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Swallowing, eating and nutrition

8) Practical tips for encouraging the person to eat after stroke

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Practical tips for encouraging the person to eat after stroke

  • Mouth Care. If the mouth is painful or food gets left behind teeth or dentures it can cause bacteria and mouth problems. Make sure the person has fully swallowed any medicine as this can also cause mouth problems. If medicine gets stuck in the mouth where the person has less feeling, tablets may start to dissolve in the mouth instead of the stomach causing ulcers and discomfort.
  • Dentures. If dentures do not fit this can make eating more difficult. Weakness of the muscles on one side of the face or weight loss after a stroke can mean dentures will no longer fit as well as they used to.
  • Position. A good upright sitting position when eating will help with swallowing. Stay sitting up for at least half an hour after eating to help digestion. If their sitting balance is not good try using extra support from pillows or by putting their arms on the table in front to help with balance.
  • Physical help. If the person needs help, try sitting in front of the them and offer a small amount of food at a time. Make sure each fork or spoonful has been swallowed before giving the next. Let the person smell the food before they eat. It helps to get saliva in the mouth ready for the food and moistens the food as it is eaten. If the person has a dry mouth, give a drink first to help the swallow. Have napkins ready to wipe the mouth. Weakness of the face muscles can cause drinks or liquid food to leak out from one side of the mouth.
  • Nutrition Advice. If the person is very undernourished ask for a dietitian referral for individual advice. The GP may be able to supply nutrition enriched drinks on prescription in a variety of thickness and flavours. Thickener can be added to ordinary drinks. This is also available on prescription.
  • Food Texture. Variety of food and flavours can stimulate appetite. Mix food with sauces or gravy to moisten. Cook food until tender. Avoid dry crumbly foods which can be harder to swallow such as crusty bread or crackers. Some people will need to have foods blended or pureed. Try to cook the same meal for everyone but if the person has a swallowing difficulty add extra cooking time or extra sauce/gravy before blending or pureeing. Some people will be recommended to use a texture modified diet. See film clip for advice on how to make this type of food.
  • Alternative flavours. Try to avoid adding salt to flavour food as it can have an effect on increasing blood pressure. Try other flavours such as finely chopped herbs or citrus. Marinate meat in fruit juices or low fat dressings.
  • Relax. The more pressured the person feels the less likely they will be to enjoy eating. Although meal time is supposed to be a sociable occasion, try to avoid talking and eating. This distracts from the process of eating. Make meal time as normal as possible. If you normally set the table continue to do so. Use their preferred cutlery and crockery if this is possible. Take your time so they don’t feel rushed.
  • Drinks. Keep a look out for any signs that the person may be dehydrated. This could be a reason why they are not eating. Dry mouth, constipation, dark urine or weight loss are all clues. This is especially important in the elderly.

NOT Practical tips for encouraging the person to eat after stroke

  • Encourage talking If the person is trying to talk and eat this can increase risk of choking. Eating and talking both require concentration and breathing control. This is more difficult if the person has swallowing problems.
  • Be quick before food gets cold Try not to rush. Go at their pace. Ensure the food is not too hot. Try to offer a small spoon of food at a time. Think about warming the plate or using an insulated plate to keep the food warmer for longer.
  • Give larger portions. A large plate full can be off putting. Try giving the person a smaller portion of food at first. If they are still hungry you can give more. Try to make foods look colourful and appetising.
  • Fuss about the mess If the person has spilt food they could be embarrassed and meal times could become more stressful or even unpleasant for them. Having napkins and wipes ready before you start. Try to clear up quickly and smoothly after the meal.

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Practical tips for encouraging the person to eat after stroke

  • Mouth Care.  If the mouth is painful or food gets left behind teeth or dentures it can cause bacteria and mouth problems. Make sure the person has fully swallowed any medicine as this can also cause mouth problems. If medicine gets stuck in the mouth where the person has less feeling, tablets may start to dissolve in the mouth instead of the stomach causing ulcers and discomfort.
  • Dentures. If dentures do not fit this can make eating more difficult. Weakness of the muscles on one side of the face or weight loss after a stroke can mean dentures will no longer fit as well as they used to.
  • Position.  A good upright sitting position when eating will help with swallowing. Stay sitting up for at least half an hour after eating to help digestion. If their sitting balance is not good try using extra support from pillows or by putting their arms on the table in front to help with balance.
  • Physical help.  If the person needs help, try sitting in front of the them and offer a small amount of food at a time. Make sure each fork or spoonful has been swallowed before giving the next. Let the person smell the food before they eat. It helps to get saliva in the mouth ready for the food and moistens the food as it is eaten. If the person has a dry mouth, give a drink first to help the swallow. Have napkins ready to wipe the mouth. Weakness of the face muscles can cause drinks or liquid food to leak out from one side of the mouth.
  • Nutrition Advice. If the person is very undernourished ask for a dietitian referral for individual advice. The GP may be able to supply nutrition enriched drinks on prescription in a variety of thickness and flavours. Thickener can be added to ordinary drinks. This is also available on prescription.
  • Food Texture. Variety of food and flavours can stimulate appetite. Mix food with sauces or gravy to moisten. Cook food until tender. Avoid dry crumbly foods which can be harder to swallow such as crusty bread or crackers. Some people will need to have foods blended or pureed. Try to cook the same meal for everyone but if the person has a swallowing difficulty add extra cooking time or extra sauce/gravy before blending or pureeing. Some people will be recommended to use a texture modified diet. See film clip for advice on how to make this type of food.
  • Alternative flavours. Try to avoid adding salt to flavour food as it can have an effect on increasing blood pressure. Try other flavours such as finely chopped herbs or citrus. Marinate meat in fruit juices or low fat dressings.
  • Relax. The more pressured the person feels the less likely they will be to enjoy eating. Although meal time is supposed to be a sociable occasion, try to avoid talking and eating. This distracts from the process of eating. Make meal time as normal as possible. If you normally set the table continue to do so. Use their preferred cutlery and crockery if this is possible. Take your time so they don’t feel rushed.
  • Drinks. Keep a look out for any signs that the person may be dehydrated. This could be a reason why they are not eating. Dry mouth, constipation, dark urine or weight loss are all clues. This is especially important in the elderly.

NOT Practical tips for encouraging the person to eat after stroke

  • Encourage talking If the person is trying to talk and eat this can increase risk of choking. Eating and talking both require concentration and breathing  control. This is more difficult if the person has swallowing problems.
  • Be quick before food gets cold  Try not to rush. Go at their pace. Ensure the food is not too hot. Try to offer a small spoon of food at a time. Think about warming the plate or using an insulated plate to keep the food warmer for longer.
  • Give larger portions.  A large plate full can be off putting. Try giving the person a smaller portion of food at first. If they are still hungry you can give more. Try to make foods look colourful and appetising.
  • Fuss about the mess If the person has spilt food they could be embarrassed and meal times could become more stressful or even unpleasant for them. Having napkins and wipes ready before you start. Try to clear up quickly and smoothly after the meal.

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