Assisting Drinking and Eating

If drinking or eating makes your loved one cough, then it's important to see our section 'coughing from drinking or eating'.

For issues with biting cutlery, or with the potential for glassware or crockery to be broken, see our section on cups and cutlery.

See our advice on hot drinks (or food) that could scald.

See our checklist of other food safety issues.

Whilst a bib might be seen as demeaning, a large cloth napkin may not be, and having a number of them to allow washing and drying is useful. It can be held on to the clothes with a clothes peg in the top corners (not under the throat, obviously) - it's best to gently pull the outer layer of clothing out slightly to make sure you don't catch the skin in the clip. If drink or food dribbles under the chin, dry it very gently (in a dabbing action) when swallowing has finished (and before it disappears under clothing).

Ensure that the person drinking or eating is sitting upright enough, and that their chin isn't bent too far forwards into their chest. Hospital-style profiling beds don't seem to have the pivot point at the right place for the hips, so raising the upper body can push the head too far forwards if the pillow isn't adjusted. The position doesn't have to be bolt upright - get a feel for what is required by trying yourself to swallow in the upright position and then in slightly less upright positions, or with your chin slightly down.

Starting with the least help required - consider whether your loved one is able to drink by themselves if the cup is lighter, i.e. avoiding a mug that is heavy of itself or because there's a large volume of drink at once. Holding it via a handle may be more difficult for them to balance, as the weight is off to the side, although on the other hand they may find it easier to know what to do if they drink in a familiar way. There are two handled cups available that could be tried if the physical effort of holding it appears to be a problem.

There's a large variety of cups on the market, including ones that are ribbed and slightly conical to make them easier to hold without slipping out of the hand, and ones that use straws and screw-on lids so they won't spill if they rest on their side. Many of these are 'unbreakable' plastic and dishwasher safe.

For a stockist in the UK see our section on drinking aids.

A drinking straw may be worth trying for those not on thickened drinks, as it doesn't require the drink itself to be held up in an accurate position. There are 'one-way' straws available, which have a valve in to prevent the drink in the straw running all the way back down into the cup each time you stop sucking - otherwise some people may not have enough suck volume in one breath to get the drink up to the tip at all.

For a stockist in the UK see our section on drinking aids.

When assisting someone to drink by holding the cup to their lips, it's important to understand that we don't drink by tipping the liquid up into our mouths, we drink by sucking it up (even without a straw). Try having a drink yourself, and noting what you do - you only tip the cup as far as you need to in order to feel the drink just touch the bottom of your upper lip, and then you suck the drink from there. This gives you good control over how much you get in one go and how quickly or slowly you get it - which is particularly important in order to avoid it going down the wrong way and making you cough. (NB see our section on coughing from drinking or eating.) You'll need a cup that's transparent enough for you to be able to see the level of the drink.

If you feel brave enough, get someone without dementia to assist you to drink, and you'll probably get a better understanding of what's needed.

When assisting someone to drink by holding the cup to their lips (as above), be careful to allow them enough time to get their breath back in between sips - they may take longer than you would. Observe when they're ready - if you go to extremes and leave it far too long between sips then you lose the pattern and they may forget what they're doing and lose interest.

Whilst for most old folks dehydration is a potential problem, there is also the (unlikely) potential for overhydration if they feel they need to keep drinking even when they've had enough, because you keep offering more drink. This could be because they're relying on your judgement, or they think the drink will still keep coming and if they don't drink it then it will drown them.

For how to determine whether someone's dehydrated see our section on checking for dehydration.

Is something discouraging them?

If someone isn't eating well without assistance then first consider whether something is discouraging them - for example they have toothache or dentures that are uncomfortable, the food is too chewy or isn't something they like. Chewing can quickly tire out old folks' jaw or swallowing muscles - if you think about it, you wouldn't be able to chew many toffees in a row before your jaw muscles started to ache. If this seems a possible cause then try softer foods for comparison.

Portion size

Also consider the size of the portion presented to them. If it's too large that could be counterproductive, by making them give up early because they know they can't finish it all, where otherwise they might push themselves further just to finish off the last bit of a smaller portion. If you're worried the portion was then too small, you could always offer a little more 'because that was quite a small portion to see if you liked it'.

Arrangement on plate

Some people with dementia will eat from one side of the plate to the other, which may mean they eat all of the potato and then all of the vegetables and then all of the meat. If you observe this to be the case, then place each different food in several areas around the plate, so they won't get bored of having just one thing in a row.

Arm strength

If the problem appears to be lack of arm strength you could try gently cushioning their wrist from underneath to support the weight as they hold and guide the fork or spoon. To some people this may seem more natural than spoon-feeding them, whilst for some it may feel the opposite.

There's a variety of cutlery on the market that's designed to be easier to hold and use, and also dishes that have rims to keep food on the plate, and ones that can keep food warm for longer using an inbuilt warm water reservoir. There are also non-slip mats that help prevent the dish moving around the table or tray.

For a stockist in the UK see our section on eating aids.

When assisting someone to eat by 'spoon-feeding', be careful to allow them enough time to chew and to swallow and to get their breath back before the next mouthful - they may take longer than you would. Observe when they're ready - if you go to extremes and leave it far too long between mouthfuls then you lose the pattern - there's a definite optimum timing.

If you feel brave enough, get someone without dementia to assist you to eat, and you'll probably get a better understanding of what's needed.