Eating well with dementia

What is dementia?

Dementia is a decline in brain function that refers to a group of symptoms that together affect the memory, thoughts, communication, behaviour, and the reasoning ability of a person. There are different types of dementia.

The importance of good nutrition

As dementia progresses, eating and drinking can become difficult for some people. Maintaining a healthy weight and ensuring adequate nutrition and hydration is important for the general health and wellbeing of patients with dementia.

Ways to encourage eating and drinking

The following pages give some suggestions to help with eating and drinking:

Serving food

• Offer soft and moist foods if these are better tolerated.
• Check the temperature of food and drink before serving.
• Make sure food is well presented and looks appealing.
• Adapted plates with lips and cups with spouts may help preserve independence.
• Discuss this with their speech and language therapist or occupational therapist.

Tackling reduced appetite and weight loss

• Experiment with seasonings and offer a variety of flavours.
• Encourage daily activities like walking or spending time in the garden to build their appetite.
• Encourage eating little and often during the day. Try using smaller plates with fewer foods on them.
• Fortify (strengthen) meals by adding extra cream, cheese, oil, butter, or sauces to increase calories.
• Use full fat dairy products.
• Offer high calorie drink: for example, milkshakes or hot chocolate.

Increasing fluid intake

Poor fluid intake can be common in dementia. Aim for your loved one to drink three pints or two litres of fluids per day (about six to eight mugs or tall glasses measuring 250ml each).

• Offer gentle reminders and prompts to drink.
• Ice lollies made from fruit juice can be used to increase fluid intake.
• Use foods with high water content: eg fruits and vegetables.
• Cordial/squash or fruit juice may be preferred to water.

Managing mealtimes

The following suggestions may help to manage mealtime challenges:

Food refusals

• Offer lots of encouragement with gentle and frequent prompts to eat.

• If food is refused, accept this, and offer something again in 30 minutes. Offer one course at a time. Extra portions can always be served.
• Try a wide variety of foods.
• Naming and describing foods and drinks may help with recognition of that food item. Avoid arguments or losing your temper.

Agitation

Agitation in people with dementia means that they may have more energy and refuse to sit at the table. Foods that can be held in the hands and eaten on the move (finger foods) can help to maintain their dietary intake. For example: sandwiches, chips, fish fingers, sausage rolls or pieces of fruits.

Eating non-food items

Attempts to eat non-food items such as napkins, soaps, creams, may happen due to confusion. If it becomes a regular habit check that they are eating enough during the day. Try to keep all non-food items out of reach at mealtimes if possible.

Creating a positive environment

• Ensure a calm and familiar environment for meals.
• Allow plenty of time to eat.
• Make sure your loved one is sat up straight and wearing glasses, dentures, or hearing aids, if they normally use them.

Other possible health problems

Constipation

Constipation might reduce a person’s desire to eat by creating a feeling of fullness and bloating. To tackle this, encourage physical activity, offer fibre rich foods (vegetables and fruits) and provide a good fluid intake.

Poor dental health and mouth care

• Ensure good mouth care by brushing your loved one’s teeth and cleaning dentures (false teeth) twice a day.
• Make appointments for them to visit the dentist or dental nurse regularly.
• Dentures need to be checked regularly for cracks, comfort and fit.
• Check your loved one’s mouth at the end of each meal for any remaining food. This can be a choking risk.

Medication

Some dementia medications can impact on nutritional intake with side effects such as:

• Poor appetite
• Nausea (feeling sick)
• Dry mouth
• Taste changes
• Fatigue (tiredness)

If you are concerned about this, please contact your GP to discuss.

Overeating

Sometimes people with dementia can forget that they have eaten and so they eat too often, leading to unnecessary weight gain. To help avoid this, you can:

• Divide their meals into two smaller portions and offer the second serving only if it is requested.
• Fill most of the plate with vegetables and salad. Serve a small portion of meat (fish, beef, poultry, or pork) and starchy carbohydrates (rice, pasta, bread, or potatoes).
• Offer snacks as an alternative to extra meals, such as yoghurt or fruits. Offer a low- calorie drink such as tea or coffee, instead of more food.

Nutritional care in later stages of dementia

As dementia progresses, quality of life becomes the priority rather than concerns for maintaining nutritional status or weight. Food and drink can sometimes be completely refused. This is part of the natural disease progression and will not necessarily cause discomfort or distress to the person.

To help promote wellbeing during this time, try to:

Maintain good mouth care

Make sure your loved one sits in a comfortable upright position while eating

Treat any pain or symptoms that could be affecting their food or drink intake

Provide emotional or spiritual support.

When to contact their GP

If your loved one is experiencing any of the following, you should contact their GP: consistent food refusals:

• Depression or low mood
• Severe diarrhoea or constipation
• Sudden onset of confusion or reduced appetite
• 5-10 per cent weight loss over three to six months
• Frequent coughing when eating and drinking or frequent chest infections.