Food for thought: Top tips for carers

Some of the biggest challenges of caring for a person with dementia involve eating and drinking. In this leaflet, carers share their experiences and offer tips and suggestions to help overcome some of these difficulties.

A poor appetite 

Many people with dementia have a poor appetite or lose interest in food. A poor appetite can result in weight loss, a lack of energy, a reduced ability to fight infections and impaired concentration. However, there are ways to stimulate a person's appetite and interest in food.

Presentation is important; bright and colourful foods are more appealing. Try not to overload the plate with too much food - offer small portions frequently. Only give the person one course at a time.

People often lose interest in their food once it has gone cold. Since people with dementia often take longer to eat, especially if they have difficulty with co-ordination or swallowing, their food is more likely to go cold.

Insulated plates can keep food warmer for longer. Alternatively, serve half portions and keep the remainder warm until the first portion has been eaten. A microwave oven can also be used to reheat food during the meal.

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.

Daily activity, such as walking or spending time in the garden, can also promote a healthy appetite.

Offer positive encouragement and gentle reminders to eat.

Some foods are difficult to eat and should be avoided. If a person has difficulties with co-ordination or using cutlery, they might find it very frustrating trying to eat food like peas or spaghetti. Adding too much gravy to food can make it more difficult to eat.

A matter of taste

People with dementia often experience a change in taste - they may suddenly begin to reject food that they have always loved and start to enjoy dishes that they never liked before.

Knowing what and when a person likes to eat and drink makes it easier to ensure that they eat well. Some people eat better at certain times of the day; they may be less tired in the morning and able to eat a good breakfast, or they may prefer to have their main meal at midday. Be flexible and make the most of 'good eating' times.

Expect the unexpected! People may enjoy unusual combinations of food or ways of eating. They may like savoury food to be mixed with sweet food, or prefer to eat dessert before the main course. Add a small amount of sugar to savoury foods such as quiche, omelettes and sauces to encourage people with a sweet tooth to eat them. People may enjoy sweeter tasting vegetables such as carrots, parsnips
or swede.

Be adventurous and cook dishes that the person may not have tried before, such as lasagne or curries. Add herbs and spices to traditional dishes to challenge the taste buds!

A person might try a dish if you give it a different name.

Catering for change

Preparing food in advance and freezing it in portions can cut down on preparation and cooking time.

Frozen or convenience food can be very useful if you are short of time and can still be part of a healthy balanced diet.

Try to keep food visible or it may be forgotten and left uneaten. A person with dementia may not remember to look in the fridge or cupboards and may need to be prompted to eat at mealtimes.

A person with dementia may need support with planning meals, making choices at mealtimes and remembering when to eat.

Keep it simple - nutritious and tempting meals do not have to be complicated. Basic cookery books that are quick and easy to use often contain the best ideas!

Drinks and liquids

To stay healthy, we need to drink about eight cups of fluid every day. Many carers express concern about people with dementia not drinking enough. If fluid intake is a problem, offer small but frequent drinks throughout the day. Use a cup or a small glass rather than a mug or large tumbler. Give the cup or glass to the person to prompt them to drink, rather than just leaving it on the table.

People may find it easier to eat soup and cereal from a shallow bowl.

It is often best to transfer drinks that are supplied in a carton to a cup, rather than expecting the person with dementia to drink them through a straw.

Maintaining independence 

If a person has poor co-ordination, they are likely to spill drinks or drop food while eating. However, this is not a reason to discourage independence or prevent people feeding themselves. There are ways to make things easier and minimise mess.

People can become agitated when trying to eat using cutlery that is difficult to manage. Adapted lightweight cutlery can solve this problem. Non-slip placemats are also available. It may help if you cut food into pieces so that the person can eat it with a spoon - this enables them to continue to eat independently.

You can buy drinking cups that are specially designed to help people drink more easily. A cup or beaker with two handles allows a steadier grip. Some cups are designed to tip without spilling, and some have spouts. These aids can be purchased from chemists, although they may be expensive. An occupational therapist can give you advice on the best aids to buy.

The use of finger foods can also allow a person to eat easily while maintaining their independence.

Laying the table

A person with dementia may be confused by vivid prints or patterns on tableware and become distracted from their food. Plain crockery, placemats and tablecloths are preferable.

People who are partially sighted may find it difficult to see white food on a white plate. Coloured plates or bowls that contrast with the food will make the food easier to see and more appealing. Dark-coloured plates highlight light-coloured food well.

The dining area and environment also have an effect on how well people eat. Serve food in a relaxed and unhurried manner. Turn the television off, so that it does not distract people. However, a radio or background music may be comforting, especially for people eating alone.

Staying safe

Many carers are concerned about the potential dangers of people with dementia using kitchen appliances or eating food that is out of date.

Replacing gas with electric cookers may help. Microwave ovens also avoid the risk of ovens and hobs being left on. However, it is important to ensure that the person is happy and able to use the new appliance.

Food storage can be a problem for people with dementia who are living alone. They may eat food that is past its sell-by date or leave food to spoil in the fridge. Check food cupboards and fridges regularly and throw away any unsafe food.

Some people with dementia may eat non-food items, such as pot-pourri, or inappropriate foods, such as pet food. If necessary, keep such items out of sight.

Eating out

Day centres or luncheon clubs can provide welcome social events and a good environment for mealtimes.

People with dementia often eat better in company. Observing and copying others can act as a cue or prompt for the person with dementia to eat.

Eating out in restaurants or pubs can be a welcome change to eating at home.
When eating out, explain to staff and other diners what difficulties the person with dementia has. This can help people to tolerate and understand unusual behaviour. Eating out with understanding friends can also be supportive.

A little too much?

Some people with dementia may start to eat a lot more than they used to and develop a constant appetite for food. This can become a problem if they gain weight, particularly if they are less mobile or inactive.

Try to turn the person's attention to other activities that may distract them from eating and food. Some people eat out of boredom, particularly if they live alone. Local day centres or luncheon clubs offer social contact that can help.

Eating behaviour

There are many reasons for unusual or 'difficult' behaviour associated with eating and mealtimes. These can range from a dislike of the food to a sore mouth or difficulties using cutlery. If the reason for unusual behaviour is identified, ways of managing it can usually be found.

Give people plenty of time to eat and provide alternative places to eat if they become agitated at the dinner table. Some people prefer to eat in company while others like to eat alone. People may reject food to start with or say they are not hungry. If this is the case, do not force the issue; offer it again later or provide a nutritious snack instead.

Healthy teeth and gums

Poor dental health or ill-fitting dentures can affect a person's ability to chew or eat certain foods. Regular dental care is vital to ensure that gums and teeth are healthy and that dentures fit well. Some people may not be able to communicate that they have toothache and may simply refuse food instead. Co-operation with dental care may also become more difficult.

Adequate and regular cleaning of teeth and dentures is important, along with a varied and well-balanced diet.
see Dental care and dementia information sheet

How to find out more

If you would like more information on Food for Thought publications and events, please contact:

Food for Thought Project
Alzheimer's Society
Ground Floor Suite
Holgate Villa
22 Holgate Road
York YO24 4AB

Telephone: 019 0463 3640
Fax: 019 0465 9561
Email: foodft@alzheimers.org.uk

Food for thought leaflet