Eating can be difficult for people with Alzheimer’s disease or other types of dementia. They may have difficulty feeding themselves, resist being fed, don’t recognize food they are given, have trouble chewing and swallowing. They don’t know they are thirsty or forget to drink. They may even try to eat non-food. Many people with Alzheimer’s want to eat only childhood comfort foods. Regular nutritious meals become more and more of a challenge. Unintended weight loss is common.
Many seniors develop problems that make them not want to eat or make it hard to maintain good nutrition, even if they don’t have a specific type of dementia. Click to read our blog “Why Seniors Don’t Want to Eat & What You Can Do About it.” It’s not surprising that many of these same challenges are also present in people with dementia:
- Poor appetite – not motivated to eat; nothing looks good
- Chewing and swallowing problems; choking and food aspiration
- Fatigue—too much effort, lack of eye-hand coordination
- Missing or broken teeth; ill-fitting dentures
- Medication side-effects
- Loneliness or depression
This blog also contains strategies for dealing with eating challenges. Below are some challenges experienced more specifically by people with dementia and strategies for their caregivers.
Remembering which medications to take and when becomes a problem. In the early stages, putting pills in a pill box marked with the days of the week can help your loved one and a caregiver see that the pills for the day have been taken.
At first, my husband who was diagnosed with early-stage Alzheimer’s, could fill the pill boxes himself. I kept a close eye on him and discovered that, before long, he would sometimes miss a pill or put two of the same ones in one day’s box. I started filling the morning and night pill boxes and checking daily to see if he’d taken them. I kept a list of his medications, dosage, and when to take them on my computer. I took the list with us to doctor visits. Neither of us had to recite which medications he was taking or when.
Eventually, he couldn’t remember how to swallow pills. Before resorting to crushing them, it is important to check with the pharmacist to learn which medications are safe to crush. Timed-release medications are one example of pills that should not be taken in crushed form. For some medications there are liquid or chewable options. Check with your doctor to see what alternatives could be prescribed.
Swallowing and Chewing Difficulties
Occasionally We all have problems swallowing or choking. A person with Alzheimer’s could have trouble like this most of the time and not know what they can do to prevent or stop it. They might resist eating or drinking anything for fear of choking. Eating problems happen to all patients as the disease progresses.
Try feeding your loved small portions throughout the day. Serve just one food at a time so there are no choices to be made. Smaller glasses, mugs and plates with rims, or weighted eating utensils might help. My husband could only drink through a straw. It is also important to maintain familiar routines.
Eating involves many steps or “sequencing.” First you get the food or drink to your mouth. You may use a fork, spoon, straw, or your hands. Next, you open your mouth and put the food in. You close your lips to keep the food in your mouth. Then, you chew the food or move the liquid to get ready to swallow. You use your tongue to move chewed food to the back of your mouth for swallowing.
Lessening cognitive abilities make it difficult to remember or perform the steps needed for safe eating. Foods must be changed in size and consistency, as needed. Eventually complete supervision during meals is necessary. The person must be fed and given cues to open their mouth, close it, chew and swallow. If a family member can’t always be present at mealtime, contact Dakota Home Care at (877) 691-0015 for a free evaluation. We can provide help with meal preparation and any eating problems your loved one might have.
If you encounter resistance when foods don’t look the same, try getting a little bit in the mouth so they can taste it and recognize it as something they like. Try blending healthy food with applesauce, oatmeal or ice cream. Protein powders and supplemental drinks like Boost or Ensure can add nutritious calories. Baby foods with protein, fruit and vegetables can be an alternative to using a blender.
Exercise and Hydration
Incorporating some walking or other activity into the day can improve the appetite and desire to drink fluids for someone with dementia. Encourage fluid intake by offering small cups of water or other liquids throughout the day or foods with high water content, such as fruit, soups, and smoothies.
People with Alzheimer’s or dementia do not need a special diet. As with anyone, eating a well-balanced, nutritious diet is important for overall health. For anyone, poor nutrition may increase behavioral symptoms and cause weight loss. Basic nutrition helps boost the health of the person with dementia and your health as a caregiver, too.
During any stage of Alzheimer’s, distractions, too many choices, and changes in perception, taste and smell can make eating more difficult. The following tips can help:
- Serve meals in quiet surroundings, away from the television.
- Keep the table setting simple. Provide only the utensils needed for the meal to avoid confusion.
- Be flexible with food preferences. A person with dementia may suddenly reject foods he or she may have liked in the past or decide they like some they’ve never liked before.
- Allow plenty of time to eat. It can take an hour or more for the person to finish.
- Eat together. Keeping mealtimes social can encourage the person to eat.
Allow the person with dementia to be as independent as possible during meals. Be ready to help, when needed. Adapt serving dishes and utensils to make eating easier. Serve food in a bowl or a plate with edges. A spoon with a large handle may be less difficult to handle than a fork.
- Serve finger foods that are easy to pick up, such as chicken nuggets, fish sticks, sandwiches, orange segments, broccoli, or cauliflower pieces.
- Don’t worry about neatness. Let the person feed himself of herself as much as possible. Set bowls and plates on a non-skid surface such as a cloth or towel. Use cups and mugs with lids to prevent spilling. Fill glasses half full and use bendable straws.
- Be alert for signs of choking. Encourage the person to sit up straight with his or her head slightly forward. At the end of the meal, check the person’s mouth to make sure food has been swallowed. Learn the Heimlich maneuver in case of an emergency.
In the last stage of his dementia, my husband refused to eat more than a bite or two of anything. He lost 30 pounds in just 3 months. Eating could not be about nutrition, only comfort. Hydration was key. One of the advantages of having an early diagnosis was he could tell me that when the end was near, he didn’t want any extreme measures, including a feeding tube, to prolong his life. I saw it as a blessing for both of us to have him pass away peacefully. If you can discuss end-of-life wishes with your loved one, it will give you the peace of mind that you are doing the right thing for both of you, whatever that is.
By Marti Lythgoe, Freelance Writer