May 31, 2016
Challenges to eating with dementia
It absolutely should be at the top of the list because it can have such a profound effect on living with the disease and the lives of all those concerned.
We know that having a nourishing, well-rounded diet gives our brain the best chance of not succumbing to the disease, but there is new research that suggests that omega-3 fatty acids in particular can play a significant role in reducing some of the risk. Also, when dementia is diagnosed, it looks as if eating a diet rich in omega-3 fatty acids could help to slow down the progression of the disease.
The problem is that as dementia progresses, our ability and desire to eat deteriorates. Which is why we need to focus on meeting those practical challenges.
Challenges to eating with dementia
- Memory loss and confusion that mean some people don’t eat
- The ability to judge temperature can disappear, so if food is served too hot it can burn our lips or throat
- Physical skills like keeping our mouths closed while food is inside, to help us chew and swallow, can become difficult
- Not being able or safe enough to cook or prepare food
- Depression, low mood and lack of energy
- Constipation through lack of fluid and fibre, or as a side-effect of drug treatment, leading to discomfort and loss of appetite
- Aggression and resistance to eating.
Calming routines
A calm, regular routine is reassuring for someone with dementia – even eating 10 minutes later, or sitting at a different table, or with friends they don’t usually eat with, can throw them. The requirement to stick to the same routine can be isolating for you, the carer, as your whole day is dictated by something which used to be flexible and sociable. One way around this is for you to feed them in the same way, at the same time, and then for you yourself to eat with friends afterwards.
Making food the focus
- Try to slow down. We juggle so many tasks when caring for someone that it can be tempting to hurry meals, which only increases the likelihood of upset and for very little food to get eaten.
- Minimise distractions. While the person is focusing on swallowing or getting the food from fork to mouth, it helps not to have the radio or the TV on to distract them.
- Take a timeout. If a meal is becoming challenging, it can help to step back for a minute, to find a moment of quiet or even a piece of music that’s therapeutic and can give you the strength to go back with a calm attitude.
- Take off the pressure. If you’re finding that the person you’re looking after is getting frustrated at not being able to eat when the sole focus is on doing so, sitting in front of the TV with a plate of something easy to nibble, such as sandwiches or cut-up soft fruits, could mean they eat while being distracted by the programme. So experiment with both scenarios.
- Wait for a better time. If they’re drowsy and not very responsive, feeding can cause choking – so try to leave a bit of time before you try again. And do seek advice if they’re overly drowsy, as it could be that a change in some of the medication they’re taking could give you a better window of opportunity for helping them to eat.
Derek’s story
‘My dad, Derek, has dementia. He used to have a hearty appetite but a big plate of food is too much for him now. His favourite meal was always a roast chicken dinner so now I make him a flask of delicious chicken soup and he sips on that instead. It’s a joy to watch him tuck in and really enjoy it.’
Managing changes
As the dementia progresses it’s highly likely that appetite and ability to eat will change. These shifts are not always down to the disease itself – sometimes medication can put them off their food, causing weight loss. Or a new drug may interfere with hunger messages in the brain, so they don’t register feeling full and stop eating. They may also forget that they have eaten and say they want more food when they don’t physically need it. Or we may want to comfort them with sweet foods. Weight gain will cause physical challenges and additional health risks, so while occasional treats are fine, try to keep to the basic structure of an overall nourishing diet.
Poor appetite
Our appetite and desire to eat anything is influenced by many factors, from physical issues such as constipation to low mood. Taking a holistic look at the person you care for and their environment may help you to improve the situation and nourish them with food that improves their wellbeing.
- Practical issues Do they have a sore mouth, badly fitted dentures, or is the effort of preparing food (if their dementia isn’t that advanced) or chewing and swallowing (if it’s more severe) preventing them from eating?
- Mood & food Some of us don’t like to eat on our own, which can be a real issue if we live alone. And when our mood is low and angry, eating can be the last thing we feel like doing. Can you, or someone you trust, take the time to sit and take the stalks off grapes, peel a clementine, cajole without pestering someone who has a poor appetite, and note if they don’t manage to eat much?
- Monitor their eating What we do know about a poor appetite is that the less we eat, often the less we fancy eating. Malnutrition can kick in, and problems such as pressure sores, poor wound healing and depression start occurring. If you suspect that your relative or friend in a care home isn’t getting the right types of food,or that they’re not getting help with eating, make yourself a nuisance and either try to persuade someone to sit with them while they’re eating, or ask if you can bring in some food.
- Food to tempt them Take your cues from the person when it comes to tempting their appetite. Are there dishes they loved in the past, favourite family recipes, easy-to-eat alternatives to tried-and-trusted meals? The scent, taste, look and feel of food can all trigger a desire to eat and provide the comfort and nourishment they need.
- Create a food mood board Often, memories are linked to foods we loved eating at a precise moment. For me, childhood summer holidays are rekindled as soon as I think about knickerbocker glories and eating fish and chips out of the newspaper on the North Wales coast, while my treasured aunt and uncle sang with the choir on the seafront. A personal food mood board made out of photos of favourite dishes, people and places can be a great way to communicate and also stimulate a jaded appetite.