People with dementia face more and more obstacles to eating and drinking as the disease progresses. Obviously a healthy and well balanced diet is important to everyone for their physical and mental health and well-being.
This page aims to look at some of the issues people with dementia face in getting a balanced diet, the consequences of not eating and drinking properly and what can be done to help and support someone with dementia to continue to enjoy their diet.
Obstacles to eating and drinking
- Lack of appetite – may be a general lack of appetite or due to a change in medication.
- Depression – can lead to a lack of appetite and apathy.
- Tiredness – may cause someone to stop eating part way through a meal.
- Pain – sore gums or ill fitting dentures may cause pain when eating.
- Constipation – a common problem for people with dementia may lead to feeling bloated or sickness.
- Poor sight – they may not be able to see the food on their plate properly.
- Poor concentration – leading to them getting distracted part way through a meal.
- Poor co-ordination – they may struggle to use a knife, fork and spoon.
- Poor communication skills – they may struggle to communicate that they are hungry or what food they enjoy.
- They may not recognise that they are hungry.
- Worries about the cost – if they are living in a care home setting, they may worry that they will have to pay for food and whether they can afford it.
- Problems swallowing – known as dysphagia, covered in more detail below.
- May not recognise food – in the advanced stages they may not recognise food and may, for example, try to put a napkin in their mouth thinking it is food, which may be an indication that they are hungry.
Consequences of not eating and drinking enough
- Weight loss.
- Illness – an increased risk of infections.
- Dehydration – leading to an increase in confusion and risk of urinary tract infections.
- Lower quality of life.
What can be done to help people enjoy a healthy diet?
- Make sure food is appealing.
- Make sure the temperature of food and drink is correct – too hot and they may burn their mouth causing sores and cold food is unappealing.
- Make sure the eating area is free from clutter, distractions and noise.
- Remind and encourage them to continue eating.
- Do not rush mealtimes.
- Try offering finger food if they struggle to use a knife and fork.
- If required, cut up food beforehand to avoid embarrassment.
- Try using a spoon if they struggle with a knife and fork.
- Try soup in a cup if they struggle with a bowl and spoon.
- Make sure cups aren’t too heavy, two handed cups are available which are much easier to handle.
- Offer food and drinks in between meals if required.
- Try offering alternative types of food like smoothies or ice cream.
- If they seem uninterested in their main meal try offering a dessert.
- Use Menu boards to help them choose food which they will enjoy, or show them different options on a plate.
Dysphagia & Dementia
A common symptom as dementia progresses is difficulty in swallowing – known as dysphagia. Although dysphagia can be present in different types of dementia, it is much more common in dementia with Lewy bodies than in Alzheimer’s disease.
Dysphagia can increase the risk of aspiration (food going down the wrong way into the lungs), choking, poor nutrition and a reduced quality of life.
Below is a summary of some of the techniques that can be used to help with dysphagia:
- Feed slowly, allowing time to chew.
- Remind to swallow.
- Try offering an empty cup or spoon to prompt a swallow.
- Offer fluids frequently.
- Check for pocketed food or liquid in cheeks.
- Place food on the strong side of the mouth.
- Encourage highly flavoured food and drinks as these provide more stimulation to the brain to prompt a swallow response.
- Offer soft or pureed food / thickened liquids.
- Make sure they’re sitting upright and are as calm and comfortable as possible before you begin.
The problems with eating and drinking we experienced with Mum
Mum struggled with eating and drinking more and more as her disease progressed, some of the things we experienced below:
- Mum had to be constantly prompted to eat and drink. She would often get distracted / bored part way through a meal and wander off.
- She started to struggle using a knife and fork and switched to a spoon and then tended to use her fingers.
- Hand tremor cause Mum to spill food, soup was a particular problem but for some reason she wouldn’t drink soup from a cup.
- Once in a care home setting she worried about how she was going to pay for her meals. We had to constantly reassure her that everything was already paid for from her pension.
- If asked to choose from more than one option, she was unable to so, as she no longer recognised food names. However if she was shown 2 different options she was always able to pick one.
- In the later stages of her illness she was unable to recognise food and she would often wipe her plate with a napkin and attempt to eat it, under the impression it was a slice of bread.
- In the later stages she was also unable to communicate that she was hungry / thirsty. Often she would lift her hand to her mouth and then start chewing, a sign that she was hungry.
- As the disease progressed she started to have problems chewing and swallowing food (see dysphagia section above). I always found that rubbing her cheeks prompted her to chew and rubbing the front of her neck prompted her to swallow.
As dementia progresses it becomes more challenging and time consuming to get them to eat and drink enough and as a result they become more frail, prone to falls and infection. They often need help cutting up food and eventually will need feeding. There are some products available to help people with dementia to eat and drink independently for longer, such as easy grip cutlery, two handled cups and plate surrounds which help them load food onto their fork / spoon. See products & devices for daily living for more details.
For more information the Alzheimer’s Society has produced a very useful fact sheet.