People with dementia can experience various eating problems. These range from problems chewing and swallowing, to dietary issues caused by a poor appetite or by overeating. Eating problems can come about because of a progressive decline in the person’s memory, thinking, planning and judgement.
Loss of appetite
A loss of appetite can be caused by:
- forgetting how to chew or swallow
- dentures that don’t fit properly
- not enough physical activity
- someone having difficulty feeding themselves
- being embarrassed by difficulties.
What to try:
- Offer meals at regular times each day.
- If the person doesn’t want to eat meals at set times or at a table, make finger foods available that they can snack on.
- Allow the person to eat when they are hungry.
- Try to make mealtimes simple, relaxed and calm.
- If the person is agitated or distressed, don’t put pressure on them. Wait until they are calm and less anxious before offering food and drink.
- Present food that looks and smells appealing.
- Try to prepare familiar dishes and foods, especially favourites.
- Consider serving small portions to keep hot food from going cold and losing its appeal.
- Offer ice cream, yoghurt or milkshakes.
- Offer snacks high in water content, such as melon, to help avoid dehydration.
- Encourage eating all or most of one food before moving on to the next: some people can become confused when flavours and textures change.
- Provide balanced meals to avoid constipation.
- Be sure to allow enough time for a meal. Depending on their ability, assisting someone may take up to an hour.
- Don’t presume the person has finished because they have stopped eating.
- Encourage physical exercise to increase appetite.
- Ensure there are no treatable causes for loss of appetite, such as acute illness or depression.
- Consult a doctor if there is a significant weight loss.
- Check with the doctor about providing vitamin supplements.
Overeating or ‘always hungry’
There are many reasons for overeating, including:
- forgetting they have eaten recently
- eating more because they are concerned when their next meal is coming
- changes in food preferences or becoming obsessed with specific foods or meals.
It can be stressful for both the person living with dementia and their carer when the person frequently asks or searches for food. This is more prevalent in the behavioural variant of frontotemporal dementia.
What to try:
- Try five to six small meals each day.
- Consider offering low-kilojoule snacks, such as apples and carrots.
- If necessary, secure some foods in cupboards.
- Ensure the person is drinking enough, because thirst can be mistaken for hunger. Offer a low-kilojoule drink instead of more food.
- Fill most of their plate with salad or vegetables.
- If boredom or loneliness may be a factor, consider whether other activities such as walks, or increased social contacts, may help.
- For excess weight gain, consult a doctor and a dietician.
Changes in taste
People living with dementia may lose their sense of taste and smell, which affects the way they experience flavour.
Some people develop cravings for strong-flavoured food that is sweet or salty. They may also enjoy unusual flavour combinations, such as mixing sweet and savoury food and flavours.
As the condition progresses, some people living with dementia may experience changes in mood such as depression and anxiety. One way they find comfort is by eating more or having food that provides a sense of comfort, which often tends to be sweets.
What to try:
- Try milkshakes, eggnogs or low-kilojoule ice cream.
- If the person prefers sweet foods and is not losing weight, it may be healthier to try fruit or naturally sweet vegetables.
- Enhance flavours by using herbs, spices, sauces and chutneys.
- Even if food combinations seem unusual, be guided by what the person would like to eat.
- Check medications for side effects. Some antidepressant medications can cause a craving for sweets.
Mouth, chewing and swallowing problems
Some causes of eating problems may relate to the mouth. Common problems include the condition ‘dry mouth’, or mouth discomfort from gum disease or dentures that don’t fit properly.
What to try:
- If dry mouth is causing problems, moisten food with gravies and sauces.
For chewing problems:
- try using light pressure on the person’s lips or under their chin
- tell the person when to chew
- demonstrate chewing
- offer small bites one at a time
- moisten food.
For swallowing problems:
- remind the person to swallow with each bite
- stroke their throat gently
- check their mouth to see if food has been swallowed
- do not give foods which are hard to swallow
- offer smaller bites
- moisten food.
- Visit a dietician or doctor for extra advice on maintaining good nutrition
- Have a dental check-up of gums, teeth and dentures.
- Consult the doctor if choking problems develop.
- Visit a speech therapist if there are swallowing problems, for advice and appropriate strategies.
At the table
Someone with dementia may be experiencing challenges at mealtimes: perhaps not understanding the table setting, or knowing what particular items are for.
What to try:
- Serve familiar food.
- Serve one course at a time and don’t overload the plate.
- Season meals in the kitchen, so that salt and pepper shakers and spice containers are not on the table.
- If drinking from glassware is challenging, consider providing drinks in no-spill cups.
- Remove distracting items from the table such as extra cutlery and glasses, and items that might be mistaken for food such as napkins, flowers or table decorations.
- Ensure table settings such as crockery and tablecloths are not patterned or busy, but plain and a different colour from the food being served.
- If the use of cutlery seems confusing, consider serving finger food.
- If using a plate is challenging, consider serving food in a bowl, to make eating easier.
- Eat together, so the person can copy you.
- Allow time for the person to respond to the food and not feel rushed.
- Keep noise and activities in the environment to a minimum.
- Ensure there is adequate lighting.
New eating problems may come up as someone’s dementia progresses. Continue to observe the person you are caring for and report new signs and symptoms to health professionals. Eating problems can be addressed with the help of a doctor or dietician.
- Whenever possible, plan for meals to be social occasions.
- Consider the way the person has liked to eat. They may have always had a small appetite, been a voracious eater or had a sweet tooth.
- Be aware of food temperatures, because although warm food is more appetising, some people with dementia lose the ability to judge if food is hot or cold. Insulated cups can hold the heat for a long time and sometimes lightweight ones can tip over easily.
- If someone living alone has spoiled food in the refrigerator, is hiding food or not eating regularly, these may be signs they need more support.
- Many people with dementia do not get enough fluids because they may forget to drink or may no longer recognise the sensation of thirst. Be sure to offer regular drinks of water, juice or other fluids to avoid dehydration.
Adapted from A. Robinson, B. Spencer and L. White Understanding Difficult Behaviours.
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