Feeding our patients

Food is so engrained in health care but we often don't realize it.

Demented patients often lose their ability to chew and swallow swell. There are too many steps for their damaged neural pathways to figure out - using a knife to cut the food to appropriate size, a fork to bring it to the mouth, chew a sufficient number of times then swallow - don't aspirate.

To make up for this, we give them puréed food. All they need to do is scoop and swallow.

Even this can be difficult. Senile patients often need multiple cueing to keep them on track in getting the food to their mouth. More cueing needs to take place to remind them to swallow. When patients are being fed, we sometimes need to do something called "double spooning" to work the visual clues that remind the patient to swallow.

This puréed food is gross. Everything looks somewhat beige and has the texture of baby food. Even worse, all factors that make the food smell like food are removed. So, we ask our demented patients to eat these trays full of monochromatic piles of mush that look and smell like paste. It's no wonder multiple cueing is needed. These well meaning manufacturers are even able to make french toast unappealing. French toast!! That's just blasphemy.

With dementia often comes depression and a strong drop in appetite. Appetite can often be stimulated by strongly yummy smelling food (why so many grocery stores have in store bakeries!), but this sense is being ignored in our food prep in hospitals.

This is why I'm one of those wacky docs who encourage outside food. McDonalds for the post GI surgery patient who hasn't eaten for 5 days and is nauseated by everything sent up by the kitchen. Homemade perogies for the grandma who just can't seem to kick this pneumonia. Dates for the palliative patient with aspiration issues if it makes him happy and he and his family understand the risk.

Families bringing in their own smelly soups and eating in front of their demented relative. This works two ways - adds the social cue for eating we are lacking in the average hospital room as well as scent the room with deliciousness to fool the patient's palate.

I have a lot to say about food. Expect more soon.


- Posted using BlogPress from my iPad