Eating and common behaviour challenges

Eating behaviours

A person with dementia may refuse to eat food or may spit it out. This may be because they dislike the food, are trying to communicate something such as the food being too hot, or they are not sure what to do with the food. The person with dementia may become angry or agitated, or behave during mealtimes in a way that challenges. This can be for a variety of reasons, for example:

• frustration at any difficulties they are having
• feeling rushed
• the environment they are in
• the people that they are with
• not liking the food
• changed perceptions about mealtimes or the environment - eg not eating lunch because they assume they have to pay for it.

They may not want to accept assistance with eating. It can be a challenge to identify what the problem is, particularly if the person is struggling to find the words to explain it. It is important to remember that these reactions are not a deliberate attempt to be 'difficult', or a personal attack.

Try not to rush the person with dementia, and help them maintain as much independence as possible. Look for non-verbal clues such as body language and eye contact as a means of communication. If a person is agitated or distressed, do not put pressure on them to eat or drink. Wait until the person is calm and less anxious before offering food and drink. Knowing about someone's life history, including past routines, may help with understanding any behaviour around eating or drinking that seems unusual.

Changes in eating habits and food preference

It is important to respect the person's preferences and beliefs when it comes to eating and drinking. For example, they may be a vegetarian or vegan, or have religious or cultural considerations regarding the food and drink they eat.

Sometimes people with dementia make food choices that do not match their usual beliefs or preferences. For example, a person who has been a lifelong vegetarian may want to eat meat. This could be for different reasons - for example:

• the person's preference has changed
• the person is remembering that they used to eat meat (before they became vegetarian)
• the person has forgotten they don't eat meat
• the person may see you eating meat and want the same, without knowing what it is.

For similar reasons, people who have other preferences may start to want something different - eg a person who does not eat pork for religious reasons may start to want pork.

It may be difficult to know what to do in these situations. Try to use what you know about the person and, if they are showing a different preference, consider what might be the reason for this. Be aware of any impact on the person's digestion - eg if they are finding something they don't usually eat difficult to digest - and always try to do what is in the person's best interests.

Catering for changing eating habits: tips for carers

• If someone has a preference for sweet foods, fruit or naturally sweet vegetables (such as carrots or sweet potato) may be a healthier option.
• Add small amounts of honey or sugar to savoury food.
• Sweet sauces or chutneys (eg apple sauce or sweet chilli sauce) can be served with savoury dinners.
• Herbs and spices could be used to enhance flavours.
• Adding a small amount of syrup, jam or honey to puddings will increase sweetness.
• Try food the person has never eaten before but remember the person's personal preferences and practices.
• If the person asks for meat but isn't a meat eater, you could try meat substitutes.
• If the person is eating unusual food combinations it is best to accept it. It is unlikely to cause them harm.

As dementia progresses, a person may put things that aren't food into their mouths, eg napkins or soap. There could be a number of reasons for this, including:

• The person no longer recognises the item for what it is or understands 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. Make sure food is available, easy for the person to see (both within eyesight and in clear contrast with the plate or immediate environment) and easy to access throughout the day so they can eat when they want to.

Overeating

Some people with dementia may eat too much or too often. They may have forgotten that they have recently eaten, or be concerned about where the next meal is coming from. If a person is overeating, they may also eat foods that aren't appropriate or things that aren't food. They might be frequently asking or searching for food. This can be a stressful situation for everyone involved.

People with behavioural variant frontotemporal dementia are likely to experience excessive eating and other changes to eating behaviour, such as changes in dietary preference and obsession with particular foods.

Tackling overeating: tips for carers

• Ensure that the person has something to do so they do not feel bored or lonely.
• Divide the original portion into two, and offer the second one if the person asks for more.
• Fill most of the plate with salad or vegetables.
• Leave bite-sized fruit or healthy snacks, eg chopped bananas, orange segments or grapes, within reach for the person to snack on when they want to.
• Offer the person a drink such as a milkshake or hot chocolate instead of more food.
• Some carers remove certain foods from the house and try to manage how much a person eats.
• If the person eats things that aren't food, then it may help to remove these and offer snacks as a distraction.
• If the person has developed a strong preference for particular foods, and is not eating enough of other foods, or they are struggling with excess weight gain, ask the GP for a referral to a dietitian.