Coping with Food Refusal

By Jane Clarke, Dietitian and founder of www.nourishbyjaneclarke.com

From childhood to old age, the rhythms of our day tend to revolve around mealtimes – and that doesn’t change once we move into a care setting. Breakfast, lunch, teatime and supper bring residents – and carers – together around the table, and can provide precious moments of sociability, fun and connection, as well as healthy food to help maintain strength and resilience.

That changes when a person refuses to eat, or is reluctant to have more than a few mouthfuls. There are lots of reasons for this – living with a condition such as dementia; feeling unhappy in a new setting; grief or illness. As a carer it’s important to tackle food refusal as soon as possible, because the less a person consumes, the less their body and mind seems to feel a need for food.

Without the nourishment their body needs, an individual’s health will suffer. They will have less energy to be engaged in physical and social activities, leading to a reduction in wellbeing and quality of life. They will become weaker, increasing risk of falls, confusion and infection.

Recovery from illness or surgery will take longer. If they are already vulnerable or living with a health condition, they may deteriorate faster.

But there are strategies that can help break the cycle of food refusal and encourage someone to begin eating again, while at the same time treating them with dignity and respecting their right to choose not to eat certain foods – after all, we all have our favourite flavours, as well as tastes and textures we can’t easily stomach. Here are some ideas…

MAKE EVERY MOUTHFUL COUNT

If portions are small, it’s essential they contain as much nourishment as possible. Enriching foods with additional vitamins and minerals, protein, carbohydrates and calories can be as simple as adding extra vegetables to a tomato sauce, grating some Cheddar cheese into mashed potato, or adding extra lentils and a swirl of cream to a soup.

DON’T SIT AT THE TABLE

This sounds controversial and I am a huge advocate for the pleasure of shared mealtimes, but they can feel overwhelming for some people and this is when the habit of refusing to eat can set in. Instead, try serving a small plate of food on a tray while they watch TV or listen to the radio. It can take the pressure off having to ‘perform’ at the table, and you may find they nibble more than expected.

SERVE A NOURISHING DRINK

A ‘meal in a mug’, like a cup of soup, a fruit-filled smoothie, or an all- natural meal replacement Nourish Drink, is a good option for anyone who feels overwhelmed when a full plate of food is put in front of them. You’ll have the reassurance that the person you are looking after has had the equivalent nutrients of a complete meal but in a form that slips down more easily than a plate of cooked food. You could try this mid- morning or mid-afternoon, instead of the usual tea and biscuit.

SWAP MEALTIMES AROUND

If the person you care for has a bigger appetite in the morning but feels too tired to eat later in the day, then provide a more substantial breakfast and take the pressure off the evening by providing a smaller snack for supper. There’s no right or wrong when it comes to having dinner for breakfast or lunch at 4pm – it’s what works best for the individual and their appetite.

EAT TOGETHER

Some people don’t like to eat alone. If some meals take place in a resident’s own room, rather than a dining room, try to take the time to sit and chat with them while they eat rather than getting on with a job else- where. It can make meals feel a lonely, challenging time for the person you are caring for, and you may find they eat more when you are with them, rather than you returning to a plate of uneaten, cold food.

If residents do sit at the table together, place the reluctant eater next to someone with a heartier appetite, as it may prompt them to follow suit and eat more.

FOLLOW THEIR CUES

We all have favourite foods so it’s worth trying to find out the dishes a person really loves. Even if they’re no longer able to enjoy the same meal, you could capture the flavours in a more accessible alternative – a roast chicken soup instead of a roast chicken dinner, say. Depending on the cognitive abilities of the resident, you could try creating a food and memory moodboard together, with photos of foods that remind them of happy times – ice cream on the beach, roast dinner on a Sunday, kippers for breakfast… It’s a great way to tempt the appetite and spark conversation.

BE ENCOURAGING

If you ask a reluctant eater if they’d like potatoes or a pudding, the answer is likely to be ‘no’. Instead, respectfully cajole them to eat by saying, ‘Let’s try a potato, or a spoonful of ice cream…’ By encouraging a few mouthfuls, rather than giving a yes or no option to a meal, it’s amazing how many people will be tempted to take a bite, and then another, and before you know it, a good portion will be eaten.

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