Tell Giselle: Food choices complicate care giving

A number of conversations with people who are now having to take care of an elderly relative prompts a closer look at how we respect and support our loved ones when they cannot fully care for themselves.

One dilemma that is often overlooked when it comes to the best ways to support anyone who is in a declining state of body or mind is how strict their dietary intake ought to be managed.

“Should I limit what my father wants to eat? I am waffling over how rigid I need to hold him to his doctor’s recommendations.”

G: This is one of those challenging circumstances that caregivers must review on a case-by-case basis. This is not a one size fits all answer as many factors are relevant and not the same at all stages of caregiving. These include the person’s overall health status, the expected number of days and or years that the person may have left, as well as how realistic it is to expect the support team (if the burden is being shared) to be able to agree on what is ideal.

Figuring out what limits can be maintained that won’t create drama at every feeding time is critically important. Caregiving is exhausting enough, and adding a fight scene over every meal or snack is brutal. Think of what it is like to feed a toddler with a discerning palate, and you get a glimpse of exasperation.

Particularly as a loved one experiences times of fragility it becomes all the more necessary to have the in-depth discussions over what is realistic when it comes to fulfilling what everyone wants or may need.

These are not necessarily the end-of-life preparations that can be complicated, painful and awkward. But if we do not know what the expectations are, as well as the boundaries for what is possible and reasonable, we will be in a world of needless hurt.

We do not want our elderly relatives to think that we are treating them as children, or without agency. Nor do we want to feel like we must parent them as we once were parented, causing a strain on the emotional bonds. Give voice to these concerns.

If you have not already had a discussion about the dietary restrictions that the medical team has recommended, that’s a good place to start. You need to be able to understand from the medical perspective why those are advised, so that you have a better grasp with which to “defend” your decision to adhere to them.

Not that you have to adhere to them, but you cannot feel certain you are giving the best care unless you learn about the consequences to a patient with particular health conditions from ingesting certain types of food and liquids. Even though research will alter our understanding of what is an optimal diet, there are certain givens that have remained constant. Such as over or

under consumption, and concerns with excess salt, sugars, fats or any ingredients that may trigger allergic reactions or counteract medications.

Standing firm can be complicated when we are well, and even more so when we are ill or deteriorating. Over thirty years ago my father was undergoing cancer treatments and had traveled out of state to visit me. At the time I had eschewed all meat, and may have been off even eggs and dairy.

That dietary practice began for mostly ethical reasons but quickly morphed into my attempt to stave off as many cancers or debilitating diseases that I thought might be in my control.

I was absolutely convinced then that any consumption of certain meats would be detrimental to his recovery. I made it clear to him and my mother I would not serve any meat at my home, and if they wanted any meat we would go to a restaurant.

I know I know this sounds nearly nuts to some readers, but this was actually a great conversation starter for what was going on with his treatments and how he was doing overall. It was also an opportunity for him to have a better grasp of the way I had chosen to live and my reasons for being this intense with him.

I believe we actually grew closer from that visit. He knew that first and foremost I held my ground because I loved him and believed it could help him get well. He also knew I was an animal lover, as was he, but I had taken it to a whole ’nuther level.

Learning to care give well means you practice perfecting a pas de deux or tango rather than your solo act. This will require some deeply intimate conversations, with the patient, as well as with yourself as you come to learn what it takes to flow well together for as long as possible.

What caring for a loved one means will not be the same for each person in that role. But what all good caregiving does have in common are mealtimes that are expressions of love and tenderness, even at those times when there is no meat on the plate.