I’ve worked with dementia for 15+ years and one of the most common concerns I hear is “They won’t eat!”
As a person ages, appetite often diminishes. Add in the sensory and cognitive decline from dementia and “poor appetite” becomes more and more common. But it doesn’t have to be.
Today’s post focuses on possible causes and solutions to help improve intake to sustain nutrition, prevent weight loss, and enjoy the social aspects of eating again.
“Why won’t they eat?”
Many factors can contribute to poor appetite:
- Visual deficits / cannot see the food clearly. One client I had wouldn’t drink water, but if I set out a glass with water mixed with a little juice to turn it red, she would drink the entire glass.
- Not hungry – Hunger declines with age and some medications
- Always hungry – The person may have forgotten that they ate.
- Don’t recognize the utensils
- Can’t recall what to do with the utensils
- Poor-fitting dentures or other mouth sores/pain
- Too loud – the environment is too distracting or upsetting
- Decreased sensation, including taste or smell
- Swallowing problems, also known as Dysphagia – if this is a concern, a consult with a Speech Language Pathologist is highly recommended to identify cause and solutions.
- Social concerns – May prefer a more social setting. May be concerned that she doesn’t have money to pay for the meal.
- Medical problems – The person doesn’t feel well; consider possible stomachache, UTI, pain, general discomfort.
Be aware of Swallowing Problems
A Common problem in dementia is dysphagia – difficulty swallowing. It can occur for a variety of reasons, but can result in problems ranging from uncomfortable coughing and throat clearing during meals to aspiration pneumonia that might require hospitalization. The traditional response of “puree foods and thickened liquids” or “chin tuck” is often not the best solution, and can often cause more problems than they help. A skilled Speech Pathologist can diagnose what is causing the swallowing problems and provide treatment to improve swallowing safety and comfort- often without diet modifications. Find a Speech Pathologist with dysphagia expertise in your area to get help.
Strategies that can help with dementia and appetite
Some of these strategies will work. Some won’t. Remember that rarely does a strategy work 100% of the time. Many need to be tried several times in order to see improvement. If they work 75% of the time or so, I’d keep it up. If a strategy happens to cause agitation, then back off and consider trying it again in a few days.
Effectiveness depends on a variety of factors including…
- the environment
- symptoms and progression of the disease
- life history
- Personal preferences
- medical situation
The strategies are provided as general tips only, not medical advice. I strongly recommend you consult with your SLP (find one here) and your doctor about your individual concerns.
Sensory mealtime strategies for dementia
- Be sure the person has their assistive devices, like glasses, hearing aids, dentures, plate guards, any other tools the person finds helpful.
- Red plates – color contrast helps the person see the food.
- Add sweetener to everything (yes, even meat and vegetables). This one causes hesitation among many care partners, but I’ve had clients go from 1 bite and leave the rest to eating their entire plate consistently, with just adding “seasoning” on the entire plate.
- Talk about how good the food looks and smells. Make it sound home-cooked.
- Consider smells – coffee brewing, bread baking in the breadmaker can stimulate appetite.
- Look through recipes, cooking magazines, watch the food network before a meal to prepare the person for eating.
- One of my favorite and most recommended strategy is ice cream, especially sherbet – the cold temperature and strong flavor is great sensory stimulation. Research has primarily been done using lemon ice, but sherbet is often easier to find and more familiar.
Make meals a social event
- Use the same routine for every meal. People with dementia can still learn through procedural memory. This means using routines and consistent sequences (first we do this, then we do that) are so much more important.
- Ask the person to help set the table. This helps them get into the mindset that it’s time to eat. TIP: Accuracy is irrelevant. Don’t correct any mistakes setting the table. It’s okay that someone may be given 2 forks. Model correct set up, give 1 step visual cues if the person is receptive. If the person doesn’t mind, you can always adjust the setting later.
- Invite the person to sit down for a cup of coffee.
- Consider peers. Some people do better alone without distractions. Others do better when their peers have a good appetite.
- Create an easy-to-read, logical “receipt” with the meal, to assure the person it’s been paid for. Or, provide some other logical-to-them reason why there is no fee.
Cognition – Strategies to help make eating easier
- Bowls – if you place the bowl in one hand and a spoon in the other and get the person started, they can often continue the pattern and feed themselves the bowl if uninterrupted. This strategy also puts the food items in the person’s visual field, which is reduced with dementia.
- 1 Spoon is easier that a full dining set.
- Provide just 1-2 food items at a time.
- Consider their usual routine. Familiarity provides reassurance in an uncertain world.
- Did they always take a lunchbox to work at the factory? Find a similar lunchbox and serve the meal from it.
- Do they have a favorite coffee mug? Favorite place to sit?
- Does the person drink but not eat? Smoothies are a great way to get real-food nutrients in an efficient way. You can add vegetables (e.g. spinach), proteins (e.g. chia or hemp seeds, peanut buttter, yogurt), fruit (anti-oxident rich berries) and more. Experiment with recipes to find ones the person enjoys.
- Use on-the go finger food for people who don’t like to sit at a table.
Dining is an important part of culture, routines, and nutrition, yet it’s often more complicated than you’d think. The changes that occur with dementia can make meals a chore instead of enjoyable. Trying different strategies can make a world of difference for quality of life and maintaining nutrition and hydration for a person with dementia.