Dementia and nutrition

Dementia is a term used to describe a number of brain disorders which are usually progressive and can be severe. The most common types of dementia are; Alzheimer’s disease, vascular dementia and dementia with Lewy bodies.

They share a gradual decline in a person’s ability to remember; with memory loss and communication problems. Understanding and reasoning may also be affected.

Nutritional Care

Changes in eating habits and eating problems are common in dementia and can greatly affect a person’s relationship with food, their eating habits and the mechanical processes of eating.

Other health problems may need to be addressed to make sure they do not interfere with eating and drinking:

• Poor dentition visit the dentist or dental nurse regularly.
• Poor sight consult an optician.
• Constipation or diarrhoea see their G.P. There are many things that can upset bowel function.
• Medications discuss with their pharmacist, G.P. or hospital doctor.
• Difficulty holding cutlery or cups, food being pushed off plates adapted cutlery, plates with lips and cups with spouts are all available and may help preserve independence.  

The following pages give some suggestions and tips to help with eating and drinking. Each person with dementia is an individual and you as a carer, relation or friend will know them best and in time you will come up with further ideas of your own.

Tips to Encourage Eating and Drinking

• Lifelong food habits may change and keep changing e.g. a previous ‘big’ eater may become a small eater who is easily put off by a full plate with a number of different foods on it. If you come across this try using two smaller plates with fewer foods on them. Insulated plates are really useful if meals take a long time. Try to adapt to food challenges, but be reassured there may never be a perfect answer.
• As far as possible eating should take place in calm, familiar surroundings without excessive distractions e.g. loud T.V. or radio.
• Eating with familiar people can help to prompt memory and generally people eat better when in company so try to sit down and eat as a family, couple or with others.
• Attempts to eat non food items may happen due to confusion. If this becomes a regular habit it may be that the person is hungry; check that they are eating enough.
• Agitation can make sitting for any length of time a problem. Some dementia sufferers may pace up and down for long periods, burning lots of energy and refuse to sit at a table. Foods which can be held in the hand (finger foods) and eaten on the move can help to maintain their dietary intake e.g. sandwiches, chips, fish fingers, sausage rolls or pieces of fruit. Finger foods are very helpful in enabling a person to eat if they no longer recognise or are able to use cutlery.
• The texture of food offered may need to be altered if chewing, swallowing and tiredness reduce the amounts eaten. Try offering foods that are soft (easily chewed) and moist (plenty sauce/gravy).
• If you regularly notice coughing after swallowing ask their G.P. for a referral to the Speech and Language Therapist who can assess swallowing and offer advice and support.
• Offer lots of encouragement with gentle reminders and prompts to eat. Naming foods and drinks can help trigger memories which in turn may help with the recognition of food items and improve food intake. Continual reassurance may be needed.
• It may help to talk about favourite foods and drinks or remember meals they have eaten out or at special occasions.
• Arguing or losing your temper over the food at the table will achieve little as your loved one’s understanding may be poor. Keeping calm and using distraction by changing the subject can work better.
• Many dementia sufferers lose the ability to gauge temperature so always check the temperature of food and drinks before serving.

Fluids

• It is very important to keep an eye on how much fluid is being drunk as a reduced fluid intake can increase confusion.
• Everybody should aim to have 3 pints or 2 litres every day; that’s about 6-8 mugs or tall glasses.

Nutritional Care in the later stages of Dementia

• As dementia advances, quality of life is the priority rather than being anxious and frustrated about eating and drinking.
• Gradually more and more help to eat and drink will be needed and this may result in less and less being taken.
• There may come a time when food and drink are refused. This is part of the natural process and does not cause the person distress or discomfort.