Understanding dementia – eating and drinking

Dementia, diet and eating habits

In some adults, dementia can affect interest in food and drink or the ability to eat and drink.   These changes can lead to poor health and distress for those living with dementia and those who love and care for them. 

Everyone has a different experience of dementia but understanding common eating and drinking problems can help you to identify the right support for anyone who is affected by them. 

Those living with dementia can experience a combination of brain, physical and behavioural changes which can make eating and drinking increasingly challenging.   Eating problems are thought to affect over 80% of those living with advanced disease increasing the risks of problems like unintentional weight loss, malnutrition, and dehydration.  

Dementia related changes which can affect eating or drinking 

This short video is a helpful introduction to this topic.

What can you do to help someone with dementia who has problems eating or drinking?

You should ensure that anyone affected by dementia can access the best care and support available.  There is plenty of expert help available via the NHS and a GP can easily advise and refer as appropriate:  

Swallowing difficulties should always be assessed urgently 

Difficulty swallowing is also known as dysphagia. You should ensure that someone with dysphagia is urgently assessed by an expert.  NHS speech and language therapists are the most appropriate experts to undertake an assessment and recommend further investigations, advice and care.   

This information from Government health experts in Northern Ireland is a very clear and helpful resource along with this from a NHS Trust.

Avoiding weight loss, malnutrition and dehydration

NHS dietitians can help to ensure someone gets the best nutritional care to avoid weight loss, dehydration, malnutrition or other diet related problems.   

Their approach usually takes the following topics into account: 

1. A full and detailed assessment of the nutritional requirements  alongside the practical difficulties and challenges 
2. Food fortification  – in the initial stages they will try and maximise the amount of nutrients  a patient eats or drinks.  This is not just about eating lots of calories, it’s about ensuring that each meal and snack contains all the necessary foods required for health including plenty of protein, vitamins and minerals alongside fats and carbohydrate.  The term used is “nutrient-dense” foods and typical examples might be about adding skimmed milk powder to any rice pudding
3. Finger foods  – foods that can be picked up and eaten by hand can help to improve food intake.   This is not about typical “party buffet”  foods, it might be a roast dinner with chunks of meat and roast potatoes alongside vegetable batons.   This approach can help adults who find it difficult to use cutlery or prefer to wander around at mealtimes
4. Food texture – changing the texture of food can help those who have chewing or swallowing difficulties.  Soft foods like mashed potato, stews, scrambled egg, fortified yoghurt can be useful
5. Food flavour and smell – strong flavours and smells can help to distinguish food and make it more attractive. Adding savoury seasonings like vinegar, herbs and spices or sweet flavours like honey or jam can help to make food more palatable
6. Mealtime arrangements – when and how meals are served can all make a difference to the ease or pleasure of eating.   Common approaches, depending on individual needs and setting, include:
   •  improving visual cues by using colour -contrasting plates, mats or tablecloths.  
   • Minimising distractions such as the TV, radio, cluttered place settings
   • Using eating aids such as adapted cutlery or cups  
   • Involving the person with dementia in preparing meals,  serving foods or clearing up afterwards. 
   • Providing plenty of time for meals
7. Prescribing oral food supplements  – these are typically in the form of yoghurts, juices or milks which have been fortified  with all the necessary nutrients.  They can seem like a quick fix or easy solution but are well regulated to ensure that they are not used unless the dietary changes listed above are inadequate
8. Tube feeding  – if all of the methods described above are not working, or if someone has a severe swallowing problem then this approach might be used.  This approach is not pleasant for individuals and carries other risks and so it is not recommended unless it is in the person’s best interests. 

Other support and information

The internet is awash with advice about helping people with dementia.  When it comes to any eating, drinking or swallowing difficulties you should always seek expert medical advice. 

• Swallowing or dietary problems might not be due to dementia  – they can also be signs of serious underlying medical problems 
• Swallowing problems can be life threatening and should be urgently assessed and managed by an expert (often by a speech and language therapist).   
• Expert help for other eating or drinking difficulties is also essential to assess the cause and to ensure that the person affected does not develop dehydration or malnutrition

The most helpful information we have found is this great leaflet which has been produced by experts working with the Public Health Agency in Northern Ireland.