How do you get someone with dementia to eat?

Reports indicate that up to 40% of people with dementia experience significant weight loss, often due to mealtime challenges. Understanding how to get someone with dementia to eat is crucial for their health and well-being, requiring patience, empathy, and thoughtful strategies tailored to their needs and changing abilities.

Quick Summary

Encouraging a person with dementia to eat involves creating a calm, distraction-free environment, offering familiar favorites in smaller portions, and using adaptive utensils. Adjusting mealtimes and serving nutritious finger foods can help preserve their independence and appetite, reducing stress for both the individual and their caregiver.

Key Points

• Create a Calm Atmosphere: Minimize distractions like TV and radio to help the person focus on eating and reduce anxiety.

• Offer Familiar Favorites: Serve comfort foods they enjoy, and be open to changes in taste preferences, including a new fondness for sweet foods.

• Serve Smaller Portions Frequently: Large plates can be overwhelming; opt for several smaller, nutrient-dense meals or snacks throughout the day.

• Embrace Finger Foods: For those with declining fine motor skills, small, bite-sized finger foods promote independence and make eating easier.

• Use Contrasting Tableware: Using brightly colored plates that contrast with the food can help a person with visual perception issues better distinguish what they are eating.

• Hydrate Regularly: Offer fluids consistently, as people with dementia may lose their sense of thirst, leading to dehydration.

• Seek Professional Help: Consult a doctor or dietitian if you notice significant weight loss or swallowing difficulties, as there may be underlying medical issues.

Understanding the Underlying Causes of Refusal to Eat

Before implementing new strategies, it's essential to understand why a person with dementia might be refusing food. The reasons are often complex and not simply about being stubborn. Their brain is changing, which affects their senses and abilities.

Common physical and cognitive reasons:

• Forgetfulness: They may simply forget to eat or not recognize that the food in front of them is for eating.
• Chewing or Swallowing Difficulties: Issues like poor-fitting dentures, mouth pain, or a declining ability to coordinate chewing and swallowing can make eating painful or frightening.
• Changes in Sense of Smell and Taste: Dementia can alter a person's senses, causing foods they once loved to taste unappealing or metallic. A diminished sense of smell can also decrease appetite.
• Sensory Overload: A busy, noisy dining environment can be overwhelming, making it difficult to focus on the task of eating.
• Depression or Anxiety: These common co-morbidities can significantly suppress appetite and interest in food.
• Medication Side Effects: Some medications can cause dry mouth, nausea, or a metallic taste, impacting their desire to eat.
• Inability to Communicate: They may be unable to express that they are not hungry, that the food is too hot, or that they are in pain.

Creating a Positive Mealtime Environment

The atmosphere around mealtimes plays a huge role in a person's willingness to eat. A chaotic, rushed environment can increase anxiety and lead to food refusal. Focus on creating a serene, predictable, and supportive setting.

• Minimize Distractions: Turn off the television and radio. A calm, quiet room helps them focus on the meal. If dining with others, keep conversation light and positive.
• Establish a Routine: Serve meals at the same time and in the same place each day. This predictability can be comforting and help cue the person that it is time to eat.
• Eat Together: If possible, eat the same meal with your loved one. They may be more inclined to eat if they see you eating and enjoying the food.
• Use Visual Contrast: Serve food on brightly colored plates that contrast with the color of the tablecloth or food. For example, use a red plate for white rice. This can help them differentiate the food from the plate and table, making it easier to see.

Adapting Food and Presentation

As a person's dementia progresses, their needs and preferences will change. The food itself and how it's presented can be powerful tools to encourage eating.

Strategies for food adaptation:

• Offer Smaller, More Frequent Meals: Large, overwhelming portions can be intimidating. Try offering five to six small, nutrient-dense meals or snacks throughout the day instead of three large ones.
• Focus on Favorite Foods: Comfort foods and familiar tastes can stimulate a positive memory and encourage eating. A person's tastes can also change, sometimes preferring sweeter flavors. It's okay to serve dessert first sometimes.
• Adjust Textures: For those with chewing or swallowing issues, soft, easy-to-chew foods are best. Options like yogurt, applesauce, scrambled eggs, pureed soups, and smoothies are great for maintaining nutritional intake.
• Embrace Finger Foods: For individuals who have difficulty with utensils, finger foods are an excellent solution. This allows them to maintain independence. Examples include chicken nuggets, fish sticks, sliced fruits, cheese cubes, or sandwiches cut into small pieces.
• Ensure Hydration: Dehydration is a serious risk. Many people with dementia lose their sense of thirst. Offer sips of water or juice regularly throughout the day. Ice cream, popsicles, and soups can also contribute to fluid intake.

Comparison Table: Finger Foods vs. Utensil-Required Meals

Feature	Finger Foods	Utensil-Required Meals
Independence	Maximizes independence and control	Requires more fine motor skills and assistance
Cognitive Load	Lowers cognitive demand (simpler)	Higher cognitive demand (multi-step)
Messiness	Can be less messy, but also allows for more controlled mess	Can be messy, but contained by plate and utensils
Portion Size	Easily controlled with small, bite-sized pieces	Often larger, more overwhelming portions
Types of Food	Versatile, includes meat, vegetables, fruits	Traditional meals requiring cutting, scooping, etc.
Examples	Sandwiches, chicken strips, fruit slices	Soup, pasta, meat with sauces

Using Effective Communication and Cues

Communication with a person with dementia often extends beyond words. Body language and gentle prompting can be highly effective.

• Gentle Verbal Cues: Avoid demanding or rushing. Instead, use simple, positive phrases like, “This soup is delicious,” or “Let's have a bite.”
• Non-Verbal Cues: Mimic eating yourself. If they are struggling, gently guide their hand to their mouth. Maintain eye contact and smile to provide reassurance.
• Respect Refusal (but Don't Give Up): If they adamantly refuse, don't force it. Try again later with a different food or snack. Their mood and appetite can fluctuate throughout the day.

Pacing and Professional Support

Caring for someone with dementia requires patience. Rushing mealtimes can lead to frustration for both of you. Allow ample time for the person to eat without pressure.

If you have concerns about weight loss, choking, or a sudden change in eating habits, it is important to consult a healthcare professional. They can rule out other medical issues, such as dental pain or illness, and may refer you to a dietitian or speech-language pathologist for swallowing assessments.

Conclusion

Navigating mealtime with a person with dementia is an evolving process that demands patience, flexibility, and compassion. By understanding the root causes of their eating challenges and implementing adaptive strategies, caregivers can create a supportive environment that encourages better nutrition and reduces stress. Focusing on the person's preferences, creating a positive atmosphere, and seeking professional help when needed are key steps toward ensuring their well-being. For more in-depth information on managing the complexities of dementia, consider exploring resources from reputable organizations like the Alzheimer's Association.

Frequently Asked Questions

What is the most common reason people with dementia stop eating?

There are many reasons, but common causes include forgetting to eat, losing their sense of smell and taste, depression, anxiety, side effects from medication, and difficulty with chewing or swallowing.

Why does a person with dementia sometimes only want sweet foods?

As dementia progresses, taste preferences can change. The sense of sweetness is often one of the last to diminish, while the ability to detect other flavors, like saltiness, may fade. This can lead to a craving for sweet items.

How can I make mealtimes less stressful for someone with dementia?

Focus on creating a calm and predictable environment. Minimize noise and distractions, establish a routine, and sit with them while they eat. Don't rush or pressure them; patience is key.

What kind of finger foods are best for a person with dementia?

Good options include soft fruits like melon or bananas, cheese cubes, sandwiches cut into small squares, cooked chicken strips, fish sticks, and muffins. The key is to make it easy to hold and chew.

Should I be worried if my loved one eats very little during a meal?

Not necessarily, as appetites fluctuate. However, if you notice significant weight loss or they consistently refuse food, you should consult a doctor to rule out other health issues and ensure they are receiving adequate nutrition.

Is it okay to serve dessert first for someone with dementia?

Yes, if they are refusing to eat other foods but will happily eat a dessert, it is better for them to eat something. You can also try offering a nutritious dessert like yogurt, pudding, or a fruit smoothie.

How do contrasting colors on plates help a person with dementia?

Visual perception can be impaired by dementia. Using a plate color that highly contrasts with the food and the table surface helps the person see the food more clearly, reducing confusion and increasing focus on eating.