For individuals with dementia, it is very important to maintain good nutrition in order to prevent deconditioning and malnutrition. It is common for people with dementia to find eating meals a challenge as dementia progresses, and this can contribute to weight loss.

Individuals with dementia may experience:

• Changes in appetite and intake
• Concerns with teeth, gums, oral mucosa, dry mouth
• Changes in taste and smell
• Loss of memory about how to chew or swallow
• Challenges at the dining table such as being easily distracted or confused, unable to identify what to do with cutlery and eating.

Good nutrition

For those over the age of 65yo, having a varied and well-balanced diet including, daily:

• 2-2.5 serves of meat and meat alternatives,
• 3.5-4 serves of dairy food,
• 3-4.5 serves of grain foods,
• 2 serves of fruit and 5 serves of vegetables.

As dementia progresses and various changes and challenges present themselves, it is common for weight loss to occur. For people who experience an increase in physical activity such as wandering or pacing, or those with various medical conditions or other energy expending conditions such as wounds, higher protein and calorie intakes are needed to prevent weight loss.

To minimise the stress associated with meal times and to assist with improving nutrition, the following suggestions may be of benefit:

Poor appetite

Loss of appetite can occur due to any of the following: difficulties with chewing and swallowing, poor dentition (including poorly fitting dentures), changes in tastes and smell, reduced physical activity, stress associated with reduced function, depression, impact of medication, and bowel issues such as constipation.

To improve intake, try these suggestions:

• Aim for 6 small meals/snacks instead of 3 larger main meals. Mid meal snacks are just as important as the main meal, and should be more substantial than a cup of tea and a plain biscuit.
• Offer protein choices at mid-meals e.g biscuits and cheese, yoghurt, milk pudding
• Offer nourishing milkshakes and snacks between meals
• Prepare familiar foods in familiar ways, especially foods that are favourites.
• Fortify meals with extra energy and protein to ensure that every mouthful counts
• Assist where required

Chewing and swallowing difficulties

• Ensure regular dental check-ups to check gums, teeth and dentures
• Check the mouth for soreness, ulcers
• Alter diet texture to include foods that are soft and easier to chew and swallow.
• Avoid hard and crunchy foods
• Add gravy and sauces to food to make them more moist
• Verbally prompt with chewing, and demonstrate the action of chewing at meal, snack times
• Consider referral to a Speech Pathologist to assess difficulties with chewing and swallowing and recommend strategies

Dry mouth and taste/ smell changes

The thirst response reduces as you age, meaning you can be dehydrated before you even notice you are thirsty. This can affect how much you eat.

• Ensure adequate fluid during the day – aim for at least 1.6L
• Alter the texture of foods to maximise intake
• Serve food with gravies and sauces to help moisten the food, and also to add flavour
• Alternate drinking and eating to assist with swallowing food
• Work with taste changes and offer foods that are preferred/ favourites
• Ensure meals are presented at the correct temperature – this increases the aroma of food, and can stimulate appetite
• Consider referral to a Speech Pathologist for ideas for managing dry mouth

Meal time challenges

It is common for meal times to become a challenge. Sitting at the table, using cutlery, remembering how to eat, can become difficult over time.

Tips for improving meal times:

• Eat together. Demonstrate how to eat - prompt and remind the resident how to feed themselves, rather than assuming assistance is required. This is important for maintaining independence
• Assist as required
• Consider using plate guards, modified cutlery as required
• Use non spill cups – these can be used for soup as well
• Make finger foods available at every meal. Most foods can be adapted to be hand held, which not only reduces stress, but also makes it easier to eat, when using cutlery is a struggle.
• (For many great finger food ideas, Food Solutions has an extensive “Finger Food Resource” available. Ask your Food Solutions Dietitian about this).
• Dementia may lead to changed sleeping patterns including being awake through the night and sleeping through day. Often meals are missed as a result. Meals, snacks and drinks should be made available outside usual meal time hours, and missed meals should be made up in “awake times” to ensure the person is not routinely missing nutrition opportunities.

The dining environment

Making small changes to the meal environment may help to keep the person with dementia engaged in the meal time experience, maintaining their independence and dignity.

• Encourage the resident to eat meals in the dining room to promote social interaction. This also increases the opportunities for encouraging nutrition and addressing any issues as soon as they come up.
• Have the meal ready before assisting the person to the table, to avoid having them wait
• Reduce distractions (turn the TV off)
• Ensure the environment is pleasant – soft music, comfortable temperature, adequate lighting, appropriate seating are important.
• Cater to specific tastes and preferences
• Ensure meals are presented in a visually appealing way
• Ensure foods are colourful and contrast with the plate and table cloth.
• Avoid patterns on crockery and table cloths
• Minimize the number of items on the table – remove “clutter”
• Serve one course at a time
• Allow plenty of time and don’t rush to clear the table
• Make meal times enjoyable

Dementia is unpredictable, with some goods days and some bad. Maximising eating opportunities on the good days can help to balance intake over the longer term. If after trying the above suggestions, a resident’s intake and weight loss are still a concern, seek assistance.

Your Dietitian can provide additional nutrition and meal options.