Eating well when you have dementia

It can be difficult to persuade someone with dementia to eat well, so don't worry if you seem to face quite a few issues and challenges. Here’s what you need to look out for…

A good diet is vital if you're living with dementia. It means you can stay as healthy as possible for as long as possible and enjoy life to the full. But what does a healthy diet actually look like if you have dementia, and how do you go about getting it?

These are some of the issues you might need to consider

1. Getting a balanced diet
2. Chewing and swallowing
3. Meal-times
4. The eating environment
5. Effect of diet on memory
6. Eating well at home
7. Getting involved

1. Getting a balanced diet

Thinking about nutrition is extremely important for someone affected by dementia because the changes they experience as a result of conditions such as Alzheimer’s or vascular dementia can have an impact on the whole eating process.

Weight loss and gain

This is not an inevitable part of the dementia journey, but either losing too much weight or putting on weight can be an issue. It can be related to a variety of problems including difficulty using cutlery, changes in appetite or taste preferences, swallowing and chewing troubles and even depression.

Malnutrition and dehydration

A lack of food or fluids over a long period of time could lead to malnutrition and dehydration, which is dangerous for anyone, but for the elderly can increase their risk of delirium, or what’s sometimes known as ‘acute confusional state’.

Meeting nutritional needs

It’s a good idea to know what an elderly man or woman actually needs in terms of nutrients so that they have a balanced diet. This is especially useful if they’re only eating small meals or finger foods.

For more information on encouraging a balanced diet, click here.

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2. Chewing and swallowing

As dementia develops, people can sometimes experience difficulties with swallowing, usually because the body’s natural reflexes aren’t activated by the brain anymore. This can affect how much food they consume and even increase the risk of choking. Chewing can also become difficult, although this could happen quite early on if they have dental problems such as cavities, sore gums or poorly fitting dentures.

Spotting problems

It’s never clear when chewing and swallowing issues might appear, but you should look out for certain signs that the person you’re caring for is struggling, including repeated coughing while eating, choking, a wet sounding voice after swallowing, reluctance to eat and food that’s simply kept in the mouth.

Pureed foods

If swallowing and chewing are proving difficult, many people start serving up softer textured or pureed foods. While this can solve some issues, it’s important not to end up giving food that is bland and unappetising. Sometimes, shredding a piece of meat and mixing with a sauce or gravy is better than simply whizzing everything up in a blender.

For more advice on chewing and swallowing problems, click here.

3. Meal-time issues

When it’s time for meals, someone with dementia may experience problems with co-ordination, remembering food and even the sequence of mealtimes. This can lead to slow, drawn out meals.

Using cutlery

Whether it’s problems gripping knives and forks, or putting fork to mouth, using cutlery can end up being quite difficult for someone with dementia, as their brain struggles to make the connections that are needed to do this. Food may fall off cutlery causing frustration and restlessness. If this happens it’s often a good idea to serve up finger foods – which will be easier to pick up and eat. You can also get adaptive eating equipment, which is ergonomically designed – that is, easy to grip and place into the mouth – to support eating.

Seeing and recognising food

Dementia can sometimes cause visual problems, making it harder to see food on a plate, particularly if it is the same colour as the plate. For example, a plate of porridge on a beige plate is going to difficult to see. It’s a better idea to serve the food in a blue or red bowl so the porridge stands out. Coupled with that is the issue of not actually recognising what the food is anymore, due to a decline in their brain function.

Making choices

There’s a fine line between providing enough food choice for someone so they feel engaged and valued, and providing too much food choice so that they have difficulty deciding what to have. Calling out a list of options can be overwhelming, especially if they can’t understand what the food is from just hearing the word. Try offering two choices if possible, basing it on their preferences, and showing them the item or packaging beforehand. If that is too much for them, go for foods that you know they enjoy.

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4. The eating environment

Think about how you like to feel when tucking into your food. In an ideal world, you’re sat at a table with the right cutlery and minimal distractions so you can focus on eating. Noises or uncomfortable chairs are bound to be off-putting, but particularly so for someone with dementia.

Distractions

A noisy atmosphere can make everything seem much more confusing to a person with dementia. They may end up just wanting to get up and walk out rather than stay and eat. So think about this when serving food. Make sure there are no distractions, such as noisy music or a loud television.

Comfort

Likewise, if a dining chair is uncomfortable, or the table is too far away or too high to reach food comfortably, it's going to make the eating experience more difficult and make them less willing to sit and eat. Sometimes people prefer a tray on their lap, or even to stand and graze on food, so be flexible and try to find out what works best for them.

5. Effect of diet on memory

Researchers and scientists are constantly looking into how and why certain foods can affect brain health and memory. In fact, it seems like there’s a news story every day that promises the latest superfood to help prevent Alzheimer’s or protect your memory. So where can you even start?

The Mediterranean diet

While nothing specific has ever been confirmed as far as eating certain foods, the enduring message seems to be that a healthy diet, with a Mediterranean slant to it (ie rich in healthy nuts, seeds, oils, lean protein, oily fish and plenty of fruit and vegetables), can definitely help.

Supplements

Plus, there have been plenty studies looking at specific nutrients or chemicals which either improve or worsen memory. If you’re unsure, start with a healthy diet overhaul and take it from there.

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6. Eating well at home

If the person you’re caring for is staying at home, they will need as much help and support as possible to ensure they can eat well, and easily.

Food preferences

If an outside carer comes in on a regular basis to cook meals or do shopping, make sure they know the likes and dislikes of the person with dementia so they can ensure the food gets eaten. Of course, they’ll also need to be flexible, as sadly, one of the effects of dementia is that people often can’t remember if they even like one food over another.

Shopping methods

Internet shopping can be a useful way of getting all the food needed from the comfort of their home. You could sit down together and pick out foods and meals that they’ll enjoy, making sure you show them pictures of the foods as you add them to your online basket. Try to book the food to arrive when you’re in attendance so that the person you’re caring for won’t feel panicked about letting a stranger in to deliver the food.

Snacks and drinks

As well as meals, you’ll need to make sure that they have access to regular snacks. You may find they prefer to graze little and often rather than sitting down for three standard meals (especially if memory problems mean they’re forgetting when they last ate). Opt for healthy snacks that require minimal preparation, such as cut up fruit, nuts, oatcakes or crackers or a small yoghurt or lump of cheese. Likewise, ensure that they have access to drinks – be it tea, coffee, juice or water – so that they stay hydrated through the day.

7. Getting involved

Remember, food and drink can be a perfect opportunity for engaging the person with dementia in daily life and conversation. Food can be a talking point, a way to meet up with other people, and a chance to help them feel purposeful and useful.

Helping with food prep

This is a great way for boosting self-esteem, encouraging appetite and helping someone feel useful and valued. It could be something as simple as buttering some bread, stirring soup, peeling vegetables or chopping up some fruit. If they’re able to do it, then let them.

Laying the table

Like food prep, this can be a useful way of helping to encourage someone to get involved in daily life and chores. Just be aware that they may struggle with what pieces of cutlery or crockery go where. Just give them plenty of time and help out if they’re having difficulty. You can also get special placemats which make it clear where knives, forks, spoons and plates should be placed on the mat.

Socialising and reminiscing

Food preparation and eating can be great tools for encouraging social behaviour and to prompt memory. Finding out what their favourite meals are, particularly ones that have played an important part in their past, could be a very useful reminiscence tool. You can then serve up these foods as a way of sparking up chats and conversation.

Food can form the basis of social events for the person you’re caring for. You could hold themed meal nights – related to a particular country’s cuisine for example – or tie food in with particular events. So serve up strawberries and cream when Wimbledon tennis is on the television, or hot cross buns during Easter.

For more ideas on how to spark memories and reminiscence, click here.