The Importance of High Fowler's Position
The High Fowler's position is a variation of the supine position where the resident's upper body is elevated to an angle between 60 and 90 degrees. For any resident eating or drinking in bed, this posture is critically important for several reasons:
- Prevents Aspiration: By sitting upright, the resident uses gravity to aid the downward passage of food and liquids into the stomach, rather than a flat position which can allow food to enter the trachea or windpipe. Aspiration can lead to serious complications such as aspiration pneumonia.
- Aids Swallowing: An upright seated position promotes effective swallowing and chewing by properly aligning the head and neck.
- Promotes Digestion: This position also assists the digestive process by allowing food to move more naturally through the esophagus.
- Increases Comfort: For many, eating in a seated position feels more normal and comfortable, which can enhance their mealtime experience and appetite.
Preparing the Resident for Mealtime
Proper preparation is just as vital as the correct positioning. The following steps should be taken to ensure a safe and dignified mealtime:
- Hand Hygiene: Before handling food or assisting the resident, the caregiver must wash their hands thoroughly to prevent the spread of infection.
- Raise the Bed to Working Height: For the caregiver's safety and proper body mechanics, raise the entire bed to a comfortable working height.
- Position the Resident Upright: Use the electric controls or manual crank to raise the head of the bed to a High Fowler's position (60-90 degrees). If the bed doesn't have this function, use wedge pillows or a backrest to achieve the upright angle.
- Provide Head and Neck Support: Ensure the resident's head is straight and not tilted back or to the side. Use pillows to support the head, trunk, and arms to prevent slumping. A slight chin-tuck can further help protect the airway.
- Bend the Knees: If the bed features a knee break, use it or place a pillow under the knees. This prevents the resident from sliding down the bed, which can cause friction and shear injuries.
- Provide Environmental Comfort: Remove any unpleasant odors or sights and ensure the environment is calm and distraction-free. Make sure the resident has their glasses, dentures, or any other necessary items.
- Serve Food Appropriately: Bring the meal to the resident on an over-bed table and position it close enough so they don't have to lean forward excessively. If assisting with feeding, sit at eye level.
Feeding Techniques and Post-Meal Care
Beyond positioning, a caregiver's technique can further reduce the risk of complications. For residents with dysphagia (difficulty swallowing), special care is needed:
- Offer small, manageable bites and allow the resident time to chew and swallow completely before offering the next bite.
- Alternate between solids and liquids, if appropriate, and always follow any prescribed dietary modifications, such as thickened liquids or pureed foods.
- Be attentive to signs of aspiration, such as coughing, a gurgling voice, or food pocketing in the cheeks.
- Most importantly, the resident must remain in an upright position (at least 30-45 degrees) for 30 to 60 minutes after eating. This uses gravity to ensure food is fully in the stomach and reduces the risk of reflux and aspiration.
Aspiration Risks in Different Positions
| Position | Description | Aspiration Risk for In-Bed Eating | Rationale |
|---|---|---|---|
| High Fowler's | Head of bed elevated 60-90 degrees, sitting upright. | Lowest | Uses gravity to assist swallowing and keep food and fluids moving down the esophagus. Aligns the airway properly. |
| Semi-Fowler's | Head of bed elevated 30-45 degrees, semi-reclined. | Low to Moderate | Safer than lying flat, but the lower angle may not be sufficient for individuals with significant swallowing difficulties. |
| Low Fowler's | Head of bed elevated 15-30 degrees. | Moderate to High | While used for other purposes, this angle is insufficient for safe eating and increases aspiration risk. |
| Flat (Supine) | Resident lying completely flat on their back. | Highest | Poses a significant risk of choking and aspiration, as gravity can cause food and liquids to enter the airway. This position should be strictly avoided for mealtime. |
Conclusion
Ultimately, selecting which position is most appropriate for the resident who will eat their meal in bed? is a decision focused on safety and preventing life-threatening complications. The High Fowler's position, with the head of the bed elevated between 60 and 90 degrees, is the gold standard for in-bed mealtime. This upright posture effectively leverages gravity, facilitates swallowing, and minimizes the risk of aspiration. When combined with careful feeding techniques and a prolonged upright period after the meal, it provides the safest and most comfortable experience for the resident. Caregivers must understand and implement these practices diligently to ensure resident well-being. By prioritizing the correct positioning, care providers are not just serving food, but ensuring the resident's safety and quality of life.
Sources
- Agency for Healthcare Research and Quality (AHRQ): Elevation of the head of bed to a semirecumbent position (at least 30 degrees) is associated with a decreased incidence of aspiration and ventilator-associated pneumonia (VAP).
- WisTech Open: In Fowler's position, the client is lying on their back with their head elevated between 30 and 90 degrees. Residents should be placed in Fowler's position any time they are eating or drinking.
