The two most common types of dementia, Alzheimer’s disease and vascular dementia, affect memory, language, thinking skills, attention span, and perception. These characteristics challenge eating and nutrition. Coupled with age-related changes in appetite, thirst, and sense of smell and taste, dementia can stir up difficulties with eating behaviors and mealtimes. Here are some tips to maintain and build nutritional status in people with dementia:
1. Create the right dining environment
Since people with dementia can be confused and overwhelmed, it’s best to keep mealtime simple and to minimize distractions. Centerpieces, extra silverware, and multiple foods can cause confusion. Offering one or two foods at a time may increase focus and food consumed.
Some people benefit from a quiet environment free of televisions, loud music, distracting conversations, areas with increased foot traffic, or windows. Also remember that verbal cues and food setup such as opening containers, taking off lids, and removing silverware from packaging may be necessary.
Finger foods like quartered sandwiches, cheese and crackers, and sliced fruits and vegetables encourage independence during mealtime since ability to use silverware is not a limiting factor.
2. Observe mealtime
Caregivers like speech language pathologists, occupational therapists, dietitians, nurses, and aides can obtain valuable insight into food preferences and eating concerns though meal rounds.
Since people with dementia may have trouble expressing their preferences, observing the foods eaten allows for customization of future meals. You may notice that someone always refuses peas or takes beverages from a straw better than a cup. This is a good time to watch for signs and symptoms of dysphagia (trouble swallowing) like pocketing food, coughing, choking, or food or beverages spilling out of the mouth, which warrant further swallow evaluation.
3. Go with the flow
Anticipate that mealtimes may take longer or be extra messy. This is normal. People with dementia are constantly changing. Someone who loved pasta previously may not desire it again. People may forget that a meal already happened and insist on having another one. If this happens, make the most of it. Offer “multiple” meals like salmon followed by mashed potatoes, and then green beans during this time to boost overall food intake.
4. Focus on high-calorie and high-protein foods
Weight loss can be a serious issue with dementia. To build or maintain weight:
- Encourage small frequent meals; i.e., three meals and three snacks a day to help reach calorie goals.
- 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.
- Liberalize meals. When a person with dementia has multiple dietary restrictions such as consistent carbohydrate and heart healthy on top of a modified consistency like pureed or mechanical soft, foods can be overly restricted and decrease the amount of food consumed. General food plans with only restrictions in consistency determined by speech language pathology will allow for the most food choices.
Just remember that each person is different and care must be individualized depending on specific needs and through observation.
Try my recipe for a delicious chocolate avocado pudding that can double as a dessert or snack.
Also try my recipe for poached salmon salad—a tasty summertime meal that’s easy and nutritious.
And my recipe for cardamom apple parsnip soup is great for fall!
Also try my slow cooker tarragon chicken and potatoes recipe. The savory scents are cozy for winter, and everyone’s tastebuds will be happy too.
And finally, try my recipe for pasta with chicken and vegetables. It's wonderful for welcoming in the spring!
I hope you find these tips helpful, and that my seasonal recipes help you make mealtime brighter for everyone. For more dementia caregiver tips, check out CPI's eBook on communication below!
ABOUT THE AUTHOR
Andrea Anderson, RDN, CD, CDE is a registered dietitian nutritionist and certified diabetes educator. She earned a Bachelor of Science in dietetics from the University of Wisconsin – Madison and later completed her dietetic internship at Loyola University Chicago. Since 2007, Andrea has served as a registered dietitian nutritionist at hospitals in Chicago and Milwaukee. Currently she’s active in the outpatient setting, specializing in diabetes and weight management.