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Nov 30, 2021

Typically, around 85% of people will experience swallowing problems medically known as dysphasia at the end of life. Your loved ones or the people you care for can have trouble swallowing food, liquids, or both. 

This is a 4-part series on Alzheimer's Care and Swallowing Problems, and this episode is focused on Maximizing Independence In Eating.

           In Part 1, I talked about The Basics of Swallowing Problems. 

           In Part 2, Modifying Textures + Flavor Building 

          and Part 3, Adaptive Equipment.

If you missed an episode, you can check them out where you found this one – or on my YouTube Channel, MelissaBPhD. 

✔️ Main Point 1: Basics of Offering Feeding Assistance

  • Sit with the person during meals 
  • Eat together if possible
  • Make eye contact
  • Offer verbal, visual, and sensorimotor cues
  • Offer small amounts of food at a slow, consistent rate 


✔️ Main Point 2: Maximize independence for Self-Feeding

  • Verbal and Visual Cues
  • NOSH adds Sensorimotor Cue with Handfeeding Techniques
  • Use of finger foods if utensils are hard to manage:

– Best for Regular and Mechanical Soft Diets

  • Sandwiches
  • Ice Cream
  • Frozen yogurts
  • Chicken nuggets

✔️ Main Point 3: Handfeeding Techniques:

  • Developed for persons living with Alzheimer's Disease, but can be used for other difficulties
  • Limited range of motion in upper arm, elbows, shoulder
  • Tremors
  • Limited dexterity of hands, fingers
  • Arm weakness
  • Lack of endurance to self-feed for an entire meal

Main Point 4: General Guidelines for How and When To Use Each Handfeeding Technique

  • Sit on the dominant side of the person you are assisting
  • Tailor amount of support to their ability in the moment
  • Promote self-feeding as much as possible
  • To assist:

– Start with Over Hand, 

– then Under Hand, 

– And Save Direct Hand for those who are totally dependent

Many people in my studies had not fed themselves for a year or two. When we started using the handfeeding techniques with them -- many started feeding themselves again. 


Visit for videos demonstrating the different handfeeding techniques.

If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at, and I will get back to you by recording an answer to your question.

About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN:

I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at