A guide to food and eating for persons with dementia

Whether we live to eat or eat to live, anyone can agree that food is an essential part of everyday life. Good nutrition is needed for health and well-being, and people with dementia are no exception.

However, because of the way that dementia affects brain functioning, they may not eat as well as they used to.

As their eating habits and patterns change, understanding and supporting persons with dementia can help to ease the stress and confusion around eating, meal times, and nutrition. 

How does dementia change a person's eating habits? 

It is well-known that dementia affects a person's memory and brain functioning. They may not remember past events well, have poorer understanding and communication skills, or face greater difficulty using their problem-solving and thinking skills. Dementia also often changes the person's mood, causing personality changes that in turn result in behaviour changes.

However, did you know that dementia can also alter one's hearing, taste, and sight? All these factors can greatly affect how they perceive the food placed in front of them. 

Additionally, as dementia progresses, a person's coordination and motor skills may be affected as well. Often, the person's ability to chew and swallow may be affected, and they may also be more easily distracted by their environment.

With these changes, eating can become a very different experience when a person develops dementia. Common changes in eating habits include:

• Not remembering how to eat the food in front of them 
• Not recognising certain foods 
• Not remembering when they ate, resulting in either over or undereating
• Suddenly showing strong preferences for certain foods or strongly flavoured foods 
• Disliking previously enjoyed foods 
• Requiring assistance with eating and swallowing food, such as modifying food textures or having a caregiver to help with feeding as they are unable to self-feed 
• Changing their eating schedule e.g. not wanting to eat at usual meal times 
• Changing portion sizes or changes in appetite 
• Not knowing how to pace themselves when eating 

These could affect the nutritional intake of a person with dementia. 

It is important to remember that despite these changes, a person with dementia will still require the same amount of nutrition as anyone else. He or she should also be getting nutrition from the same table meals, unmodified, as much as possible. 

What difficulties might a person with dementia face during meals?

During a meal, how are people with dementia affected? Some common challenges would be: 

1. Changes in food preferences

People with dementia may not want the same foods they used to like or accept. They may not be able to to taste flavours as well as before and crave stronger flavours. They may also start mixing unusual flavour combinations.

Recommendations:

• Follow their lead and accept the changes in their taste profile. If it’s not too unhealthy, let them eat what they wish to have. 
• Use spices to enhance the flavour of food, and also offer fruits in place of sweets. Search for seasonings with low-sugar, low-salt content to minimize additives to food. 

2. Mood changes

Dementia can cause mood changes, such as erratic shifts in mood from happy to angry, or personality changes. For instance, a meek and shy individual may suddenly be overly aggressive in demeanor. 

People with dementia could get upset with being served meals.

Recommendations:

• Use a visual schedule or reminder for the person with dementia for meal times, to prepare them ahead of time. 
• If the person gets upset, don’t take it personally. Calmly clean up and serve the food another time when the person is more calm and ready to eat. 

3. Difficulties with using cutlery 

In the later stages of dementia, motor coordination difficulties can occur. A person with dementia may find it difficult to hold utensils and feed themselves. They may also not sense when food is coming to their mouths and not open them. 

Recommendations:

• Cut food up into smaller pieces so it can be eaten more easily.
• If utensils are too difficult to use, encourage the person to use his or her hands to feed himself or herself. Choose foods where finger feeding is possible. 
• If the person seems to have difficulty using cutlery, you may need to prompt them and guide their hand to their mouth to remind them of the process involved.
• To maintain independent feeding for as much as possible, consider purchasing special utensils. An occupational therapist could help in assessing what may be suitable adaptations to be made for the person. 

4. Chewing and swallowing difficulties 

Some people with dementia develop dysphagia. This may occur due to not being able to swallow properly, or not being able to chew food properly for swallowing. 

There are many different reasons for dysphagia in people with dementia — recommendations will be made according to the root cause of the dysphagia. 

Recommendations:

• See a speech therapist for an assessment of chewing and swallowing skills. They can provide recommendations for the person with dementia on how they can maximise their meal intake. 
• Some suggestions may include helping to pace the person's feeding, positioning them safely, feeding only when the person is alert and active, and performing oral hygiene measures like cleaning the insides of the mouth after eating.  

5. Eating too quickly or too slowly

Typically at a later stage, some people with dementia may forget how to pace themselves when they eat. They do not feel the food in their mouth properly, and may take bites too quickly. They may also hold food in their mouths and not swallow. 

Recommendations:

• The caregiver can provide cues for the person with dementia during eating to pace himself or herself. Some cues include verbal instructions to chew and swallow, or describing the smell and sight of food to stimulate the person to know it’s time for the next bite.

How can you encourage a person with dementia to eat well?

Eating well does not refer to eating only during specific meal times, but whether the person with dementia is getting adequate nutrition throughout the day. You can try some of the tips below for the person with dementia to encourage them to maximize nutritional intake through food: 

1. Keep the dining table free of clutter:

Keeping dining spaces clutter-free helps the person with dementia to focus on what they are putting into their mouth and reduces any distractions which could hinder eating.

2. Adopt a meal routine:

Have a fixed number of meals at around the same time every day, so that this becomes predictable to the person with dementia and helps them and yourself develop a schedule around this pattern. A meal routine can also help people with dementia remember to eat.

3. Providing visual contrast between the food and the dining utensils:

Some people with dementia find it difficult to see the food in front of them due to visual difficulties and poor vision. Using contrasting colours, such as a red plate, can help the person with dementia to see the food better. Describing the food to the person with dementia may also help them with tasting the food better. 

4. Accompany them during meal times:

Company during meal times can provide moral support and encourage the person to eat more. Also, having someone to accompany the person could help ensure safe feeding and assist the person with any needs they may have. 

5. Give them time to finish their meal:

Do not rush them to finish their meals. Instead, give them enough time to eat to satiety. It may take longer than usual for them to eat their meals due to perceptual difficulties, and they may start and stop eating several times throughout a meal.

Moreover, rushing them to finish the meal creates undue stress and makes eating a negative experience for the person with dementia. 

6. Understand and accept their changes in food preferences, although they may not be conventional:

Allow the person with dementia to mix foods up into different flavour combinations if they request it. This may be due to changes in taste and perception, and they may require stronger, distinct flavours to be able to adequately taste and eat the food. 

7. Allow them as much independence as possible to eat:

If a person with dementia can still hold utensils, try to have them continue to feed themselves as much as possible. This helps them to continue exercising their functionality and can help to maintain a sense of independence and self. Of course, it is important to adapt to their needs when necessary.

8. Provide alternatives outside meal times:

You can offer healthy snacks, like crackers or fruits, to supplement main meals. If your loved one was not hungry during a meal, having a snack could help boost their nutritional intake and keep them satiated.  

9. Split up meal times:

Some people with dementia might forget that they have already eaten and request more food almost immediately. If your loved one tends to ask for more food, you can consider splitting up meals into several portions, so the person gets several smaller plates of food instead of one huge meal. Additionally, they will be less likely to overeat. 

10. Don't worry about mealtime messes:

Refrain from commenting on the mess during meals as it can be discouraging to the person with dementia. It can also make it tougher for you to help your loved one eat their fill. Instead, set bowls and plates on a non-skid surface such as a cloth or towel. Use cups and mugs with lids to prevent spilling. Fill glasses half full and use bendable straws.

It may also be helpful to schedule bath times after a meal so that you can clean up your loved one as soon as possible if they dirty their clothes.

Tips to make meals more enjoyable and safe

Mealtimes are an opportunity to gather, to taste, and to enjoy. Especially during the middle stages of dementia, changes in perception, taste, and smell can make mealtimes more difficult. How can we help persons with dementia to have a safe and enjoyable meal with their loved ones? 

1. Check the temperature of food:

Some people with dementia may find it challenging to perceive hot or cold temperatures, which leaves them at risk of consuming food that may be too hot. Remember to check the temperature of the food, so that it will not burn or scald your loved one. You can serve food in smaller portions as well, so that food can be kept warm and will not go cold as easily. 

2. Reduce environmental distractions:

Serve meals in a quiet environment, without any background noise from the television or radio. This helps the person with dementia to focus on the food while eating and reduce choking risks. 

3. Offer only one item at a time:

The person may be unable to decide what food they want to eat, or stuff too much food at a go. You can opt to serve dishes one by one, such as serving rice first, then vegetables. 

4. Feed the person, if needed:

At some point, the person with dementia may not be able to feed themselves safely anymore. This may be due to increased choking risks, or being unable to lift the utensil or food to their mouths by themselves. In this situation, you can feed the person with dementia to pace feeding for them and also help to keep them safe while eating. 

5. Frequently check in on current food consistencies and whether the person with dementia can handle them: 

With dementia, a person’s condition will deteriorate with time. This means that a person with dementia will experience changes in their bodily functions and ability.

It is important to assess at different stages of the condition whether the current food textures are suitable and safe for them. A speech therapist can help to assess appropriate food consistencies for the person with dementia. 

6. Increase appetite by increasing exercise:

Some people with dementia may not get hungry enough to eat their food during meal times. You can try doing exercise with the person, such as going out for a walk, or doing safe indoor exercises at home. This may provide an appetite boost. 

7. Provide descriptions of the food to aid declining perceptual abilities:

Food is enjoyable when there is taste, texture, smell, and memory. With ailing cognitive functions, some people with dementia are no longer in touch with what something may taste or feel like.

Helping to describe the food in front of the person, or linking it with a memorable event, may bring back enjoyable experiences with food and enhance the mealtime experience for the individual. 

ALSO READ: A caregiver's guide to hygiene for the terminally ill

This article was first published in Homage.