As dementia progresses, eating and drinking can become difficult for some people. This factsheet looks at some of the difficulties that people with dementia may have with eating and drinking, and suggests ways to help.
A person with dementia may no longer recognise the food in front of them. They may struggle to use a knife and fork as co-ordination becomes difficult. The person may not open their mouths as food approaches and may need reminding to do so. Food may be difficult to chew or swallow or they may not want to accept assistance with eating.
If you are supporting a person with dementia at mealtimes it is important to remember that these reactions are not a deliberate attempt to be ‘difficult’, or a personal attack. The difficulties are likely to be related to changes caused by the person’s dementia. When supporting a person at mealtimes it can be a challenge to identify what the problem is, particularly if the person themselves is finding it difficult to find the words to explain.
Tips: Supporting a Person with Dementia to Eat and Drink
- Meals should be relaxed and unhurried. Allow plenty of time and make sure that there are no distractions such as a television or excess noise in the background.
- Do not feel you need to prepare elaborate meals – it is probably better to devote your energy to ensuring that the person eats and enjoys their food. Preferences and styles of eating may change, try to be flexible.
- If a person is agitated or distressed, do not pressurise them to eat or drink. Wait until the person is calm and less anxious before offering food and drink.
- If the person is drowsy or lying down, they may struggle to swallow safely. Ensure that they are alert, comfortable and sitting upright or, if in bed, well-positioned, before offering food and drink. (An occupational therapist can advise on positioning techniques and aids, ask your GP for a referral.)
- Take care when offering ‘just boiled’ hot drinks – some people with dementia may lose the ability to judge temperature.
- If the person appears to have difficulty using cutlery, you may need to prompt the person and guide their hand to their mouth to remind them of the process involved.
- Alternatively, if a person is struggling to use cutlery to eat, offer foods that can be eaten without a knife and fork, ie finger foods. Foods that can be picked up with the fingers are often easier to eat when co-ordination becomes difficult.
- If you have to assist a person to eat and drink, talk about what you are offering them to help remind them of tastes and flavours.
Possible Reasons for Poor Appetite
Difficulties with eating and drinking can have an effect on a person’s health and on some of the symptoms of their dementia. It can result in weight loss and worsen confusion. There are numerous reasons why a person may have difficulty eating and drinking or decline food and drink. These include:
- Depression – Loss of appetite can be a sign of depression. Depression is very common; when someone becomes aware that they are in the early stages of dementia, feelings of despair and hopelessness are understandable. There are effective treatments for depression, including medication and other therapies. If you suspect that this is the problem, consult your GP. When the depression lifts, the person’s appetite should return. (See Factsheet 444, Depression.)
- Physical discomfort – The person may be having problems with badly fitting dentures, sore gums or painful teeth, all of which will make eating uncomfortable. If you think this might be a problem, ask your dentist to check.
- Lack of exercise – If the person is not very active during the day, they may not feel hungry. Try to encourage them to move around during the day and take part in physical activities or exercise. Consult a physiotherapist for advice on suitable exercise, you can get a referral from the GP.
- Damage to the brain – A person may not recognise the food and drink in front of them due to damage to the brain caused by dementia. Remind them of what the food and drinks are. The person may develop altered patterns of eating, for example, eat at times of the day that are unusual for them. Be flexible as to when food is available and encourage a person to eat whenever their appetite is good.
- Difficulties with chewing and swallowing – Chewing and swallowing can become difficult as dementia advances. If the person you are caring for is experiencing difficulties chewing and swallowing food, ask their GP for a referral to a speech and language therapist, who can offer advice and support.
- Changes in food preferences – Some people may develop significant changes in preferences for food. They may start to enjoy tastes that are unusual for them, such as spicy or sweet food. Experiment with seasoning foods and offer a variety of flavours to tempt the appetite.
- Constipation – This is a common problem and can result in a person feeling bloated or nauseas and can lessen their desire to eat. Try to prevent constipation by encouraging activity, offering fibre-rich foods and plenty of fluids (guidelines recommend at least eight cups a day). If constipation becomes a severe problem, consult your district nurse or GP.
- Living alone – If the person with dementia is living on their own, they may experience difficulties preparing food, locating food or remembering to eat what is provided. Meals on wheels may no longer be helpful because they forget to eat the meal delivered unless prompted. These are signs that the person needs more help. It is possible to arrange for home carers to visit the person at mealtimes and either prepare a meal for them, or stay with them while they eat. Contact your local social services department for more information.
As dementia progresses, a person may lose weight unintentionally as a result of many of the difficulties mentioned above. This is may be more noticeable if the person is very active because, for example, if they are walking regularly they will need more calories (energy) to maintain their weight. Some people may find small, frequent meals or nutritious snacks more tempting and easier to eat than three main meals a day, particularly if their appetite is small. If the person you are caring for is losing weight ask their GP for a referral to a dietitian.
Changes in Eating Habits
Some people with dementia may experience periods where they seem to eat constantly and consequently struggle with excess weight gain. This is often a temporary phase but does need appropriate support. It is important to understand why this is happening and not to deny a person food if they are hungry. Recognise that the person may be bored and eating for comfort.
The person may develop preferences for particular food types, for example sweet flavours, which they eat excessively causing excess weight gain. They may no longer recognise that they have just eaten and ask for another meal repeatedly.
- Ensure that the person has something to do so they do not feel bored or lonely.
- Leave pieces of chopped fruit, for example, bananas, orange sements or grapes, within reach of the person to snack on as desired.
- If the person has developed a preference for particular foods, to the extent that this dramatically restricts the variety of food eaten, or they are struggling with excess weight gain, ask the GP for a referral to a dietitian. It is important that the correct advice is provided to help devise a nutritious eating plan suitable for that person’s need.
As dementia progresses, a person may put non-food items into their mouths, eg, napkins or soap. There could be numerous reasons for this.
- They may no longer recognise the item for what it is or understand what it is for. Remove from view the items that the person may confuse for food.
- The person may be hungry. Offer food as an alternative to the item. Ensure that food is available for the person, which is easy to see (both within eyesight and in clear contrast with the plate or immediate environment) and access throughout the day so the person can eat when they want to.