Food for Thought
Difficulties eating and drinking
A poor appetite
A person with dementia may develop a poor appetite or lose interest in food. This can cause weight loss and a dip in their overall well-being. A poor appetite may develop for numerous reasons, for example, a change in food preferences, difficulties chewing and swallowing, co-ordination problems affecting eating and drinking or depression.
There are many ways to stimulate a person's appetite and interest in food. It is important to find out the types of food a person likes and what they can physically manage, but the following tips may also
- Make food and meals look good enough to want to eat. Colourful food such as a bowl of chopped fruit is attractive and eye-catching.
- Try not to overload the plate with too much food - offer small portions at frequent intervals throughout the day and have gaps between courses.
- Be flexible and make the most of 'good eating' times. Some people eat better at certain times of the day, whether this is at breakfast or later in the day at teatime.
- It is easy to lose interest in food once it has gone cold. If someone has difficulty with co-ordination or swallowing, their food is more likely to go cold. Serve half portions and keep the remainder warm until the first portion has been eaten.
- Use a microwave to reheat food during the meal.
Also consider the following points.
- Encourage the person to get involved at mealtimes. Helping to prepare food or laying the table can remind a person that it is time to eat as well as help to maintain their skills and independence.
- Help to build a healthy appetite through daily activities such as walking or spending time in the garden.
- Offer positive encouragement and gentle reminders to eat and describe the food offered to build the person's interest.
- Consult the GP if you suspect the person may be depressed. This can be quite common but there are effective treatments available. When the depression lifts, the person's appetite should return.
Changes in food preferences
A person may experience a change in food preferences as dementia progresses. They may start to enjoy flavours and foods that they were not previously keen on, or they may take a dislike to food that they have always liked. This may be as a result of damage to specific areas in the brain or a desire for stronger flavours as taste perception alters with age.
Such changes can impact on the amount and variety of foods eaten. Some people may enjoy unusual combinations of food or ways of eating, often wanting to mix sweet and savoury flavours and foods. Many people favour sweet tastes and these can be used to enhance the flavour of food. The following are suggestions for people whose food preferences and tastes are changing.
- Add a small amount of sugar or honey to savoury foods such as quiche, omelettes and sauces.
- Try roasting parsnips with honey, or add a honey glaze to cooked carrots.
- Be adventurous and cook dishes that the person may not have tried before (eg mildly spiced curries).
- Serve fruit chutneys or sweet sauces (eg apple or cranberry) with main course dishes to add sweetness and flavour.
- Add herbs and spices to traditional dishes to challenge the taste buds.
Some people with dementia may start to eat far more food than they normally would. This may be down to increased activity levels and genuine hunger, eating out of boredom or loneliness, or developing a fondness for higher calorie sweet flavoured foods. Gaining a small amount of extra weight should not be seen as a concern but if the weight gain becomes excessive, it can make it more difficult to get around and the person will start to feel uncomfortable. Consider the following options.
- Provide healthier alternatives to cakes, biscuits and confectionery, such as pieces of fresh fruit, dried fruit or vegetables.
- Encourage the person to be involved in activities they enjoy to stimulate their interest and reduce boredom.
- Local day centres or lunch clubs offer social contact that can help to reduce social isolation.
'Making a pizza together is fun. I buy the base and it is easy for mum to add the toppings she wants. However, I do find I need to have twice as much cheese, as for every handful that goes on the pizza a handful is eaten by Mum!
Daughter of person with dementia
Drinking enoughSome people with dementia may struggle to drink enough throughout the day and will be at an increased risk of dehydration. It is important to encourage fluid intake to help maintain hydration and good health. Try the following suggestions.
- Encourage them to use a cup or a small glass rather than a mug or large tumbler.
- Offer gentle prompts and reminders so that the person recognises the drink in front of them.
- Offer the person the cup rather than leaving it on a table.
- Offer small but frequent drinks throughout the day.
- Transfer drinks that are supplied in a carton with a straw to a cup or glass.
Problems with co-ordinationSome people with dementia find eating with cutlery or drinking from a glass difficult because they have problems with co-ordination. This can be frustrating and they may feel embarrassed if they drop food
or if the task becomes messy. This can be sufficient to put a person off eating at mealtimes. The following tips may help.
- Cut food into pieces so that the person can eat it with a spoon -this enables them to continue to eat independently.
- Use non-slip mats to help keep crockery on the table.
- Use drinking cups with two handles to allow a steadier grip. These aids can be purchased from chemists or online, although they may be expensive. An occupational therapist can give you advice on the best aids to buy.
- If cutlery is difficult to use, offer finger foods which can be easily eaten without the need for cutlery (see the section on finger foods).
- Allow a person to eat where they feel comfortable.
Difficulty chewing and swallowing
Poor dental health or ill-fitting dentures can affect a person's ability to chew or eat certain foods. Some people may not be able to communicate that they have toothache and may simply decline food if it hurts to eat.
Regular dental care is vital to ensure that gums and teeth are healthy and that dentures fit well. Adequate and regular cleaning of teeth and dentures is important. Discuss any concerns promptly with the person's dentist.
Difficulties related to swallowing can vary from one person to the next but are often more common as dementia progresses.
Any noticeable difficulty with swallowing must be assessed and managed appropriately. A person who has difficulty swallowing may hold food in their mouth, chew continuously, and cough during or after eating. It is vital that the correct advice is sought regarding swallowing difficulties and food textures. A speech and language therapist can assess and offer advice (see the section on professional support).
If a pureed or texture modified diet is required, careful consideration and planning is needed to ensure the diet is nutritionally adequate and flavoursome. Pureed food is often made by adding a liquid such as water which will dilute its nutritional value. This will also affect the taste resulting in bland flavours. Such diets are often low in fibre and can look unappetising. A dietician can advise on fortification (adding ingredients to food to increase its nutritional content) and ensure such diets meet the person's nutritional needs.