What to do when a person with dementia won't eat?

According to the Alzheimer's Association, up to 40% of people with Alzheimer’s disease experience significant weight loss, often due to a decreased appetite. When a person with dementia won't eat, it's a difficult and emotional challenge that requires patience and creative problem-solving.

Quick Summary

Address a dementia patient's refusal to eat by exploring potential causes like pain, medication side effects, or confusion, and then employ strategies such as adapting mealtimes, serving preferred finger foods, and reducing distractions to encourage better intake. Adapt the environment and the food itself to make eating easier and more appealing, ensuring comfort and dignity for the person with dementia.

Key Points

• Check for underlying issues: Assess for physical problems like ill-fitting dentures or pain, medication side effects, and swallowing difficulties before assuming a simple refusal.

• Create a calm dining environment: Minimize distractions by turning off TVs and radios to help the person focus on eating, reducing anxiety.

• Offer familiar and preferred foods: Appeal to personal history and potentially altered tastes by serving favorite comfort foods in small, frequent portions.

• Adapt food presentation and texture: Use contrasting, plain dishware and offer soft, easy-to-chew finger foods to aid visual perception and physical ability.

• Encourage independence and provide gentle support: Allow the person to feed themselves as much as possible, using hand-over-hand guidance and positive reinforcement when needed.

• Recognize when to seek professional help: Consult a doctor, dietitian, or speech therapist for significant weight loss, swallowing problems, or suspected depression.

Understanding Why a Person with Dementia Won't Eat

Addressing a refusal to eat effectively begins with understanding the root causes, which can be complex and varied in dementia patients. Unlike simple pickiness, this behavior often stems from the progression of the disease itself or other health issues.

Potential Causes for Appetite Loss

• Changes in Taste and Smell: Dementia can alter a person's senses, making food taste different or unappealing. Sweet flavors are often retained longer than savory ones.
• Physical Discomfort or Pain: Issues such as poor dental health, ill-fitting dentures, mouth sores, or general pain can make chewing and swallowing painful.
• Medication Side Effects: Certain medications can decrease appetite, cause nausea, or affect the sense of taste. Reviewing medications with a doctor can help identify these issues.
• Difficulty with Swallowing (Dysphagia): As dementia progresses, the muscles used for swallowing can weaken, increasing the risk of choking and making eating a frightening or uncomfortable experience.
• Confusion and Forgetfulness: The person may forget how to use utensils, not recognize the food in front of them, or forget that they have already eaten.
• Environmental Overstimulation: A noisy or busy dining environment can be distracting and overwhelming, making it difficult for the person to focus on eating.
• Depression or Anxiety: Mood changes are common with dementia and can significantly reduce a person’s appetite.

Practical Strategies for Caregivers

Once you have considered the potential reasons for the eating difficulties, you can implement targeted strategies to help. A patient and empathetic approach is key to improving the situation without causing distress.

Adapt the Mealtime Environment

• Reduce Distractions: Create a calm, quiet, and relaxing dining atmosphere. Turn off the television and radio, and remove distracting clutter from the table.
• Use Visual Cues: Many people with dementia experience changes in visual and spatial perception. Use a plain-colored tablecloth that contrasts with the plate and brightly colored plates to help the person distinguish the food.
• Create a Routine: Serve meals at the same time and in the same place each day to provide a sense of security and predictability.
• Enhance Lighting: Ensure the eating area is well-lit to help the person see their food clearly.

Modify Food and Presentation

• Offer Familiar Favorites: Serve foods that the person has enjoyed throughout their life. This can evoke positive memories and encourage them to eat.
• Focus on Finger Foods: For those who struggle with utensils, provide bite-sized, easy-to-handle finger foods such as chicken strips, cheese cubes, or soft vegetable sticks.
• Enhance Flavor and Smell: Because the sense of smell may be diminished, use herbs, spices, or sweeten foods to make them more appealing. The smell of cooking can also stimulate appetite.
• Try Smaller, More Frequent Meals: Offer small portions or nutritious snacks throughout the day instead of three large meals. This can be less overwhelming and better for a dwindling appetite.
• Consider Softer Textures: For swallowing difficulties, offer soft foods like mashed potatoes, yogurt, or pureed soups. Adding gravy or sauces can also moisten food.
• Temperature Check: Always check the temperature of food and drinks, as a person with dementia may have a reduced ability to sense if something is too hot.

Provide Supportive Assistance

• Encourage Independence: Allow the person to feed themselves for as long as possible. Use adaptive utensils with larger handles or plates with raised edges to make it easier.
• Gentle Prompting: If the person forgets what to do, provide gentle, patient reminders. Using a hand-over-hand technique to guide the utensil can also be effective.
• Eat Together: Sharing a meal with the person can create a social and pleasant atmosphere, and they may be encouraged to eat by watching you.
• Be Patient and Positive: Mealtimes may take much longer than they used to. Avoid rushing or pressuring the person, and keep a calm, positive tone.

A Comparison of Mealtime Adaptations

Strategy	Benefits	Considerations
Finger Foods	Maintains independence, avoids complex utensils, simple to prepare.	Might not be suitable for all types of meals; can become messy.
Smaller Portions	Less intimidating, easier to consume before getting cold.	May require more frequent meal or snack offerings throughout the day.
Sweet Flavors	Often preferred as taste perception changes, can encourage eating.	Must be balanced to avoid excessive sugar intake; use healthier sweet options like fruit.
Contrasting Dishware	Helps distinguish food from plate and table, reducing confusion.	Requires specific dishware purchases; may take time for the person to adjust.
Reduced Distractions	Improves focus on eating, lowers anxiety during meals.	May not be practical in all care settings, especially with other people present.

When to Seek Professional Medical Care

While the above strategies can be highly effective, some situations require professional medical intervention. It is important to know when to escalate concerns.

• Significant Weight Loss: Consult a doctor if the person is experiencing rapid or significant weight loss.
• Swallowing Issues: If you notice signs of dysphagia, such as coughing, gagging, or drooling during meals, a speech therapist can provide a swallow evaluation and specialized strategies.
• Severe Dehydration: Look for signs of dehydration such as dark urine, confusion, or dizziness.
• Suspected Depression: Discuss persistent sadness, loss of interest, or withdrawal with a doctor, as depression may be a treatable cause of appetite loss.
• Feeding Tubes in Advanced Dementia: In the final stages, when eating becomes unsafe or impossible, a difficult conversation may be needed. Guidelines recommend against routine tube feeding for advanced dementia, focusing instead on comfort care. For a more detailed discussion on this topic, consult the JAMA Network's guidance on Eating and Swallowing Problems in People With Advanced Dementia.

Conclusion: A Patience-Based Approach to Mealtimes

Caring for a person with dementia who refuses to eat requires patience, empathy, and adaptability. By first investigating the underlying reasons for their behavior, and then adjusting the environment, food, and your approach, you can significantly improve mealtimes. Small, frequent meals, a calm setting, and a focus on beloved foods can turn a stressful event into a positive interaction. Remember that your support and presence are just as nourishing as the food itself, and do not hesitate to consult a healthcare professional if you are concerned about weight loss or other health issues.

Frequently Asked Questions

What is the most common reason a person with dementia won't eat?

There are many reasons, but common issues include a reduced sense of taste and smell, difficulty swallowing, or confusion that prevents them from recognizing food or remembering to eat. Pain from dental problems or side effects from medication are also frequent causes.

How can I tell if my loved one with dementia is having trouble swallowing?

Signs of swallowing issues (dysphagia) include coughing, gagging, or choking during or after eating. Other indicators are drooling, food falling out of the mouth, or a gurgly sound in their voice. A speech-language pathologist can perform a formal swallowing assessment.

Is it okay to offer sweets if a dementia patient has lost their appetite?

Yes, it can be beneficial. In the later stages of dementia, the preference for sweet tastes often remains, and adding a little sugar or offering sweet, nutritious snacks like milkshakes or pureed fruit can encourage eating. The focus shifts from strict dietary rules to ensuring caloric and fluid intake.

Should I be concerned about weight loss in a person with dementia?

Significant or rapid weight loss should always be a concern and warrants a consultation with a doctor. While some weight loss can be expected in later stages, it's crucial to rule out other medical issues or address nutritional deficiencies.

How do you handle a dementia patient who refuses to open their mouth to eat?

Try a gentle approach, without pressure. You can try a 'hand-over-hand' technique, guiding their hand with the spoon to their mouth. You can also try a small amount of a preferred food on the person's lips to encourage them to open their mouth, or try again later when they are calmer.

What are some good finger food ideas for someone with dementia?

Good options include cut-up chicken nuggets, fish sticks, cheese cubes, fruit slices like melon or orange segments, steamed broccoli or cauliflower florets, and bite-sized sandwiches.

How does using different colored plates help someone with dementia eat?

Changes in visual perception can make it difficult for a person with dementia to distinguish food from the plate or table, especially with patterned dishware. Using a plain plate that contrasts with the food and the table can help them better identify what they are eating.