3. Common problems
Poor appetite, cognitive impairment (problems with mental abilities), physical disabilities and sensory impairments (hearing and sight loss) can all cause the person with dementia to have problems eating and drinking.
Although eating and drinking difficulties are fairly common in people with dementia, each person's difficulties will be unique to them and their situation. Because of this you should take into account the person's preferences, beliefs, culture and life history. For example, their religious beliefs may mean they do not eat certain foods such as pork or shellfish, or they may be affected by the environment around them. You should tailor solutions to the person's individual needs and preferences.
As dementia progresses, the person is likely to need more support to meet their needs.
There are many reasons why a person may lose interest in, or turn down, food and drink.
- Depression - Loss of appetite can be a sign of depression. Depression is common in people with dementia. There are effective treatments for depression, including medication and other therapies. If you suspect that the person you care for has depression, consult your GP.
- Communication - The person with dementia may have problems communicating that they are hungry or that they don't like the food they have been given. They may communicate their needs through their behaviour. For example, they may refuse to eat or hold food in their mouth. Giving them a choice of food, or using prompts and pictures, may help.
- Pain - The person with dementia may be in pain, which can make eating uncomfortable. They may have problems with their dentures, sore gums or painful teeth. Oral hygiene and regular mouth checks are important.
- Tiredness - This can also be a cause of people with dementia not eating or giving up part way through a meal. It can also lead to other difficulties such as problems with concentration or difficulties with co-ordination. It's important to be aware of this and support the person to eat when they are most alert.
- Medication - Changes to medication or dosage can result in appetite changes. If you think this may be the case, speak to the GP.
- Physical activity - If the person is not very active during the day, they may not feel hungry. Encouraging them to be active will be good for their wellbeing and may increase their appetite. Equally, if the person is very active or restless (walking about or fidgeting) they may use extra calories and need to eat more to replace them.
- Constipation - This is a common problem and can result in the person feeling bloated or nauseous, making them less likely to want to eat. Try to prevent constipation by encouraging activity, offering the person fibre-rich foods and providing plenty of fluids. If constipation becomes a problem for the person, speak to the GP.
Encouraging appetite: tips for carers
There are lots of ways to increase a person's appetite and interest in food and drink. Knowing the person will help, as everyone has their own routines, preferences and needs. You will also have a better idea about their likes and dislikes. It's also important to think about what they can physically manage. Here are some ideas that may help:
- Make food look and smell appealing. Use different tastes, colours and smells. The aroma of cooking - eg freshly baked bread - can stimulate someone's appetite.
- Look for opportunities to encourage the person to eat. For example, if the person with dementia is awake for much of the night then night-time snacks may be a good idea.
- Give the person food they like. Try not to overload the plate with too much food - small and regular portions often work best.
- Try different types of food or drinks, eg milkshakes or smoothies.
- Food tastes may change, so try stronger flavours or sweet foods.
- Don't stop someone eating dessert if they haven't eaten their savoury meal. They may prefer the taste of the dessert.
- If food goes cold it will lose its appeal. Consider serving half portions to keep food warm. Use a plate warmer or a microwave to reheat food.
- If the person is having difficulties chewing or swallowing, try naturally soft food such as scrambled egg or stewed apple in the first instance, before considering pureed food.
- If you do consider pureed food, seek advice from a dietitian or speech and language therapist to make sure it's nutritious and has enough flavour.
- Encourage the person to get involved at mealtimes. They could help prepare the food or lay the table.
- Try to give the person encouragement and gentle reminders to eat, and of what the food is.
- A relaxed, friendly atmosphere with soft music may help.
- Use eating and drinking as an opportunity for activity and social stimulation. It may be an opportunity to talk about food from their childhood, and this can be used to encourage appetite.
- If the person refuses food, try again a bit later. If they continue to refuse food, speak to the GP.
- It is always best to aim for the least stressful solutions. Common sense and a creative approach often help.