Mr. Scott (not his real name) is a seventy year old retired postman who lives at home with his wife. After three years of noticeable cognitive decline, he is now moderately demented.
Ideally, the exercise program should be carried out at least three times a week (daily if possible). The routine should begin with eight to ten minutes of stretching exercises. For some patients this part of the program may be all that is feasible, and this time may be extended to include the entire exercise program. The stretching exercises might include the arms and shoulders, the hips, the knees, and the ankles. Side bends, toe touches, sit-ups, leg lifts, and other familiar exercises are to be encouraged if possible. In the greatly incapacitated patient, the stretching exercises can be performed for the patient by the caregiver in a passive fashion, although this is not as beneficial as are the active exercises. After the stretching period, whenever possible, a twelve- to thirtyminute aerobic exercise program should begin. This may include walking, stationary cycling, or other exercises of this type. In inclement weather, walking may be done inside the house or, in this present day and age, at the nearest mall, where the temperature is usually in a satisfactory range. Milder forms of exercise may be all that can be done. These might include extending and rotating the arms or holding on to a chair and alter nately swinging one leg and then the other.The exercise program, if it is strenuous enough to produce an increased heart rate, an increased breathing rate, and significant perspiration or sweating, should be followed by a cooldown period of at least four to six minutes. The patient should be kept moving during this time. The stretching exercises are very important at this time also.Tips To Increase Food Intake if Chewing And Swallowing Are ProblemsBe sure dentures fit properly.Use gravy or sauces to help moisten food.Provide fluids at mealtime to help with swallowing. If fluids such as , water are difficult to swallow, try Jell-O or milkshakes.Encourage the patient to eat slowly and chew food thoroughly. Verbal reminders may be needed. If the patient is not able to chew regular meats, use soft meat alternatives to maintain adequate protein intake. Foods such as deviled eggs, egg salad, soft meat salads, meat soups or milk-based soups, milk pudding, and custards are suitable substitutions.Try mashing or shredding foods. Using shredded fruits or vegetables in salads, Jell-O, or stir-fry may increase food intake.Avoid grinding food: it becomes dry and difficult to swallow unless broth or gravy is used to help moisten the food. It is better to maintain as normal a dietary pattern as possible. Try precutting foods and putting the smaller bite-size pieces into casseroles and soups so that the food is easier to eat but the patient still feels he/she is eating regular foods. Avoid using baby foods if possible. If a pureed diet is necessary, try using a blender or food grinder to puree normally prepared foods. Using baby foods may unknowingly be degrading to the patient, thus making him/her feel as if he/she is being treated like a child.Food Guide Pyramid: A Guide To Daily Food ChoicesThe most useful guide currently available for food selection is the Food Guide Pyramid. The Food Guide Pyramid puts the dietary guidelines into action. The pyramid is an outline of what to eat each day. It is not a rigid prescription, but a general guide that lets you choose a healthy diet. The pyramid calls for eating a variety of foods to get the nutrients you need.