Addressing Challenges to Eating with Dementia

I have supported many individuals living with dementia, their families and carers, in my work as a nutritionist running a clinical practice and working with care homes to advance the nourishment of their residents. But I also have personal experience of the eating, nutritional and emotional challenges this condition can bring, as my amazing dad has fronto-temporal lobe dementia and it affects how, when and what he wants to eat.

Dad’s lunch has to be at one o’clock; there is no flexibility, otherwise his anxiety levels and confusion rise. The clock dictates our lives to an obsessive degree, but it’s worth it for the comfort his routine provides him. My dad also needs to know before he starts eating that there will be some pudding to follow, otherwise he can get upset and confused. At the moment we are noticing that my dad’s sweet cravings are getting a lot stronger, which is so often the case with people living with this progressive disease.

Dementia can affect desire and ability to eat in many ways and not everyone experiences the same challenges. Use these simple strategies to help prompt a poor appetite and develop calming mealtime routines.

CHALLENGES TO EATING WITH DEMENTIA IN A CARE SETTING

• 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 the lips or throat
• Physical skills such as keeping the mouth closed while food is inside, to help with chewing and swallowing, can become difficult
• 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 regular routine is reassuring for someone living with dementia – eating 10 minutes later, sitting at a different table, or with fellow residents they don’t usually sit at the table with, can throw them. The need to work to a regular rhythm is one of the advantages of a care setting, but where possible, it’s important to flex to fit with the individual needs of those you look after. If mealtimes are challenging, are you able to offer two sittings or separate tables, so that those who need variety and diversity get to switch tables and companions, while those who need consistency have the familiarity of a regular routine?

MAKING FOOD THE FOCUS

Mealtimes can be time-consuming and challenging – but they can also be highlights of the day that nourish with sociability and fun, as well as food. So, while you may have set up an efficient system of cooking, serving and clearing away dishes, don’t forget to focus on the important bit, eating together.

• 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 and give both you and the person you are caring for a chance to calm down and regroup.

• Take off the pressure. If 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 medical 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.

MANAGING CHANGES

As dementia progresses it’s highly likely that appetite and ability to eat will change. These shifts are not always down to the disease itself – some- times medication can put a person 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 they may crave 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
• 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?
• 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 a resident isn’t eating enough, keep a diary of what they manage at mealtimes to help you create a care plan for them.
• Create a food mood board Often, memories are linked to foods we loved eating at a precise moment. 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 and it can be a lovely ‘memory activity’ for residents living with dementia.