Eating Challenges with Alzheimer’s and Dementia

Alzheimer’s and dementia often present numerous eating challenges. Regular, nutritious meals are important to maintain, as poor nutrition and eating habits can aggravate confusion and lead to physical decline. These tips will help you understand what causes eating challenges with dementia in your loved one with Alzheimer’s/dementia, and how you can encourage good nutrition in each stage of the disease.

In the early stages of Alzheimer’s/dementia, your loved one may forget to eat and lose the skill needed to plan for and prepare nutritious meals. As the disease progresses, your loved one may experience a diminished sense of smell and taste, which can cause a loss of interest in eating. Your loved one may also lose the ability to effectively use utensils necessary to eat. Agitation and distraction may affect mealtime greatly, so it will be important to plan for a distraction-free and consistent mealtime. In the later stages of the disease, your loved one will experience difficulty chewing and swallowing, which will challenge your ability to ensure proper nutrition.

Tips to Improve Nutrition

• Maintain familiar routines.
• Don’t rush mealtime.
• Don’t worry about messes!
• Offer favorite foods and drinks.
• Check food temperature before offering.
• Offer vegetables, fruits, whole grains and lean proteins.
• Cut down on refined sugars, high saturated fats, high salt and cholesterol.
• Provide foods that are calorie-dense and dementia-friendly: peanut butter sandwiches, milkshakes with added protein supplement, pudding cups, ice cream, pureed fruit and sweetened yogurt.
• Keep distractions to a minimum; use a soothing voice and turn off the TV and cell phones. Calming music may be helpful.
• Be sure your loved one is in a seated position at 90 degrees to prevent choking.
• Serve meals on bright, solid-colored dishes. A color contrast between the tableware or placemat and the dinnerware serves as a visual cue for self-feeding.
• Your loved one may need assistance at meals to increase caloric intake. If she says that she does not want to eat more, allow her to rest, and then try to get her to eat more with your assistance.
• Be mindful of textures that she is most responsive to.
• Place a beverage directly in front of your loved one, not off to the side.
• Be sure dentures are in place for all meals and secure with denture adhesive if necessary. If your loved one is refusing to wear his or her dentures, it may be dental issues or it may be necessary to modify the diet.
• Bowls are easier than plates. Spoons are easier than forks.
• Bowls with suction cups are helpful.
• Use straws or lidded cups for liquids.
• Offer one or two types of food at a time, in small portions.
• Offer three meals and snacks, or smaller meals throughout the day.
• Provide the major caloric meal early in the day.
• Add butter, syrup and dipping sauces to increase calories.
• Offer foods that are easy to chew and swallow. Avoid popcorn, nuts, raw vegetables and other foods that are difficult to chew.
• Remind your loved one to thoroughly chew and swallow carefully throughout the meal.
• Cut food into bite-sized portions. Finger foods are even easier: pieces of fruit, cheese, crackers and other snacks.
• Eating your meal with your loved one often improves intake.
• Your loved one’s physician may add supplements if weight loss and nutrition are a problem. You may consider adding an instant breakfast drink mixed with ice cream.

Staying Hydrated

Staying hydrated can be one of the bigger challenges in your loved one with Alzheimer’s/dementia. Offering small cups of water and fluids throughout the day is very important. Be sure adequate amounts of liquids are consumed at meals. Generally, your loved one may not request something to drink—you need to provide it to her. A health shake between meals may be a way to hydrate her as well as provide added calories. Offer other foods with high water content, such as fruit, soups and smoothies. It may be necessary to offer fluids every two hours to maintain hydration.

Watching for signs of dehydration will be imperative in maintaining your loved one’s overall health: 

• Weight loss of two pounds or more in a 24-hour period
• Increased confusion
• Dizziness or headaches
• Dry mouth
• Sunken eyes
• Inability to sweat or produce tears
• Rapid heart rate
• Low blood pressure

Staying Alert for Swallowing Difficulty

“Dysphagia,” or difficulty swallowing, often occurs in the late stages of Alzheimer’s disease when the patient loses the gag reflex and has decreased levels of consciousness. Ensure that your loved one is sitting up straight with her head slightly forward when eating. At the end of every meal, be sure and check your loved one’s mouth to ensure that all food has been chewed and swallowed. Aspiration pneumonia is a leading cause of death in those with Alzheimer’s, so it is critical you watch for the signs of dysphagia and refer to a speech therapist when you notice these signs:

• Coughing or choking at meals

• Wet vocal quality during or after meals
• Decrease in the amount of food eaten
• Increasing time and effort spent at mealtime
• Food, liquids or saliva leaking out of the mouth
• ‘Cheeking,’ or holding foods in the mouth instead of swallowing them
• Spitting out food
• Difficulty swallowing medications
• Unexplained weight loss
• Excessive drooling
• Eating too fast, or cramming food into the mouth
• Extended chewing before swallowing
• Clearing throat frequently during a meal
• Dehydration
• Chest congestion
• Aspiration pneumonia

Combating Swallowing Challenges

Using all of the techniques mentioned above will help combat swallowing challenges in your loved one. In the later stages, offering pureed foods and a soft diet will help aid in swallowing. Using a commercial thickener like “Thick-It” in thin liquids may also be recommended for your loved one with swallowing challenges. Thickened liquids won’t trickle down the throat as readily as thin liquids and are less likely to cause coughing, choking and aspiration. Your loved one’s physician, speech therapist or nurse will recommend the thickness necessary, depending upon the patient’s ability to chew and swallow. If your loved one is on thickened liquids, then ALL liquids provided must be thickened to the recommended consistency.

The clinician will recommend the minimal level of thickness needed for swallowing safety. As with anything, there are benefits to these thickening agents, but there are also risks. These preparations don’t work for everyone, and in some cases, they can lead to dehydration. They may also reduce the effectiveness of medications when taken together with the thickening agent.

Things to be Alert to When Feeding Your Loved One

In the later stages of the disease, it may become necessary for you to feed your loved one in order to maintain safety and nutrition. When it comes to this, be sure to follow the above pointers on eating and maintain a relaxed, comfortable environment, sticking to a routine. It will be very important for you to take your time with feeding, to avoid choking and agitation. Never rush your loved one when it comes to feeding.

Follow these additional pointers to ensure feeding success!

• Be sure that the last bite has been swallowed before the next is provided.
• Give only small bites of food on a spoon.
• You may need to be prepared to give the next bite after your loved one swallows the last bite, to maintain her interest in eating.
• If your loved one has difficulty opening her mouth for food entry, you may brush a spoon against the lips, to aid in opening her mouth.
• You may gently brush her cheeks and neck to encourage swallowing.
• Place food well into the mouth to assist with chewing.
• Frequent cueing may be necessary, i.e.: “Open your mouth, chew the food, and now swallow.”
• Alternating liquids with solids may assist with swallowing each bite.
• Check for pocketing. Food must be cleared before adding the next bite.
• It’s best to end with liquids.

For more helpful resources to assist in caring for a loved one with Alzheimer’s, or to learn more about our highly specialized Connections Dementia Care Program, contact the expert in dementia care in Phoenix and the nearby areas, Nightingale Homecare, at (602) 504-1555.