The later stages of dementia

8. Eating and weight loss

Eating and drinking becomes more difficult as dementia progresses. A person in the later stages of dementia is likely to experience a range of difficulties with eating including loss of appetite, pain and symptoms related to the dementia.

Many people with dementia lose weight in the later stages. Weight loss can affect the immune system and make it harder for the person to fight infections and other illnesses. It can also increase the risk of falling and make it harder for the person to remain independent.

People in the later stages of dementia may also develop difficulties with swallowing (dysphagia) and chewing. People with swallowing problems are at risk of choking and of food or saliva going down the windpipe, causing an infection. Swallowing difficulties can be common in the later stages as the person’s muscles and reflexes no longer work properly. They can be distressing for the person and those supporting them. If the person is having difficulties it’s important to speak to the GP – they may refer the person to a speech and language therapist or nutritional specialist. For more information see factsheet 511, Eating and drinking.

The person should be supported to eat and drink for as long as they show an interest and can do so safely (even if they just take a mouthful or a sip). There are ways to help make this easier for the person. For example:

  • choosing a plate that is a different colour to the food (so they can see it more clearly)
  • giving the person enough time
  • putting the drink in their hand if they are struggling to see it.
  • changing the consistency of food and drinks (for example serving it in liquid or puree form). Only do this following advice from a professional such as a dietitian or speech and language therapist.

Eating and drinking can still bring the person pleasure, even in the later stages. It’s important to support them to eat and drink things that they enjoy. Many people’s tastes will change as they get older and as dementia progresses (for example, they might start to prefer sweet food).

Think about the person’s oral health as this will have an impact on their ability to eat and communicate (as well as helping with their general health and wellbeing). If the person has poor oral health it may lead to pain, which could mean they don’t want to eat or they behave in ways that are out of character. For more information see factsheet 448, Dental care and oral health.

People in the later stages of dementia may behave in ways that are out of character. These behaviours can be difficult to understand and there are often different reasons for them. They may be a sign that a person’s need is not being met (for example, they are in pain), or that they are confused or distressed. Often behaviour is a means of communication and can be a result of the person feeling a certain way (for example scared or anxious).