Food for thought: Facilitating independence with finger foods

 

Dietician Denise Burbidge discusses finger foods as a flexible, dignified meal option for people with moderate to severe dementia

Aged care workers and people caring for a loved one with dementia know that a nutritious, balanced diet is vital in maintaining body weight, hydration and general well-being. However, achieving a balanced diet for people with dementia is often very challenging, especially as their condition progresses and their ability to verbalise decreases. People with dementia may lose weight for many reasons: they may forget if they have eaten or they may no longer be able to recognise some foods, or recognise food at all.

People with dementia can face a number of challenges when sitting down to a meal. A common difficulty faced in middle to late stage dementia is coordinating eating and drinking. People with dementia might also struggle to use a knife and fork. Understandably, this can be frustrating and embarrassing for a person with dementia (Alzheimer’s Society 2012). Food gets dropped and meal times become messy and tiresome.

There can be confusion with use of condiments, such as putting sugar in the main meal and salt on desserts. Distraction is common, and carers often need to redirect the individual to the task at hand or back to the dining table.

Using finger foods in place of traditional meals may prolong a person’s independence and stimulate them to eat more frequently. Finger foods can be eaten easily, without the need for cutlery, hold their form when picked up and require limited chewing. Serving finger foods for people with

Antipasto ingredients are often soft, as well as nutritious. Photo: Barbara Dieu

moderate to severe dementia is a way to help preserve dignity, increase self-esteem and enable independence at a time where mobility or coordination may be limited. A person served finger foods is in complete control over what they eat, when they eat and how much they eat: a vast contrast to that of being helped to eat, especially in institutional settings (such as aged care homes) when a member of staff has only a limited time available to help at mealtimes.

Suitable finger foods include: small sandwiches, cubes of cheese, meatballs, fruit platters or small fruit muffins. Ideally, finger foods in a dementia menu wouldn’t frequently include party pies, sausage rolls and other common party foods, as these lack adequate nutrition.

 

Dementia-friendly finger foods

Miniature versions of foods are often better than cutting up larger items, as this creates a more stable product that is less likely to fall apart. Finger foods are generally not expensive: the goal is to use basic ingredients to create small, flavoursome items.

Many cultures provide examples of finger foods which could be adapted for older people: antipasto from Italy features a range of meats and vegetables, as does yum cha (or diӑn xin) from China. Meze – finger foods common to the Mediterranean, Balkans and parts of the Middle East are often moist and combine grains, dairy (yoghurt and cheeses), meat and vegetables. Food items can be softened and ingredients substituted as required.

Whilst it is possible to achieve all the required nutrients on a finger food diet, fibre and folate are often low as food items such as breakfast cereals and leafy green vegetables are more challenging to adapt. If you are considering commencing a finger food menu for someone you care for, be sure to alert the person’s GP and/or dietitian so that micro-nutrient levels can be monitored and supplemented if required.

Food safety

Ideally, finger foods are served at room temperature (with hot foods allowed to cool) or comprise non-perishable ingredients. The composition of foods will depend on how well the person with dementia is eating. If they are content to eat at a dining table, then a range of hot and cold foods can

Many cultures have a tradition of finger foods before or as a meal. Photo: Midori

be served. A person who wanders and prefers small pieces of foods across the day will benefit from a range of non-perishable foods (such as breakfast bars made with muesli) to reduce the risk of food-borne bacteria. When people are eating with their fingers it is a good idea to encourage hand washing and have wipes available before and after meals to minimise food contamination and gastric upset.

Of course, when implementing finger foods as part of a menu, the issue of choking needs to be considered. Remove seeds and skins, ensure soft and moist items are available for those with difficulty chewing or swallowing, and continue to provide adequate mealtime supervision. Avoid toothpicks and other sharp objects.

 

Sample finger food menu

Note: Some people may need to be offered the same food on several occasions before they accept it. A minimum one week trial of a finger food menu is recommended.

Breakfast Cereal bar, 5 dried prunes, 1 glass orange juice, tea/coffee, OR Hard boiled egg (shell removed), 1-2 wholemeal toast (cut into strips), 1 glass milk, 1 banana, tea/coffee
>Morning tea Orange wedges, tea/coffee, OR Cheese cubes and savoury crackers, tea/ coffee
Lunch Mini lamb burgers with cheese and lettuce in buns with thick-cut chips, ice cream in a cone, water, juice, cordial, OR Mini salmon patties with baby sweet corn, potato wedges and green beans, fruit platter of cut up fresh fruits (remove skins and seeds), water, juice, cordial
Afternoon tea Mini apple muffinTea/coffee, OR Pikelets with margarine and jam, Milkshake or smoothie
Evening Meal Thin puree soup (serve in cup) with bread and butter, Zucchini slice, served with cherry tomato (halved), carrot/celery sticks, salad leaves, Fruit juice, cordial, water, OR Thin puree soup (serve in cup), Bread and butter, Chicken kebabs, tortilla wrap and yoghurt dip, side finger salad, Fruit juice, cordial, water
Supper Warm milk drink and sweet biscuit, OR Milk drink and fruit toast with butter

 

Denise Burbidge is an accredited practising dietitian and accredited nutritionist. She is a senior dietitian at Leading Nutrition. Contact Denise at: denise.burbidge@leadingnutrition.com.au

 

References

Alzheimer’s Society (2012) Food for thought. Alzheimer’s Society factsheet. London: Alzheimer’s Society.

Crawley H, Hocking E (2011) Eating well: supporting older people and older people with dementia, a practical guide. Abbots Langley, Herts, UK: The Caroline Walker Trust.

 

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