. They had placed oxygen tubing to help him to breathe. The staff was hopeful that he would be fine, as he had many close calls but had always pulled through.
The next morning, Dad’s condition was worsening and he was rushed to the emergency room. He was alive when the ER personnel contacted me, but he quickly passed within 30 minutes while we were on our way to see him.
Koko's story began like most of ours. She knew little about caregiving and had to learn as she went. Not all of us will go on to earn our credentials in gerontology, but most of us feel as though we share credentials with Koko in that we earned our caregiver's stripes in the trenches.
Thanks to Koko Kawasaki for her personal story as well as her tips that can help all of us cope with our loved one's eating problems in a more positive way.
Carol is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. She runs award winning websites at _ www.mindingourelders.comand www.mindingoureldersblogs.com. On Twitter, f_ollow Carol @mindingourelder and on Facebook: Minding Our Elders
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