Meals are a fundamental part of everyone’s day, yet they are often the most difficult part of the day for dementia caregivers . Diet and nutrition are critically important for the well-being of those with dementia, yet many lack the faculties to maintain proper nutrition on their own. As such, diet is a common source of secondary health complications for those with dementia. The topic can be divided into three core issues: lack of appetite, difficulty with consumption, and unhealthy food choices.

Lack of Appetite:

• Dentures don’t fit correctly, causing pain while eating.
• Medication causes decreased appetite.
• Not getting enough exercise.
• Decreased ability to smell and taste food
• Memory loss such that food can’t be recognized as food.
• Over-consumption of soda, diet soda and sugary foods diminishes appetite at meal-times.¹

Difficulty with Consumption:

• Someone with dementia may need to concentrate harder to accomplish any task, including eating, so make it easier by lowering noise and activity in the environment. Eat in quiet, clean, simple settings. You want your loved one to feel comfortable, without needing to rush.
• Too many food options can cause frustration and overwhelm someone with dementia. Plate small portions.
• Demonstrate the steps, like using a fork and knife to cut a piece of meat or spreading jam on toast. Resist the urge to feed your loved one, who may just be missing that one step or cue to continue with the meal.
• Use of utensils becomes more difficult as dementia progresses. Cut food into smaller bite-sized pieces, or serve finger foods.
• Serving meals in bowls rather than on plates can facilitate eating, as the sides make it easier to scoop food onto a fork or spoon.
• Someone with dementia will probably have an easier time drinking if you provide a straw.
• Serve soft foods. Start with bite-sized, until mashed or pureed foods are needed.
• Learn the Heimlich maneuver, in case of choking. Classes may be offered at a local hospital or through the Red Cross.
• Be careful with watery liquids. Thicken liquids with cornstarch or unflavored gelatin, because a person who has difficulty swallowing is more likely to choke on thin liquids.²

Unhealthy Food Choices:

• Add more fat. Of all the macronutrients, fat has the most calories per volume. Each of these equal about 100 calories:
  • One tablespoon of butter, mayonnaise, nut butter, or olive oil.
  • Two tablespoons of avocado, salad dressing, or unsalted nuts.
• Offer high-calorie beverages like whole milk, juice, regular soda, and lemonade instead of water or unsweetened coffee and tea.
• Fruits and vegetables are loaded with vitamins and minerals, but relatively low in calories and protein. Add extra fat (see above for ideas) or cheese to vegetables and sugar or honey to fruits to promote weight gain or maintenance.
• Promote protein at every meal and snack. Protein is important to maintain muscle mass, functioning, and strength through aging. Think meat: poultry, seafood, eggs; dairy: milk, yogurt, cheese; or even protein drinks and powders.³

Final Tips:

• If your loved one is still capable of preparing their own food, double check that they are correctly turning off ovens, stoves, and other appliances. Gas stoves are of particular concern. Also, make sure that they have quick access to an emergency telephone in the event of a kitchen accident.
• During advanced stages of dementia, never leave a loved one alone during meal time. The risk of choking increases as the disease progresses, and a delay of even a minute during a choking crisis can be extremely dangerous.
• Keep a close eye on blood pressure, weight loss, and oral care. Each of these is a strong corollary to proper nutrition and diet; if you see issues related to any of these elements, consider talking with a nutritionist.

For more, see this article from the NIA, or this article from the Family Caregiver Alliance.