How motor and sensory difficulties can affect eating
Various motor and sensory difficulties can affect someone's ability to eat. Here we describe some of the challenges.
Problems with co-ordination
People with dementia may struggle to handle cutlery or pick up a glass. They may also have trouble getting food from the plate to their mouth. A person with dementia may not open their mouth as food approaches and may need reminding to do so. They may also have other conditions that affect their co-ordination, for example Parkinson's disease. This could lead them to avoid mealtimes because they are embarrassed by their difficulties or want to avoid struggling.
- If the person is struggling with a knife and fork, chop up food so it can be eaten with a spoon.
- 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.
- Try finger foods - eg sandwiches, slices of fruit, vegetables, sausages, cheese and quiche. These are often easier to eat when co-ordination becomes difficult.
- Let the person eat where they feel most comfortable.
- Speak to an occupational therapist about aids that can help, such as specially adapted cutlery, lipped (high-sided) plates or non-spill cups.
Eating and drinking aids
The Alzheimer's Society shop has a range of products that can help with eating and drinking.
Chewing and swallowing
A person with dementia may have difficulties with chewing food. They may forget to chew or they may hold food in their mouth. Certain foods, such as sweetcorn or dry biscuits, may be more difficult for the person to chew or swallow. These should be avoided if chewing is an issue. Good oral hygiene is important. If the person is feeling pain in their mouth, chewing will be uncomfortable and difficult.
If the person wears dentures, they should be comfortable and fitted properly. People with dementia can get tired easily. Eating soft, moist food that needs minimal chewing can help.
As dementia progresses, swallowing difficulties (called dysphagia) become more common, although they can vary from person to person. If a person is having difficulty with swallowing, a referral to a speech and language therapist can help. Difficulties can include holding food in the mouth, continuous chewing, and leaving foods that are harder to chew (eg hard vegetables) on the plate. Swallowing difficulties can also lead to weight loss, malnutrition and dehydration.
If the person is drowsy or lying down, they may struggle to swallow safely. Before offering food and drink, make sure they are alert, comfortable and sitting upright (or, if in bed, well positioned). A physiotherapist can advise on positioning techniques and an occupational therapist can advise on aids for eating and drinking. Ask the GP for a referral.
Some people with dementia will lose the ability to judge the temperature of food. Make sure food is not too hot, as it could burn the person's mouth and cause eating to become uncomfortable.
The sensation of thirst changes as people get older, which can sometimes mean the person isn't aware they're thirsty. A person with dementia may also have similar problems. They may be less able to provide drinks for themselves. The person should be encouraged to drink throughout the day. The recommended amount is 1.5 - 2 litres a day.
Just placing a drink in front of someone doesn't mean they will drink it. Also, an empty cup doesn't always mean that the person has drunk its contents. It may have been spilled, drunk by someone else, or poured away.
Ensuring the person drinks enough: tips for carers
- Have a drink on hand whenever the person is eating something.
- Use a clear glass so the person can see what's inside, or a brightly coloured cup to draw attention.
- If possible, offer the person the cup or put it in their line of sight.
- Describe what the drink is and where it is, so that if the person has a problem with their sight they are still able to find the drink.
- Offer different types of drink (both hot and cold) throughout the day such as soup, water, fruit juice and tea. All fluids count.
- Make sure the cup or glass is suitable - not too heavy or a difficult shape.
- Foods that are high in fluid can help, eg gravy, jelly and ice cream.
Problems with mental abilities
Recognising food and drink
People with dementia may struggle to recognise food and drink, which can result in it going uneaten. This can be due to damage that dementia causes to the brain, unfamiliar food, or how food is presented. If the person with dementia has problems with their sight, they may not be able to see the food. It may help to explain what the food is and to use pictures. Make sure the person is wearing the correct glasses. It's important not to assume that the person doesn't want to eat.
People with dementia may not be able to concentrate well, which means they may have difficulties focusing on a meal all the way through. This may be because they are tired. Don't assume someone has finished because they have stopped eating. Finger foods and smaller portions can help to make the task easier. If you are helping someone to eat and it goes on for too long, it can turn into a negative experience - eg the food can become cold.