Alzheimer's and dementia care: Making mealtimes easier

For people with Alzheimer's disease or other disorders causing dementia, eating habits and nutrition can be complicated by several factors. Changes in memory, behaviors and senses may contribute to poor nutrition. In turn, poor nutrition can cause a decline in behaviors and overall health.

If you're caring for someone with dementia, understand what causes eating problems and how you can encourage good nutrition.

Causes of poor nutrition

A lack of interest in food, poor eating habits, resistance to eating or loss of appetite may be related to a number of issues.

• Memory loss. A person with dementia may forget to eat or drink.
• Trouble sequencing or multitasking. Challenges with planning, following steps or doing multiple tasks may lead to difficulty cooking or preparing meals.
• Sensory changes. A decrease in the sense of smell or taste may result in a lack of interest in food.
• Agitation. Agitation and related changes in behavior may make it difficult to eat enough during mealtimes.
• Dental problems. Poorly fitting dentures, mouth sores or other dental problems may result in avoiding food or beverages.
• Medications. Some medications can result in a loss of appetite.
• Lack of exercise. A lack of exercise can result in a loss of appetite.
• Poor coordination. A change in physical coordination can make it difficult to handle utensils.
• Depression. Depression can result in a lack of interest in eating and a decreased appetite.
• Constipation. A lack of dietary fiber, water and exercise increases the risk of constipation, which can lead to a lack of appetite.
• Poor chewing and swallowing skills. In later stages of the disease, a person with dementia will likely have difficulty chewing and swallowing.

Support for people with early-stage dementia

If the person with dementia lives alone or doesn't need constant care, you can take steps to promote good nutrition:

• Call with reminders to eat at mealtimes.
• Help with shopping to stock the kitchen with healthy, easy-to-prepare food items.
• Make meals in advance and demonstrate how to prepare or heat the meals.
• Use meal delivery services, meals at adult community centers or other services that provide meals to older adults.

Mealtime support

Several strategies can help the person in your care have the best possible experience at mealtimes and get adequate nutrition.

• Routine. Eat at the same time every day as much as possible. If mealtimes are too long or difficult, consider frequent, smaller meals throughout the day.
• Hydration. Offer small glasses of water frequently throughout the day to promote adequate hydration. Offer food with high water content, such as fruit, soups, milkshakes and smoothies.
• Calm environment. Avoid distractions, such as a television or radio. Remove unnecessary clutter from the table. Turn off phones.
• Dishes and utensils. Choose dishes that are easiest to use: white dishes instead of patterned dishes, bowls instead of plates, spoons instead of forks, or fingers instead of utensils. Use bendable straws or lidded cups.
• Food servings. Cut food into bite-sized pieces before serving, or make finger foods. Serve one type of food at a time, as deciding what to eat may be agitating.
• Food choices. Make favorite and familiar foods, while ensuring generous servings of vegetables, fruits and whole grains.
• Encouragement and modeling. You can help with the basic mechanics of eating by demonstrating how to hold a spoon, when to take a drink or how to chew enough after a bite. Gently hold the person's hand to help with using a utensil.

Foods to avoid

The doctor will likely recommend limiting:

• Alcohol. Avoid alcoholic beverages, which can contribute to confusion or agitation and which increase the risk of falls.
• Caffeine. Limit caffeinated beverages, which increase the risk of dehydration.
• Choking hazards. Avoid foods that are difficult to chew or swallow, such as raw carrots, popcorn and nuts.

Professional support

Regular conversations about nutrition are an important part of ongoing care for a person with dementia. A care team can help you provide adequate nutrition.

• Primary care doctor. If there are changes in weight and eating habits, call the doctor. Ask for advice on the use of vitamins or supplemental beverages.
• Dietitian. A licensed dietitian can offer guidance on healthy and simple meal planning for a person with dementia.
• Occupational therapist. An occupational therapist can provide services and training that supports eating skills and suggest tools that make eating easier.
• Speech-language pathologist. These specialists can provide assessment, therapy and caregiver training to assist a person who has difficulty chewing and swallowing.
• Service agencies. A county or area agency for older adults can help you identify service programs or professionals that support dementia caregiving.