Dementia and Eating Issues

Nutrition and meal support for a loved one with dementia

Dementia and eating issues are very common.  Do you have a loved one with dementia that is not eating or experiencing swallowing issues?  For people living with dementia and their relatives and care givers everyday living can become a challenge. Dementia can make it harder to do simple daily activities such as using the bathroom, socializing, cooking and self-feeding.  

You might be asking yourself  

• How can I make sure my loved one stays healthy? 
• How does dementia affect nutrition? 
• What can I do to support dementia and eating issues that may show up for my loved one? 

Depending on the stage of the disease and the eating behavior the risk of malnutrition may be high. However, how dementia is expressed is individual and the recommendations are as well. According to Gail Elliot, gerontologist and founder of the DementiAbility Program, “if you know one person with dementia… you know one person with dementia”. This powerful statement expresses, in only a few words, the diversity of behavioral responses to dementia.  

The 7 stages of dementia

Dementia is divided in seven stages. Risks of dehydration and malnutrition increase as the disease progresses.  

Stage one: The person has no cognitive decline. People without dementia belong to this stage.  

Stage two: The person forgets certain things, such as where their keys are.  This is usually forgetfulness associated with aging. 

Stage three: Forgetting becomes more regular, but it usually doesn’t have a major impact on daily activities.  

Stage four: Considered early stage of dementia. The person will show difficulty in problem solving, remembering recent events and managing their own financial affairs. Some people might have difficulty remembering mealtimes, their level of appetite or their food preferences. However, for some dementia and eating issues don’t present as a problem and there may be no nutrition concerns while cooking and eating meals continues normally. 

Stage five: The person has major cognitive decline; they are more confused and may not remember the time/date/year or where they are. At this stage, the person may need support in toileting and getting dressed. Generally, the person is unsafe to prepare meals on his/her own and may need support or cuing in feeding.  They may also show difficulty swallowing and/or have a decreased appetite.  

Stage six: The person has severe cognitive decline; they generally do not remember the time/date/year, where they are, some relatives, may not remember their life and their personality may change. At this stage, the person is generally incontinent, has difficulty communicating and needs support in every aspect of the daily activities.  They may show worsening difficulty swallowing and feeding. Weight loss is often a major concern.  

Stage seven: Called end of life stage.  The person is not able to communicate anymore or perform any daily activities and unable to feed themselves.  

Nutrition and dementia

While it is impossible to generalize and predict the nutrition and eating problems associated with the disease because every individual responds differently, some challenges are more common and well known:  

Taste and smell change

Many families would testify that they do not know what their loved one likes anymore. As dementia advances, new food preferences appear and some might dislike a food item that has forever been appreciated. This can even be more challenging when the person is no longer able to communicate. It is recommended to describe the food with positivity (example: “I made you a great butternut squash soup and I added some cream in it, just the way you like”).  Try different foods regularly or try foods the person used to dislike and keep a record of the new preferences for quick reference.  

Forgetting
 

Forgetting can affect a person’s nutritional intake in many different ways. Some people will forget the time to eat, others will not recognize the food in front of them and some don’t make a good connection to swallow when the food is in the mouth. Extra support, cuing, and patience is the key.  

Loss of self feeding ability

As the disease progresses, it is common to see the person not remembering how to use their utensils or having more rigidity in the movement of feeding themselves. The best practice recommends to maintain their autonomy as much as possible. Cuing or using the hand-over-hand or hand-under-hand techniques would usually be recommended first while total assistance may be recommended as the disease progresses.   Here is a helpful video on Handfeeding Assistance for Dementia and Alzheimers. 

Difficulty swallowing (dysphagia)

Difficulty eating and swallowing may cause severe risks of harm. The cognitive decline and muscle loss may change the ability to eat and swallow normal food. When it is suspected that a person has difficulty swallowing, a referral to a Registered Dietitian specialising in dysphagia should be made to assess the safety on normal food and fluids. Recommendation for altered food texture or fluid consistency may be made for safety and to increase the food intake. 

Assistance by a Dietitian specializing in dementia and eating issues

A Registered Dietitian specializing in dysphagia can help by:   

• Conducting dysphagia assessment to identify the most appropriate food texture and fluid consistency for safety and to prevent choking. 
   
• Preventing malnutrition and weight loss by offering suggestions on how to increase the protein and calories of the food choices provided.
   
• Ensuring a good food intake by helping brainstorm new ideas to accommodate preferences, supporting healthy mealtime behaviors and reducing distractions 

Ask for support from a Dysphagia Dietitian – don’t go through the journey alone. Having adequate support will help increase your, and your loved one, quality of life to keep sharing positive memories.  

If you are looking for support from a private practice Dysphagia Dietitian and to help support dementia and eating issues contact us to see if we can assist.  For more information on our personal nutrition counseling support programs visit:  Personal Nutrition Counseling for Dementia and Dysphagia (Swallowing Issues)