How to Solve Eating Problems Common to People With Alzheimer's and Other Dementias

7 common Alzheimer's eating problems and how to cope with them
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1. Doesn't eat, won't eat

Possible causes
The person may forget mealtimes altogether because of memory loss.

The person may not eat much during meals because of:

  • A short attention span.
  • Distraction.
  • Confusion about how to use utensils.
  • Confusion about how to eat the particular food served.
  • Something problematic about the food (temperature, flavor, lack of familiarity).
  • A physical impairment (sore mouth, upset stomach, reaction to a new medication, problem with denture fit).

What to do

  • First be sure you're dealing with a true lack of sufficient calories and nutrition, not merely a finicky eater or a small appetite. Older sedentary people generally need fewer calories than those who are younger and more active. So avoid comparing an older adult to other members of the household.
  • Rule out physical problems by checking in with a doctor, especially if the change seems sudden or the person is losing weight.
  • Avoid coaxing and cajoling, which can set up a power struggle. Better to focus on more subtle strategies.
  • Serve meals and snacks at consistent times to build a routine that's expected.
  • Allow plenty of time for meals so the person doesn't feel rushed. If kids are present, don't make them fidget and wait until everyone has finished each course (which can make the person with dementia feel rushed or push her to say prematurely that she's finished). Serve the person with dementia at her own pace.
  • Help the person focus on the meal at hand: Turn off background noise. Remove clutter from the table (papers, books, napkin holders).
  • Another way to help focus is to highlight the plate and cup by putting them on a contrasting solid placemat (for example, white plate on red placemat). A study in Clinical Nutrition found that people with Alzheimer's eat and drink more when using high-contrast tableware.
  • Avoid patterned dishes or table coverings, which can be distracting.
  • Offer matter-of-fact, gentle prompts during the meal (in later stages of the disease): "Pick up the fork . . . scoop up the potatoes . . . take a bite."
  • Focus more on protein than perfect nutritional balance; serve foods with protein and calcium at each meal.
  • Tilt toward high-caloric, nutrition-dense foods for a birdlike eater, such as dishes made with cheese, butter, nut butters, whole milk. Casseroles can be a good choice, especially those found in older cookbooks published before today's low-fat craze.
  • Don't serve foods that are too hot.
  • If big meals just aren't consumed, break them up into snacks served at intervals (for example, eggs at breakfast, toast an hour or two later, a smoothie still later).
  • Look into Meals on Wheels or other programs to deliver a hot meal each day if, for example, an elderly spouse is the primary caregiver.

2. Eats too much

Possible causes
The person:

  • Forgets having eaten (even when he just left the table minutes earlier).
  • Loses the ability to register the sensation of fullness.

What to do

  • Serve food restaurant style (brought to the table all on one plate) rather than family style (with serving dishes on the table), which invites second and third helpings.
  • If the person is an all-day snacker, make the available snacks low-calorie and filling, such as popcorn, apple slices, raw vegetables with yogurt dip (make sure choking isn't a hazard).
  • Provide the person with plenty of activities to engage in to distract him between meals, since overeating may fill the vacuum of not having anything to do.
  • Store snacks out of sight and out of reach, so the person has to ask for them rather than help himself.
  • Don't deny the person food that you're eating yourself; instead, limit portions.
  • Reassess any of your own habits that might be encouraging the person with dementia to overeat (such as mindless eating while watching TV), given that he has less self-control.

3. Doesn't drink enough liquid (dehydration)

Possible causes
The person:

  • Loses the awareness of being thirsty.
  • Simply forgets to drink during the day or with meals.
  • Purposely doesn't drink because using the bathroom afterward is a physical challenge (either to use the commode or to get there in time, or both) or is something the person doesn't want to have to do in public.

What to do

  • Offer liquids throughout the day; don't wait for the person to ask.
  • Don't just hand over a glass; stand by and make sure the drink is actually sipped.
  • Vary the types of beverages offered: water, juice, milk, hot chocolate, cider. Even coffee, tea, and soda are okay in moderation (about a cup a day) if the person prefers them. The latest thinking is that a cup or two a day doesn't pose a diuretic effect that would lead to dehydration. For someone not consuming enough liquids, liquids in any form are probably beneficial.
  • Do, however, curb caffeinated beverages if fear of getting to the bathroom on time is an issue, as caffeinated drinks can cause frequent urination.
  • Issue mild reminders during the meal: "Have a sip of water . . . try the iced tea."
  • Leave athletic water bottles around the house or carry them around during the day. However, many older people aren't in the habit of drinking this way, so if it doesn't work, don't press the point.
  • Serve fruit, which contains a lot of water, especially watermelon, melon, and citrus.
  • Be sure you know the symptoms of dehydration: increased confusion or lethargy, complaints of headache, dry skin or mouth, feeling warm to the touch. Call the doctor, who may recommend a rehydration solution (such as Pedialyte). If you can't rehydrate the person by getting him to take liquids, and you don't see a change in symptoms, he may need IV (intravenous) hydration.
  • Know that diarrhea and vomiting increase the risk of dehydration, so monitor the person especially closely when he's ill, and notify the doctor if you suspect dehydration.

4. Messy eating

Possible causes
The person may have:

  • Lack of fine-motor control.
  • Lack of attentiveness.
  • Decreased interest in self-care and hygiene.
  • Any combination of the above.

What to do

  • Lower expectations and look the other way as much as you can. Spilled food can always be cleaned up.
  • Use a vinyl tablecloth, which is easily wiped clean, or paper placemats that can be discarded.
  • Place a napkin in the person's lap before serving food. (It might not stay there, but it's a start.)
  • Cut up foods before serving.
  • Serve fewer "risky" foods, such as sauces and condiments (mustard, ketchup, mayo). Preseason food before bringing it to the table.
  • If manipulating utensils is difficult, switch to a "spork," a combination spoon-fork often sold in camping stores. Spoons with thick handles are also easier to hold.
  • Serve finger foods that eliminate the need to use a utensil, such as fried chicken, chicken strips, pizza cut into bite-sized pieces, fish sticks, sandwiches. Cook eggs omelet-style and cut them into strips or squares that can be picked up.
  • At first, offer finger-food meals to everyone at the table, so the person is less apt to feel infantile.
  • Serve soup in a mug, not a bowl, and let it cool somewhat first.
  • Use unbreakable dishes or heavy ironstone that's less likely to slide around.
  • Choose plastic cups over glass ones.
  • Serve only one or two foods at a time.
  • Serve liquids in a cup with a spout (available in some hospital-supply stores), or pour only a small amount at a time into a small cup.
  • If you must point out a mistake (mustard smeared on the cheek), sound casual and surprised ("Oh, that mustard is so messy, let me help you get it off your cheek") rather than shaming or blaming.
  • Wash stained clothes at night so they're not worn repeatedly (a common behavior among people with Alzheimer's).

5. Goes on food jags

Possible causes

  • The person finds that familiar favorites are comfort foods, and anxiety may make these seem preferable.

What to do

  • Indulge food preferences as much as possible, provided the overall diet is reasonably balanced. It's okay to serve the same entrée day after day. (You can always cook something else for yourself.)
  • Serve the same food more than once in a day if it's requested.
  • Ask the doctor about adding vitamins if the diet seems unbalanced.
  • Consider preparing the food in different formats: A hot chicken breast might be refused, for example, while chicken soup or chicken salad might be eaten without complaint.
  • Try to serve old favorites from the person's childhood or prime of life; these are often still remembered and preferred.

6. Doesn't swallow, chokes

Possible causes
The person:

  • Finds it physically difficult to swallow (this is called dysphagia).
  • Forgets to chew.
  • Consumes food too rapidly.

What to do

  • Avoid hard foods: popcorn, nuts, hard candy, hard raw vegetables (such as carrots), hot dogs (unless finely diced), grapes, apples.
  • Avoid foods that require a lot of chewing: celery, steak, chips.
  • Avoid sticky foods such as peanut butter.
  • Mash up foods or puree them in a blender or baby-food grinder; finely dice meat and cheese.
  • Choose nonsolids, such as puddings, gelatins, applesauce, small-curd cottage cheese.
  • Try nutritional supplement drinks (such as Ensure).
  • Be sure liquids aren't too thin; they may be drunk too quickly, causing a choking hazard.
  • Choose thicker soups, purees, and smoothies, which are easiest for seniors with chewing and swallowing problems.

7. Self-feeding has become impossible

In addition to the suggestions above:

  • Be sure the person is sitting upright.
  • Alternate solids with sips of liquids.
  • Make foods more liquid as you feed -- for example, add extra milk to mashed potatoes.
  • Gently coach the person through feedings: "Okay, open your mouth . . . now close . . . now chew . . . swallow. . . ."
  • Try touching the person's chin or cheek as a gentle way to stimulate chewing.

 


7 months ago, said...

What if she does senseless things like pouring drinks onto the floor, food or table, tipping food out everywhere, rubbing food into clothes etc, and getting agitated and aggressive if you try to stop her from doing so?


7 months ago, said...

What if she does senseless things like pouring drinks onto the floor, food or table, tipping food out everywhere, rubbing food into clothes etc, and getting agitated and aggressive if you try to stop her from doing so?


9 months ago, said...

My wife has severe scoliosis and is tipped sideways so that when she eats food it often falls onto her lap or the floor. Are there things like adult plastic bibs which would help or can you get specialist chairs which would hel her to stay more upright?


9 months ago, said...

For kchalifour: My husband and I are the primary caregivers for my father. I discovered that my father likes to open his own bottles of water (Dasani is fabulous with no plastic bottle aftertaste), and open his own bottle of Boost. While my husband thought he was helping when he opened bottles, etc, my father then would not drink as he should...it was quite odd. he also is becoming rather picky about food, and refuses "beige" food (except Asian pears...now out of season..), and while he has always loved quesadillas, today he made a face that was pretty hurtful (much like children make). So, for some reason aesthetics is becoming really important to him. If his smoothie is dark (like with blueberries) it doesn't get the "play" that a smoothie made with raspberries gets. Check the flavor of your mother's meal replacement shakes. My father won't drink chocolate Boost, as he says it tastes chalky, but loves the vanilla and the strawberry. There again...color may play a role in your mother's refusal. Hope this helps.


9 months ago, said...

For Florida26: Visit a sight called "TheWrightStuff" They specialize in many items I have not seen anywhere else. You might find the perfect utensils for your husband, as they have different utensils for different needs.


10 months ago, said...

To: kchalifour , The best advice I can give you is to go there at meal time and feed her. Nursing homes won't feed them. They say the resident has the right to refuse. I don't think thats right because they can't make a decision like that. Thats why she was placed in the Nursing home.


10 months ago, said...

My husband has Frontotemporal Dementia and eats well, but chews on the fork and spoon, biting on the tines of the fork. I am looking for hard plastic utensils so that if he chews on them, he won't crack his teeth. Any help will be appreciated.


10 months ago, said...

Hi, my mom is 68 years old and was put in a nursing home in late December due to late stages of Althziemers. Since she was placed in tge home sge has lost 0vet 30 pounds since being placed 2 months ago. She refuses to eat or drink her meal replacement shakes. I'm wondering if anyone would know of ways to get her to eat or meal ideas or anything that will help her to get some nurishment. I'm so worried about her.


about 1 year ago, said...

Hi, my name is Mary and my dad is 85 years old and My sister thinks he has diamentra what are the symptoms and how do we know for sure?


about 1 year ago, said...

I wanted to add a few tips about not eating or drinking enough. I have someone help a few times a week and noticed a problem when she fed my Mom lunch, vs. me feeding lunch. It's a simple lunch, but the difference we discovreed is that I brought my Mom in the kitchen while preparing and it's done superfresh before her eyes and she gets to SMELL the food, the toast toasting, for example, and the hot soup. . I completely underestimated the power of AROMA to stimulate appetite. I also make a process of having an nice variety of flavored herbal teas (e.g. various Celestial Seasonings flavors, such as black cherry, raspberry, etc) and would show her two boxes to ask what she would like to drink after her meal. The AROMA of the tea is appealing and a relaxing moment after eating her meal. They usually aid in her digestion as well as give her a relaxing time after her meal as she may take her meds with them too. This guarantees three full drinks minimum each day.


about 1 year ago, said...

Please look at the medications your loved ones are on for dementia or for what ever. Momma's medicines all have the side effect of poor or no appetite. Also the med's have their own side effect interactions which are harmful. Just because the Dr. prescribes it doesn't mean it is working or good for the patient. If you have a say read your warnings look at how or what or what not is happening or what is happening. Use your voice. It could save your loved ones and help them. And help you! Zyprexa very bad causes rapid heat beat eventually no two ways about it cardiac arrest.. If your loved ones are not psycotic don't give them drugs like that. It will make them like Zombies. Lexapro also no no..it takes their mind away. Aricept for dementia doesn't do any good but it does make you have high blood pressure. High enough you will need two blood pressure med's then you will need eliquis blood thinner that causes internal bleeding.all of these which take your appetite but don't fear now they give you megestrol to give you an appetite but that sends you back to rapid heart rate which eventually you will be back in the hospital with congestive heart failure same side effects as prolonged zyprexa. FDA did a report stating zyprexa is not for elderly dementia patients. Why didn't anyone get the memo? I was told by a Dr. That Dr.s get a kick back for every prescription they write if this is true there you go. Look carefully at all medication. All side effects. Remember one day this could be you. Treat everyone with love, respect and kindness. Read your warning and look at the patient carefully with love. Use God to help you understand the ropes. You are now the eyes..the ears..and the heart for your loved ones. God bless you all...x..o


about 1 year ago, said...

After posting my article a few minutes ago. I read some of the other articles. I am so sorry life is so hard for you and your loved ones. After reading your articles I realized my Momma doesn't have the problem my siblings have the problem. Your parents won't eat mine will. Either the siblings are too lazy to fix the food or in to big of a hurry with their life to take the time. Or they don't have the patience. Or they plain ole just don't care. That simple!..Thank God I do...Momma will get stronger and come back 100%. With God all things are possible! Thank you all and God bless you with your parents and friends. Please remember they are human. But most of all remember they are in there somewhere. Time and lots of patience and LOVE are needed. What if that was you?! How would you want to be treated. Dignity and Respect. God bless all of you always and forever.. We all need that...x..o


about 1 year ago, said...

My Momma has drug induced dementia. My siblings and I care for Momma at her house.The siblings just started taking her to their houses. We have Momma two days on two days off. Then five days on and five days on. The siblings started giving Momma boost or some other protien shake in her cappuccino which my brother stated she drinks that - - - t three times a day. And now on their daily log fruit smoothie which no ingredients are listed dont know if it is made fresh or not with very little or no solid food at all So when it is my time and I cook her fresh vegetables and whole meals her stomach is so shrunk and her desire for real food is just not there. It is a struggle to get her to eat. If I sit long enough eating my food she gradually eats. I am happy when she eats what ever portion she eats and I tell her she ate great. Only being served liguids with very little or no food at all five days then feeding her solids is also impacking her intestines. I thought fresh fruits and vegetables along with the chewing process and digestion process is important. Momma has teeth. Why they started boost ect. I don't know. Momma does eat if you fix what she likes when she wants it which is usually pretty much on the reguar scheduled breakfast, lunch, or dinner times. I give her small meal portions and snacks in between her meals. Am I wrong to cook real meals with solid food. I thought boost, etc. was a supplement. Boost like to boost or add to a small appetite not a 24/7 main course in cappuccino three times a day for a meal plan. I thought food was fuel for your body. I feel eating and remembering to eat is important. Momma even ask me for certain foods at times that really makes me feel good. Happy! She wants to eat. To recover I feel food is a very important part of the process. We are what we eat. I know liquids are important too. Momma drinks lots of water with an orange, lemon, lime, or mango squeezed in it. Any ideas would be greatly appreciated. This is not a food challenge between the siblings but me wanting a speedy revovery for Momma's health and to get her mental state back. I want her 100%. Momma is a treasure. Now I have put a Kelloggs protien shake in Momma's cappuccino for breakfast before but along with a complete meal not just as a meal. I try to keep her away from caffiene as much as possible. She does have her coke every once in a while. She will ask for water or do we have a nice coke.That gives me hope when she knows what she wants and ask for it. Thank you and God bless you


about 1 year ago, said...

My sister has been in an Alzheimer's unit for 6 years now. She is at the point where she is only given pureed food and thickened liquids. She must have had a stroke at some point because the left side of her mouth droops. She packs food in her mouth, forgets to swallow, falls asleep while she is eating, and because of the drooping side of her mouth everything wants to fall out. I found the comment someone made about pressing a spoon against her tongue to provoke her to swallow to be very encouraging. I plan to try it the next time I feed her. But she still looks at me like she knows me and smiles sometimes. I found your article very interesting.


over 1 year ago, said...

I received a phone call from the facility where by mother is living and during the coloring time she ate a blue crayon. I'm shocked... Why would she mistake it for food?


over 1 year ago, said...

I have a alzheimer's wife and she has begun to sleep all day and when it comes to drinking she may take a sip and then fights me, she use to drink well through a straw but now she just blows bubbles. I have to hold the cup or bottle up to her mouth. Sometimes it doesn't look like she's taking in any of the liquid. How do I get her to drink? Feeding her is getting more difficult as well. She doesn't want to open her mouth, and she will just try to nibble on the tip of the spoon. What do I do? Please help!