A healthy and balanced diet is essential for our physical and mental health. Food is also an important part of an individual’s life. Many of our favourite experiences and memories involve preparing and sharing food with family and friends. The experience of Dementia can have a big effect on ‘usual’ eating habits. As a result, getting the correct nutrition through food can sometimes be difficult. This can lead to under-eating resulting in weight loss, or over-eating, causing weight gain. This article aims to aid care-givers and family members make meal-time as comfortable and nutritious for the person they are caring for.
People living with Dementia may experience problems with eating and drinking. These problems may stem from the following:
➢ Depression - Loss of appetite can be a sign of depression. Depression is common in people with Dementia. Please consult your GP if you suspect your loved one may be exhibiting signs of mental distress.
➢ Communication - A person with Dementia may have problems communicating that they are hungry or that they don't like the food they have been given. This can make eating a confusing and distressing time for an individual living with Dementia. Ensuring good, open dialogue can help restore comfort during mealtime.
➢ Pain - A person with Dementia may be in pain, which can make eating uncomfortable. They may have problems with their dentures, sore gums or painful teeth. Oral hygiene and regular mouth checks are important.
➢ Change in appetite - Dementia can also lead to changes in appetite and sense of taste and smell, which can reduce the person’s desire to eat.
➢ Medication - Changes to medication or dosage can result in appetite changes. If you think this may be the case, speak to the GP.
➢ Physical activity levels - If a person with Dementia is not very active during the day, they may not feel hungry. Encouraging them to be active will be good for their wellbeing and may increase their appetite. 30 minutes of exercise a day is recommended when possible.
➢ Constipation - This is a common problem and can result in the person feeling bloated or nauseous, making them less likely to want to eat. Try to prevent constipation by encouraging activity, offering the person fibre-rich foods and providing plenty of fluids. If constipation becomes a problem for the person, speak to the GP.
➢ Dysphagia/trouble swallowing - As Dementia progresses, swallowing difficulties (called dysphagia) become more common, although they can vary from person to person. A speech and language therapist or doctor may advise changing the type and texture of foods and liquids to make them easier to chew and safe to swallow. Please seek the advice of your GP if you suspect any difficulty with ingestion or swallowing.
Firstly, it is important the person feels comfortable in the setting where they are eating. This may be helped by applying the following measures.
➢ Maintain a routine - Remind the person when meals are due and try to maintain a routine.
➢ Familiar environment - Make the environment as appealing to the senses as possible. Familiar sounds of cooking, smells of the kitchen and food, and familiar sights such as tablecloths with flowers can all help. A noisy environment can be distracting. The eating environment should be calm and relaxing. Switch off background noise.
➢ Describe the food - Describe the food as it may help the person to recognise what they are eating. Make sure that glasses, dentures or hearing aids are worn during the meal if needed
➢ Be flexible to food preferences - Develop a food preference list and remember to adjust as tastes change. Try not to exclude foods too quickly and re-try ones that haven’t been tried for a while. Maintaining a Dementia patient’s interest in food is essential for proper nutrition.
➢ Be flexible about meal times - Encourage foods at times in the day you notice the person tends to eat better.
➢ Allow sufficient time - It is important the person does not feel rushed and ensure they have enough time to eat at their leisure.
➢ Company at meal times - Eat with the person if they enjoy the company, however, be aware some people may not like eating in company.
➢ Little and often - Adopt a ‘little-and-often’ meal pattern; if they are not eating three meals a day introduce nourishing snacks and drinks throughout the day.
➢ Distinguish food from the plate - Contrasting colours will help identify foods, avoiding patterned plates is important. If possible use specially adapted cutlery for people with Dementia.
➢ Finger foods - Consider foods that are easily eaten with the fingers if a person struggles with cutlery, such as fruit pieces, small sandwiches or cereal bar. Serve food on small plates if a person has a small appetite or, if the person is slow to eat, serve a small portion first and then a second helping that you have kept warm.
A healthy and balanced diet, however, can make a big difference in Dementia's regression. The basic nutrition tips below can help boost the person with Dementia's health and your health as a caregiver, too.
➢ Provide a balanced diet with a variety of foods. A diverse, healthy meal plan can include vegetables, fruits, whole grains, low-fat dairy products and lean protein foods.
➢ Limit foods that are high in saturated fat and cholesterol. Go light on fats that are bad for heart health, such as butter, lard and fatty cuts of meats. However, healthy fats such as those found in avocado are a great source of calories.
➢ Cut down on refined sugars. Often found in processed foods, refined sugars contain calories but lack vitamins, minerals and fiber. A sweet tooth can be satisfied with healthier options like fruit or juice-sweetened baked goods.
➢ Limit foods with high sodium and use less salt. Most people in Ireland consume too much sodium, which affects blood pressure. Cut down by using spices or herbs to season food as an alternative.
Do not worry if the person you are caring for cannot manage a balanced diet every day. If they are not eating three meals every day, encourage snacks and finger foods. They can be very nourishing and can be easier to eat than larger meals. Snacking is a great way to ensure the person you care for is reaching their nutritional targets for the day. All food groups should be included when organising nutrition for a person with Dementia. Here are some tips for supplementing main meals:
➢ Warm beverages - can be comforting for a person with Dementia; In particular, milk-based drinks, such as hot chocolate, milky coffees and milkshakes. Try not to make them too hot. For a person in the later stages of Dementia, use a non-spill cup with a lid.
➢ Small sandwiches - Sandwiches are an excellent way to ensure a patient meets their daily calorie intake. Add fillings that are a good source of protein such as egg, tuna, ham, chicken, cheese or cheese spreads and peanut butter. Add salad, sweetcorn, peppers, sliced tomato and flavour with mayonnaise, pickles or chutneys. Cut sandwiches into small squares or triangles.
➢ Savoury biscuits - crackers, slices of warmed pita bread with hummus, cheese spreads or pate.
➢ Toast fingers - with cheese spread, melted cheese, jam or peanut butter.
➢ Baked goods - Fruit loaf, scones, pancakes with butter/cream and jam.
➢ Small individual cakes - Miniature cupcakes can be an excellent treat for individuals with Dementia.
➢ Cereal bars - Grain cereal bars are calorie dense and a great snack if struggling to reach intake targets at mealtime. Small biscuits like digestives or fig rolls are also suitable.
➢ Chopped fruits and vegetables: Carrot sticks, cucumber slices, cherry tomatoes, grapes, chopped apple, chopped banana, orange segments, melon and pineapple chunks.
Nourishing drinks: High-calorie drinks can be made at home or purchased in health food stores if a person with Dementia is refusing to eat or displaying weight loss. Choose nourishing drinks which contain energy, protein, vitamins and minerals such as milk based drinks, fresh fruit juice or fortified drinks rather than having water, fizzy drinks or tea too often.
It is important to determine if the person is aware of the changes in their eating habits. Food should not be taken away or hidden from a person who has the capacity to make choices about what they want to eat. This is particularly important in situations where the person is gaining weight excessively. Eating more than usual or having extra portions of food should only be deemed a concern if it is causing health-issues. Speak to a professional before drastically altering meal plans or food. Dementia is considered a complex condition and the risk of malnutrition and weight loss/gain is significant as it progresses.