Eating

If you are caring for someone with dementia you will want to try and ensure that they enjoy their food and that they eat a healthy, balanced diet. But mealtimes can be stressful, particularly as dementia progresses. Here are some suggestions.

A calm, regular routine is reassuring for someone with dementia. They are likely to cope better if meals are relaxed, unhurried occasions. Try to allow plenty of time for eating and make sure there are no competing distractions.

• Poor Appetite
• Overeating
• Maintaining independence
• A healthy diet
• More tips

Poor appetite

If the person has a very poor appetite and does not seem interested in eating this may be due to a number of reasons.

• People often become depressed in the early stages of dementia and lose interest in food. If you suspect depression consult the GP as it can often be treated. Once the depression lifts the person's appetite should return.
• The problems may be due to badly fitting dentures or sore gums which make eating uncomfortable. Check with a dentist.
• The person may not feel hungry because they are not doing enough during the day. Encourage them to be more active and take more exercise.
• In the later stages of dementia people may not understand that they are supposed to eat the food in front of them. You may need to keep reminding them or guide the food to their mouth
• Sometimes chewing and swallowing can become a problem. If this seems to be the case ask your GP to refer you to a speech therapist for help or contact the speech and language therapy department of your district general hospital.
• If the person is living on their own there may come a time when they forget to eat or even hide meals which you or meals on wheels have supplied. This is a sign that they need more help. You need to talk to social services about possible alternative arrangements.

Overeating

Some people with dementia will eat far more food than they require if left to their own devices. This may be due to to changes in the brain accompanying dementia which are not yet fully understood. In many people it is only a temporary phase. Sometimes the person may forget they have eaten and ask for food again or they may continue eating whatever food is available.

You will want to limit the person's food intake if they are consuming excessive amounts so that they do not become very uncomfortable after eating or put on a great deal of weight. People with dementia often prefer carbohydrates and sweet foods if left to choose for themselves. This is particularly the case with people who overeat. Such foods may provide comfort and help the person to feel less depressed. However, it is important for their health to make sure that they do not overeat and that they eat a balanced diet.

You need to be alert if the person is inclined to 'scavenge' for food. As well as eating too much, they could consume unsuitable or dangerous substances.

• Put anything which you do not wish to be consumed out of sight or out of reach.
• Try to distract the person's attention or find them a satisfying activity as a substitute for eating.
• If they are determined to have more food try providing non-fattening snacks such as raw carrots or celery.

Maintaining independence

It is important to encourage the person to feed themselves for as long as possible. Table manners may deteriorate due to forgetfulness or problems in co-ordination, so you will need to be flexible and tolerant.

• Try to concentrate on praising the person for their efforts in eating rather than worrying about any mess.
• Common-sense measures such as attractive plastic tablecloths, napkins to protect clothing and bowls instead of plates can make it easier for you to cope.
• An occupational therapist (OT) can advise on eating aids such as non-slip mats, plates with suction pads or cutlery with handles that are easier to grasp. You can contact an OT through your GP or social services.
• Finger foods such as small sandwiches with nutritious fillings may be helpful for people who have difficulty in managing cutlery or who are restless and will not stay seated at the table.
• Cutting food up into small pieces or liquidising may help in the later stages.
• If you do have to feed the person, try putting a spoon in their hand and guiding it to their mouth to encourage their involvement. Never try to feed someone when they are drowsy or agitated or when they are lying down as they are more likely to choke.

A healthy diet

It is important to encourage the person to eat a balanced diet.

Lack of certain nutrients can lead to illness or increased confusion. If the person refuses to eat certain foods that you feel they need consult the GP. The GP may suggest suitable alternatives or prescribe vitamin and other supplements.

• Some people develop a taste for particular foods during the later stages of dementia. While you will want to give them reason-able amounts of what they enjoy, you need to ensure that they continue to eat a healthy diet.
• Constipation is quite common, especially in the later stages, and can make the person more confused. Make sure they eat plenty of fibre and drink plenty of liquid.
• If you are worried because the person is losing weight contact the doctor. They may be eating too few calories or there may be a medical problem. Some people with dementia need more calories because they are so restless and active. However, it is quite normal for people to lose weight in the later stages of dementia although it is not clear why.

Tips

• Elaborate meals are not essential. It is probably better to devote your energy to ensuring that the person eats and enjoys their food.
• You may find that frequent small meals or nutritious snacks are more tempting for people who are restless or have poor appetites.
• You may need to offer the person salt and pepper or sauces and then remove them if they are likely to use them repeatedly.
• Make sure food and drinks are not too hot as the person may lose the ability to judge.
• Make sure they drink enough liquid each day. Too little liquid can lead to de-hydration which can make them more confused. People vary in their thirst but a good guide is at least eight cups of liquid a day.
• Encourage the person to help with activities such as preparing food, laying the table or drying the dishes for as long as possible. This can help them to feel useful and more involved.

October 1997

Page Text supplied by The Alzheimer's Disease Society of Great Britain