Dementia - eating

A person with dementia may find eating difficult. Loss of appetite, loss of memory and problems with judgement can cause difficulties with food, eating and nutrition. The person may forget how to chew and swallow, or may be distracted by their environment.

Meal times provide us with an opportunity to spend time with our family and friends, as well as share food together. Meal times can become stressful for the person with dementia and their carers. There are ways to make your life as a carer easier and to help the person with dementia maintain a healthy diet.

Loss of appetite and dementia

A person with dementia may forget how to chew and swallow. Other reasons for an apparent loss of appetite may include ill-fitting dentures, insufficient physical activity and being embarrassed by difficulties in eating.

Things that might help to manage loss of appetite include:

• Check with the doctor to make sure that there are no treatable causes for loss of appetite, such as acute illness or depression.
• Offer meals at regular times each day.
• Allow the person to eat when hungry.
• Encourage physical activity.
• Provide balanced meals to avoid constipation.
• Offer ice-cream or milkshakes.
• Try to prepare familiar foods in familiar ways, especially foods that are favourites.
• Encourage the person to eat all or most of one food before moving on to the next – some people can become confused when tastes and textures change.
• Try to make meal times simple, relaxed and calm. Be sure to allow enough time for a meal – helping the person to eat can take up to an hour.
• Consult a doctor if the person with dementia experiences significant weight loss (such as 2.5 kg in six weeks).
• Check with the doctor about vitamin supplements.
• Carers should also make sure their own diet is varied, nutritious and enjoyable.

Overeating or insatiable appetite and dementia

Dementia may cause some people to overeat or even develop an insatiable (unstoppable) appetite.

Things that might help to manage overeating include:

• Try five to six small meals each day.
• Have low calorie snacks available, such as apples and carrots.
• Consider whether other activities, such as walks or increased socialisation, may help.
• Lock some foods away, if necessary.
• Leave healthy snack foods on the table – this may be enough to satisfy some people.

Sweet cravings and dementia

People with dementia may crave sweet foods. Things that you can try to help manage sweet cravings include:

• Check medications for side effects – some antidepressant medications cause a craving for sweets.
• Try to satisfy the sweet cravings with foods that have some nutritional value, such as milkshakes, eggnogs or low-calorie ice-cream.

Mouth, chewing and swallowing problems in dementia

Some problems with eating may relate to the physical condition of the mouth. A dry mouth or mouth discomfort from gum disease or ill-fitting dentures are common problems.

Things that might help to improve the condition of the mouth include:

• Arrange a dental check-up of gums, teeth and dentures.
• Moisten food with gravies and sauces if a dry mouth is causing problems.
• For chewing problems, try light pressure on the lips or under the chin, tell the person when to chew, demonstrate chewing, moisten foods or offer small bites one at a time.
• For swallowing problems, remind the person to swallow with each bite, stroke the throat gently, check the mouth to see if food has been swallowed – do not give foods that are hard to swallow, instead offer smaller bites and moisten food.
• Consult their doctor if choking problems develop.

Problems eating at the table for people with dementia

Behaviour such as pouring a glass of juice into a bowl of soup or eating dessert with a knife are signs that a person with dementia is having difficulty at the dinner table.

Things that might help with eating at the table include:

• Serve one course at a time and remove other distracting items from the table, such as extra cutlery, glasses or table decorations.
• Make sure the crockery is plain and that its colour contrasts with a plain tablecloth and with the food being served.
• If the use of cutlery is too difficult, serve finger food.
• Allow plenty of time to eat.
• Keep noise or activity in the environment to a minimum.
• Make sure there is adequate lighting.
• Eat with the person with dementia so that they can follow your lead.
• Serve familiar food.

Other meal-time strategies

Some other strategies to consider for making meal times less stressful include:

• Keep eating simple – not all food has to be eaten with cutlery if this is becoming difficult. Finger foods can be a nutritious and easy alternative.
• Keep in mind a person’s past history with food – they may have always had a small appetite, been a voracious eater or had a craving for sweets.
• Watch food temperatures – while warm food is more appetising, some people with dementia have lost the ability to judge when food or drink is too hot. Beware of using foam cups – they hold the heat for a long time and tip over easily.
• Offer support – spoiled food in the refrigerator, hiding food or not eating regularly may all be signs that someone living alone needs more support.
• Offer fluids – regular drinks of water, juice or other fluids are essential to avoid dehydration. Many people with dementia do not get enough fluids because they may forget to drink or may no longer recognise the sensation of thirst.
• Be prepared for changes – many of the eating problems of dementia are temporary and will change as the person’s abilities deteriorate.

Support for families and carers

Carers should make sure their own diet is varied, nutritious and enjoyable.

Dealing with a range of issues can be difficult for some people with dementia and their families and carers. If you would like further assistance or to speak to someone personally about your particular situation, call the National Dementia Helpline or the Dementia Behaviour Management Advisory Service (DBMAS), a national telephone advisory service established to support carers.

Where to get help

• Your GP (doctor)
• Your local council
• Your local community health centre
• National Dementia Helpline, Dementia Australia Tel. 1800 100 500
• Aged Care Assessment Services Tel. 1300 135 090
• My aged care Tel. 1800 200 422
• Cognitive Dementia and Memory Service (CDAMS) clinics
• Carers Victoria Tel. 1800 514 845
• Carer Gateway Tel. 1800 422 737
• Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers