Alzheimer's Society

It is important to do what you can to make sure the person you are caring for enjoys their food and eats a healthy, balanced diet. As dementia progresses, eating can become difficult for some people. However, by making a few changes you can help keep mealtimes as enjoyable and stress-free as possible.

Problems with eating are common in dementia. At times, the person may refuse to open their mouth, or may need to be reminded to do so. Sometimes, they may accept food but will not swallow it, or they may accept it but then spit it out. At other times, they may resist the person trying to feed them, and push them away, or they may throw their food about or turn their head away. This can be exasperating or distressing for the person trying to feed them, but it is important not to take it personally. These reactions do not mean that the person is deliberately being difficult − the behaviour is more likely due to discomfort in the mouth, or incorrect signals being received by the brain.

Helping someone with dementia to eat: three key principles

• Keep calm − A calm, regular routine is reassuring for a person with dementia. Meals should be relaxed, unhurried occasions, so allow plenty of time and make sure that there are no distractions such as television or radio. Never try to feed a person when they are agitated, or if they are drowsy or lying down, as there is a danger of choking.
• Be flexible − As the dementia progresses, changes in eating habits are likely to take place. Accept that mealtimes might become very different to how they used to be, or to how you would like them to be.
• Help the person to feel involved − If you have to feed the person, try putting the food into their hand and guiding it to their mouth, so that you involve them in the process of eating.

A healthy diet

It is important to encourage the person to eat a balanced diet. If they are lacking certain essential nutrients, they may become ill or more confused. The government guidelines for a healthy diet are:

• Enjoy your food.
• Eat a variety of foods.
• Eat the right amount to be a healthy weight.
• Eat plenty of foods rich in starch and fibre.
• Eat plenty of fruit and vegetables (at least five portions a day).
• Don't eat too many foods that contain a lot of fat.
• Don't have sugary foods and drinks too often.
• Don't eat too many foods high in salt, and cut down on the amount of salt added in cooking and at the table.

Dementia affects people in different ways but some problems, such as appetite loss and overeating, are particularly common. There are many ways to help overcome these problems and ensure that the person eats a healthy, balanced diet. We now look at each of these in turn.

Appetite loss

There are several reasons why a person with dementia may have a poor appetite or seem uninterested in eating. 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 or sore gums, both 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.
• Damage to the brain − In the later stages of dementia, the person may no longer be able to understand that the food in front of them is there to be eaten, even if they are hungry. This is because the nerve pathways in the brain are damaged, so the message is not getting through. You may need to keep reminding them to eat, or guide the food to their mouth.
• Difficulties with chewing and swallowing − Chewing and swallowing can become difficult as dementia advances. If this seems to be the case, ask your GP to put you in touch with a speech and language therapist, who may be able to offer some advice.
• Constipation − This is a common problem, especially in the later stages of dementia, and can make the person with dementia feel bloated and confused. Try to prevent constipation by making sure the person eats a fibre-rich diet and drinks plenty of fluids. If constipation becomes a severe problem, consult your district nurse or GP.

Other things to look out for include:

• Weight loss − In the later stages of dementia, weight loss is a common symptom, but we do not yet know why. If the person you are caring for is losing weight but is not at this advanced stage, ask their GP for a referral to a dietician. If they are very restless and physically agitated they may be using more energy than the calories they are consuming, or there may be a medical problem.
• Appetite loss in those living alone − If the person is living on their own, you may find that they are not eating any food that you have provided, or they may start hiding food. Meals on wheels may no longer be helpful because they forget to eat the meal delivered. 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.

Overeating

Sometimes a person with dementia may eat more food than they need. This can be due to changes in the brain caused by the condition, and is often only a temporary phase. Alternatively, it may be caused by memory loss. The person may completely forget that they have eaten − even if they have just done so. 
If a person is eating excessive amounts, try to limit their food intake to prevent them from feeling uncomfortable after eating, or becoming overweight.

Sometimes a person with dementia will feel compelled to search out and consume any type of food. In addition to the problem of overeating, this type of behaviour can cause the person to eat or drink unsuitable, or even dangerous, substances.

If you are trying to help prevent someone from overeating, try the following suggestions:

• Put anything that you don't want the person to consume out of sight or out of reach.
• Try to distract their attention, or find a satisfying activity, as a substitute for eating.
• If the person constantly seeks out food, try to provide healthy snacks such as fresh or dried fruit, or raw vegetables such as carrot sticks.

During the later stages of dementia, some people develop a taste for specific foods. Foods with strong flavours are surprisingly popular at this stage. This is due to the physical damage to the brain, and is not harmful. So long as it's healthy, try to give the person the food they want to eat. If you are worried about the nutrition of the person you are caring for, talk to your GP, who may decide to prescribe vitamins or other dietary supplements.

Tips: helping a person with dementia to eat well

• Don't 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.
• If the person is restless or has a poor appetite, they may find frequent small meals or nutritious snacks more tempting than large meals.
• Dementia affects people's sense of taste. You may need to offer sauces or seasoning that the person did not use before to enhance the flavour of their food.
• However, make sure that the person does not use seasonings such as salt or chilli excessively.
• Make sure that food and drinks are not too hot to serve − people with dementia may lose the ability to judge temperature.
• Encourage the person to drink enough liquid each day. Too little liquid can lead to dehydration, which can make the person more confused. A rough guide is at least eight cups of liquid a day.

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.
 
For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue

Further reading

For more information about dementia, eating and nutrition, see our 'Food for thought' booklets:
• 325, Finger food ideas
• 326, Top tips for carers
• 327, Eating and nutrition

These are available, at a cost of £1 each, by contacting 01753 535 751 or alzheimers@xcalibrefs.co.uk

Factsheet 511

Last updated: July 2008
Last reviewed: July 2008

Reviewed by: Gwen Coleman, Food for Thought Manager, Alzheimer's Society