Many things can change in a person’s life when they are diagnosed and progress through dementia and Alzheimer’s. Mealtimes can become more significant as it provides an opportunity to have some control and make choices in addition to helping with orientation to time and place. Mealtime structure has positive benefits to nutritional and mental status and facilitates opportunities for social interaction.
People with dementia and Alzheimer’s may, over time, experience:
- reduced ability to communicate their needs regarding food and drink;
- inability to recognise their own sense of appetite of thirst;
- reduced coordination when eating and drinking;
- inability to use or recognise the function of cutlery and crockery.
Good nutrition is an important part of providing care for someone with Alzheimer’sor dementia and it is essential to help them to access a healthy and varied diet. It is very common for people withAlzheimer’sor dementia to change their food and drink preferences although this varies from person to person.
|Poor nutritional intake can lead to:
- Reduced cognitive function;
- Less energy;
- Reduced muscle mass and strength;
- Reduced mobility;
- Increased susceptibility to infection.
Reasons for Dietary Intake Deteriorating
- Lowered sensation of hunger or thirst;
- Forgetting to eat or drink;
- High activity (often described as ‘pacing’ , ‘kinetic’ or ‘agitated’) and no longer being able to tolerate sitting long enough to eat a meal;
- Reduction in sense of smell and therefore taste, with an associated reduced enjoyment of food;
- Loss of interest in food;
- Being easily distracted;
- Mistakenly feel that they have eaten already and then refusing to eat;
- Forgetting that they have already eaten and wanting more (leading to weight gain);
- Changing tastesand preferences;
- No longer recognising food;
- Struggling with noisy environments;
- Unable to recognise or remember how to use cutlery, plates and cups;
- Difficulty with chewing and swallowing, making it much more difficult to eat comfortably.
Managing the Food Environment
Managing the food environment can make eating easier for people affected by dementia and Alzheimer’s. Aim to make mealtimes less stressful and more enjoyable in order to support nutritional intake and health. Stay relaxed, calm and available to provide support at mealtimes. It is important to allow the person to still feel helpful and involved in the preparation of food — for example, laying the table or helping with dishes— for as long as possible to help them stayed tuned into the eating environment,reminding them that it is time to eat.
Setting the Eating Scene
Calm and Quiet Environment
- Use a dedicated favourite or familiar place where meals are eaten regularly. This does not have to be a formal dining room, just the place where the person is happiest to eat;
- Eating in a small group of familiar people may not necessarily increase dietary intake but it does provide positive social interaction;
- Keep the room bright and airy;
- Talk about positive things such as the nice cooking smellsandhow good the food looks;
- Sit down to eat and drink with the person if possible;
- Ensure that the basics for comfort have been covered:
- the person has been to the toilet,
- they have washed their hands,
- if they need glasses, dentures or hearing aids that these are ready and available for use;
- Change cutlery if necessary to ones that are easier to handle, e.g. cutlery with wider, chunkier handles;
- If eating takes a long time, serve the meal in separate portions to keep it warm.
Setting up Table
- Ensure that the room is quiet, away from noisy kitchen areas, without people moving through it or chatting across the person;
- Turn off televisions and radios unless the person enjoys music while they eat;
- Allow plenty of time to eat, 35 – 40minutes is often recommended;
- Avoid interruptions while they are eating;
- In a busy setting, try to avoid other people interrupting or asking questions as this can increase disorientation.
Those suffering from Alzheimer’s or dementia may eventually need some assistance when eating but always remember that self-feeding, however messy, is always the best option.
Keep the table simple. Avoid distractions such assalt and pepper pots, sauce bottles, flowers, candles, or decorative tablecloths. Use primary coloured plates, especially red and blue, as these offer contrast to the food and can help increase dietary intake by up to 30%. Use lipped or high-sided bowls, plates, and adapted cutlery if necessary to make eating easier. A plain, solid-coloured place mat can help the person recognise where to sit and eat.
Solutions to Common Problems
This section will detail some possible solutions to common problems experienced by those affected by dementia or Alzheimer’s and how carerscan deal with them. Reminding g& Encouraging the Person to Eat
- Try to capitalize on times of the day when the person seems more inclined to eat and respect that these times can change. Ensure that a nutritious, balanced meal if offered when the person expresses the desire to eat;
- If they are still able to feed themselves, they should. It can be helpful to sit with them;
- Encourage them to sip a drink and take bites of their food. Ask them if they want more, when appropriate;
- Keep drinks offered small so that the person can focus on eating;
- Bo positive about the food and comment on how good it is and what it tastes like. Asking what something tastes like or if it is hot enough can be used as a way to remind and encourage them to eat or drink more;
- Serve half portions of one course at a time to ensure that food stays warm and also to avoid confusion over what to eat first;
- The usual order of meal courses can become confused. There is no harm in being flexible and letting the person have dessert first if it encourages them to eat and you are confident they will eat their main meal too;
- Use gentle prompting by putting cutlery in the care recipient’s hand or gentle hand-over-hand assistance for feeding if tolerated;
- Avoid removing plates when eating with others until everybody — including the care recipient — has finished as this may be taken as a signal to stop eating.
Overeating & Wanting to Eat too much
It is more common to worry about weight loss rather than weight gain in a person suffering from dementia or Alzheimer’s, however, weight gain can happen if the person insists that they have not eaten when they have already. This is usually a temporary phase. However, there are some things to look out for if weight gain becomes a concern:
- Be aware that they may scavenge for food and make sure that all leftovers are put away and that access to high calorie snacks is limited;
- Make sure that spoiled food is in a bin that is out of reach;
- Try to offer additional portions of fruit and vegetables;
- You may also try dividing a meal up into smaller portions and offering them separately at different stages if the person is in the habit or returning and insisting on having their meal again.
Changes in Preferred Food
It is very common that people change their favourite foods as they experience alterations in how flavour, texture and smell are recognised. They might start to enjoy spicy foods and highly flavoured foods that they did not enjoy in the past.For this reason,you might be surprised to find that people with dementia or Alzheimer’s develop a taste for food combinations that perhaps you would not try yourself!
This is a good opportunity to introduce new foods that they may not have liked before, particularly healthy and nutritious foods that, if adopted into the everyday diet, could make up for some nutritional deficiencies and diminished appetite. Keep an updated list of new foods that the person now enjoys. Increasing flavour in food does not have to be complicated, adding herbs, spices, or lemon juice can make a big difference. Try not to add extra salt, particularly if the person has high blood pressure or the vascular form of dementia. If you are offering things like pickles, relishes, vinegar, mustard, salad dressings, or tomato ketchup to increase flavour, ensure that you choose low salt varieties and low calorie ones if you are worried about weight gain.
Bear in mind that not everyone starts to like new foods and some people find it easier to remember and enjoy the foods of their childhood more.
Only Eating Sweet Foods
It is common, especially at the end stages of dementia or Alzheimer’s, for the person to only accept very sweet foods, which can have a negative impact on nutritional balance. It is important to seek the support of a clinical dietician in order to maximise the nutrient density of the person’s diet at this point.
If the care recipient will only eat sweet foods, there are a number of ways to try and get as much nutrition in as possible.
- Do not resort to low nutrient dense foods like biscuits or cakes;
- Encourage the consumption of milk-based desserts, e.g. crème caramel, thick and creamy yoghurts, custards, rice pudding, semolina, or mousses;
- Fruit based desserts are also good options, e.g. stewed or tinned fruit. Add a bit of honey or golden syrup to make them sweeter;
- Some vegetables are quite sweet-tasting, e.g. peppers, carrots, sweet corn, or sweet potatoes. You can also consider adding a little bit of honey or golden syrup to other vegetables too.
Dealing With a Very Active Person Who Finds it Hard to Sit Down to Eat
People experience symptoms of dementia or Alzheimer’s disease differently and while some are very capable for sitting for periods of time without becoming distracted, others can become highly agitated and therefore pace or move around a lot. These active individuals are at risk of both losing weight and finding it difficult to eat enough to meet their increased energy expenditure. To counteract this, a number of measures can be introduced:
- Offer 5 – 6 smaller meals each day instead of three larger meals;
- Bite-size or finger foods can help someone eat on the go while also allowing them to eat independently, without needing assistance, and encouraging them to eat more often. High calorie, nutrient dense options are recommended for people at risk of weight loss;
- Leave small snacks in places where the person frequently paces or sits;
- Make an effort to walk and chat with the person while offering snacks;
- Keep track of times of the day when the person seems most restful and aim to have meals at these times.
Finger foods are a good option for a number of reasons. They are a good way to work calories in throughout the day while not being as daunting as a large meal, particularly for those who are reluctant to eat. They are also easy to eat and do not require cutlery, which can allow for greater independence and lend towards more of a willingness to eat. Finally, they can be eaten on the go for those who are easily distracted at mealtimes or agitated. If using finger foods, do not just offer lots of party foods. These are often of low nutritional value. Instead, offer bite-size portions of regular foods. The following are some examples:
- Mini scones with butter, jam and cream;
- Breakfast cereal bars;
- Pieces of chopped fruit or vegetables,e.g. chunks of apple or pineapple, orange segments, carrot or celery sticks and dips, etc.;
- Fingers of toast or crackers with cheese or pâté;
- Slices of pizza, bruschetta, garlic bread, falafels;
- Mini meatballs, pieces of fish or chicken;
- Roast potato cubes, potato waffle, chips;
- Mini sandwiches with moist fillings can be useful as they are comfortable to hold. Use a variety of breads including sliced bread, chapattis, roti, naan, tortilla wraps, and pitta breads. Good moist fillings include salmon, tuna, or chicken mayonnaise, grated cheese, peanut butter, mashed banana, and hummus.
People with dementia or Alzheimer’s can be prone to dehydration due to loss of the sensation of thirst or forgetting to drink. Most people need 6 to 8 glasses or mugs of fluid each day. This helps with concentration, keeping the kidneys healthy and avoiding constipation. The following are some tips to help encourage care recipients affected by dementia or Alzheimer’s to keep hydrated:
- Offer drinks from red or blue cups and glasses;
- Keep hot drinks warm with insulated mugs. It may take some time for the person to drink them and if they stay tasting good the person is more likely to finish them;
- Fluids can be worked into the diet in many ways not just through water. Fruit juice, herbal teas, small amounts of regular tea and coffee, and soup can all hydrate. Ice lollies and ice cubes made from juice are also an option;
- If they are reluctant to drink, make sure to leave bottles of drinks placed within their view so that they might be self-prompted to drink;
- It can be helpful to sit together and have tea or coffee or another beverage in a social setting to encourage fluid intake.
There are two important instances when it is very important to seek professional help and guidance:
- If the person with dementia or Alzheimer’s is experiencing weight loss, request an urgent referral to a clinical dietitian.
- If you notice any difficulties with chewing and/or swallowing, request an urgent referral to a speech and language therapist for assessment. For more information, see our fact sheet on Managing Nutrition with Dysphagia in Older Age.