Not eating with dementia is often due to difficulty swallowing and a loss of appetite. But eating changes can be subtle, even in the earliest stages of the condition. Focusing on comfort, accessibility, and quality foods can help.
Dementia is a broad clinical term for memory loss and cognitive decline not typical for the aging process. Alzheimer’s disease is the most common type of dementia, accounting for up to 80% of dementia diagnoses.
Eating changes in dementia are common. Early
For caregivers, knowing what to do when someone living with dementia won’t — or can’t — eat is an important part of preventing malnutrition.
When someone living with dementia doesn’t want to eat, it’s usually not because they’re being stubborn or combative.
As a neurodegenerative process, dementia changes how the brain functions, and eating involves more than just feeling hungry.
A 2020 review on eating behavior in dementia indicates eating pattern changes often start slowly and are related to memory decline. You may head to the grocery store, for example, and not recall what you needed to buy or how to cook it correctly. This can steer you toward low quality, ready-made options or simpler meals overall.
As dementia progresses, memory decline can cause you to miss a meal or can lead to overeating, especially if your appetite is starting to change.
Your brain controls your appetite, and as dementia alters brain function, you may not feel hungry as often or as much.
Other factors that can prevent someone living with dementia from eating include:
- poor motor control, like trouble swallowing or difficulty chewing
- general discomfort
- inactivity
- depression
- isolation
- sleep disturbances
- changes to sense of smell and taste
- altered food cravings
- comorbid conditions
- communication impairment
- medications
You can’t change how hungry someone feels, but as a caregiver, there are ways to encourage someone living with dementia to eat and to make the most out of what they do ingest.
Additionally, many people with dementia also have dietary restrictions due to medical conditions, such as diabetes or liver disease. This can make feeding someone with dementia even more challenging for you as a caregiver.
Ruling out causes of pain
People who have dementia can become less aware of their physical condition and may be prone to injuries or infections. Furthermore, they can have a hard time explaining their physical discomfort.
If your loved one has suddenly lost interest in eating, it could be a sign of pain or discomfort, such as from a urinary tract infection (UTI), stomach upset, a tooth abscess, or even a broken bone.
Talk with their doctor to see if they need to be seen, and whether they might need treatment for an infection or injury. Often, their appetite will improve after the situation is treated.
Prioritizing comfort
At mealtime, being mindful of room temperature, posture, seating support, lighting, and general atmosphere can help.
Once physical comfort is taken care of, you can focus on mental well-being. Making meals a social experience and allowing plenty of time to finish are ways to keep mealtime a positive experience.
Reducing distractions
Eating might be easier if it’s the only thing to focus on. You can help keep eating the priority by limiting dual activities, like having a meal and watching television at the same time.
However, you should take cues from your loved one and observe which setting is best. They may eat better when enjoying other things during meals, or they might prefer quiet, uninterrupted meal times.
Using nutrient-dense foods
Sometimes you have to make the most out of what someone does eat. You can do this by focusing on nutrient-dense options, like meal replacement shakes and soups, or by getting clever with combining foods.
Consider flavoring nutrient-rich foods with toppings or sauces that your loved one enjoys.
Being kind and patient
It can be frustrating when someone living with dementia doesn’t want to eat, but punishing them or holding them accountable for typical meal behaviors isn’t going to help.
Let them be messy if they need to be, for example. You can adapt by using plastic tablecloths and other disposable items.
If they keep asking for more food because they can’t recall eating, consider having multiple, smaller servings available rather than just saying “no.”
When you’re experiencing cognitive decline, complexity can be frustrating and another reason to not want to eat.
You can keep meals straightforward by:
- offering a variety of options
- serving one food at a time to avoid decision overwhelm
- accommodating abilities, like using bowls instead of plates
- choosing foods that are easy to pick up with your fingers
- serving colored plates and bowls that make food more visible
- preparing foods with easy-to-chew and swallow textures
- pre-cutting food items into bite-sized pieces
- using thickening agents to help with swallowing liquids
- providing straws to maximize fluid intake
- offering foods at a ready-to-eat temperature
When it comes to making meals for someone living with dementia, the Alzheimer’s Association suggests the following:
- limit foods with high cholesterol and saturated fat
- focus on vegetables, fruits, whole grains, lean protein, and low fat dairy
- swap refined sugar products with fruit or juice-sweetened baked goods
- avoid high sodium foods and use less salt in cooking
Keeping these concepts and mealtime strategies in mind, there are many easy meal options to choose from when caring for someone living with dementia.
Soups
Soups are an easy way to add a large number of nutrient-dense foods to one dish. Soups can be customizable to individual palates, and boiled ingredients are typically softer and easier to eat.
Soups aren’t for everyone. If swallowing is an issue, soups may need to be thickened before they can be easily swallowed.
Snack platters
Too many food options can be overwhelming, but snack platters, such as cut-up cheese, meatballs, and fruit, offer a way to present small amounts of bite-sized food choices that can be eaten by hand.
Smoothies
When you need to get the most out of a meal and don’t have much volume to work with, smoothies are a way to condense fruits, vegetables, and protein into a drinkable form.
Smoothies tend to be thicker compared to juices, which makes them easier to swallow because they move more slowly down your throat.
Slow cooker meals
Foods cooked in slow cookers are known for being tender. Meats and vegetables soften over the course of the day while retaining their flavors.
Using this kitchen appliance also opens up the opportunity to cook an entire meal at once to save time.
Pasta
Pasta has to be cooked with care to ensure it becomes soft enough for someone living with dementia, and the choice of pasta can also matter. Small noodles, rather than strands of pasta, may be a better option.
There are also whole grain, gluten-free, or veggie-based pasta options that can provide additional nutrients to the meal.
Additionally, pasta sauce provides a great opportunity to puree in vegetables that might otherwise be avoided or unappetizing.
Living with dementia can affect eating in a variety of ways. In addition to mechanical difficulties with eating, your appetite can decline, and you may not find the same foods appealing anymore.
When someone living with dementia isn’t eating, you may want to try addressing any pain or discomfort they may be feeling, making mealtime as comfortable as possible, and providing food that is the right size and texture.