Practical Guide: What Do You Feed Someone with Dementia Who Won't Eat?

Nearly 50% of individuals with advanced dementia experience challenges with eating. For caregivers asking what do you feed someone with dementia who won't eat, the key is combining patience with proven nutritional strategies to ensure their health and well-being.

Quick Summary

Offer nutrient-dense, soft foods and high-calorie smoothies. Simplify choices, create a calm mealtime routine, use adaptive utensils, and try finger foods to encourage independent eating.

Key Points

• Identify Root Causes: Food refusal often stems from confusion, physical discomfort, or medical issues, not just a lack of will.

• Simplify the Environment: Minimize distractions, use high-contrast dishes, and offer only one or two food items at a time to reduce overwhelm.

• Focus on Nutrient Density: Prioritize high-calorie, high-protein foods like smoothies, purées with added fats, and full-fat dairy to make every bite count.

• Encourage Independence with Finger Foods: Easy-to-handle items like cheese cubes, soft fruits, and chicken strips can promote self-feeding.

• Maintain a Consistent Routine: Serving meals at the same time each day in a familiar setting can reduce anxiety and improve intake.

• Consult Professionals: If weight loss is significant or you notice signs of swallowing problems, seek advice from a doctor, dietitian, or speech therapist.

Caring for someone with dementia presents many challenges, and food refusal can be one of the most distressing for caregivers. It's a complex issue that rarely stems from a simple lack of hunger. Understanding the underlying reasons is the first step toward finding compassionate and effective solutions to ensure your loved one receives the nutrition they need.

Why People with Dementia Refuse to Eat

Before changing what you serve, it's crucial to explore why the person might be refusing food. The reasons can be physical, cognitive, emotional, or environmental.

Cognitive and Psychological Reasons

• Lack of Recognition: The person may no longer recognize the items on their plate as food.
• Overwhelm: Too many choices on the plate can be confusing and overwhelming.
• Distraction: A noisy or busy environment can make it impossible to focus on the task of eating.
• Depression or Apathy: A low mood can significantly reduce appetite.
• Paranoia: In some cases, individuals may develop suspicions about the food being offered.

Physical and Medical Reasons

• Dental Problems: Painful teeth or gums, or poorly fitting dentures, can make chewing difficult and unpleasant.
• Swallowing Difficulties (Dysphagia): Dementia can affect the muscles involved in swallowing, making it frightening or uncomfortable to eat.
• Medication Side Effects: Many medications can cause dry mouth, a metallic taste, or decreased appetite.
• Constipation or GI Discomfort: Underlying digestive issues can make eating feel unappealing.
• Fatigue: The person may simply be too tired to manage the mechanics of eating a full meal.

Actionable Strategies to Encourage Eating

Once you have a better idea of the potential causes, you can implement targeted strategies. Patience and flexibility are essential.

1. Optimize the Mealtime Environment

• Minimize Distractions: Turn off the TV and radio. Have the person eat in a quiet, well-lit area away from high-traffic parts of the house.
• Keep it Simple: Serve only one or two food items at a time to avoid overwhelming them.
• Use High-Contrast Dishes: A brightly colored plate (like red or blue) can help someone with visual perception issues distinguish the food from the plate. Avoid patterned plates or placemats.

2. Focus on Nutrient-Dense, Appealing Foods

When appetite is low, every bite counts. Prioritize foods that are high in calories and nutrients.

Excellent Food Choices:

• Smoothies and Shakes: Blend full-fat yogurt or milk with fruit, protein powder, and even a spoonful of nut butter or avocado for a calorie-packed, easy-to-consume meal.
• Soft, Easy-to-Chew Foods: Think scrambled eggs, mashed potatoes (with butter and cream), full-fat cottage cheese, puréed soups, and oatmeal.
• Flavorful Finger Foods: If utensils are a challenge, offer foods they can eat with their hands. This promotes independence and can be less intimidating.
  • Cubes of mild cheese
  • Soft-cooked chicken or fish sticks
  • Wedges of peeled, soft fruit like melon or banana
  • Steamed broccoli or carrot sticks
• Enhance Flavors: Dementia can dull the senses of taste and smell. Add healthy herbs and spices to make food more appealing. Sweet flavors are often preferred, so slightly sweetening foods with maple syrup or serving healthy desserts can help.

3. Adapt Your Approach

• Establish a Routine: Serve meals and snacks at the same time each day.
• Offer Smaller, More Frequent Meals: Six small meals may be more manageable than three large ones.
• Eat Together: The person may be more inclined to eat if they see you enjoying the same meal.
• Use Adaptive Tools: Weighted utensils or special cups can help those with tremors or coordination issues.

Comparison of Feeding Assistance Techniques

If the person needs more direct help, consider these approaches.

Technique	Description	Pros	Cons
Verbal Cueing	Gently reminding the person to take a bite, chew, and swallow.	Promotes maximum independence.	May not be effective in later stages.
Hand-Over-Hand	Placing your hand over theirs to guide the utensil to their mouth.	Provides physical support, maintains dignity.	Can be misinterpreted as force if not done gently.
Direct Feeding	Placing food in the person's mouth with a utensil.	Ensures nutrition when self-feeding is lost.	Highest risk of aspiration, loss of autonomy.

When to Seek Professional Help

While these strategies can be very effective, it's important to know when to involve a healthcare team. Consult a professional if you notice:

• Significant, unintentional weight loss.
• Signs of dehydration: dark urine, dry mouth, dizziness.
• Frequent coughing or choking during meals, which could indicate dysphagia.

A doctor, registered dietitian, or speech-language pathologist can provide a thorough assessment and personalized recommendations. For more information and support on caregiving, the Alzheimer's Association is an invaluable resource.

Conclusion

Navigating food refusal in a person with dementia requires a blend of creativity, patience, and detective work. By creating a positive mealtime environment, offering nutrient-rich and easy-to-eat foods, and adapting your approach to their changing needs, you can ensure they remain nourished and feel supported. Remember to care for yourself as well, as this journey is a marathon, not a sprint.

Frequently Asked Questions

What if someone with dementia only wants to eat sweets?

A preference for sweets is common as taste buds change. Instead of fighting it, leverage it. Offer nutritious, sweet options like fruit smoothies, yogurt with honey, or oatmeal with brown sugar. You can also 'hide' nutrients by blending vegetables into a sweet fruit smoothie.

How can I increase their calorie intake without serving large meals?

Focus on high-calorie additions. Add butter, olive oil, or cream to mashed potatoes and soups. Use full-fat milk and yogurt instead of low-fat versions. Nut butters and avocados are also excellent sources of healthy fats and calories that can be added to many foods.

Are there specific utensils that can help with eating?

Yes. Adaptive utensils can make a significant difference. Weighted utensils can help stabilize tremors, and curved or angled utensils can make it easier to bring food to the mouth. Plates with raised edges (plate guards) can also help with scooping.

Should I ever force someone with dementia to eat?

No, forcing someone to eat is not recommended. It can increase agitation and create a negative association with mealtimes. It also increases the risk of choking and aspiration. Instead, focus on gentle encouragement and the strategies outlined in this guide.

How important is hydration if they are not eating?

Hydration is critically important. Dehydration can worsen confusion and lead to serious health issues. If they refuse to drink water, offer other liquids like milk, juice, or broth. Foods with high water content, such as melons, soups, and gelatin, also contribute to hydration.

What are the signs of swallowing problems (dysphagia)?

Signs of dysphagia include frequent coughing or throat-clearing during or after eating, a gurgly-sounding voice after swallowing, food pocketing in cheeks, and watery eyes. If you see these signs, consult a speech-language pathologist immediately.

Can medication side effects cause a loss of appetite?

Absolutely. Many medications prescribed to seniors can cause dry mouth, a metallic taste, nausea, or decreased appetite as a side effect. Review all medications with their doctor to see if any could be contributing to the eating problem and if alternatives are available.