Diets Debunked

Dementia is a progressive condition that affects cognitive function, memory, and behaviour. One of the lesser discussed but critically important aspects of dementia care is nutrition. People living with dementia often face significant challenges in maintaining a healthy diet, which can lead to weight loss, dehydration, malnutrition, and a decline in overall health. Understanding these challenges and implementing effective strategies can help improve quality of life for individuals with dementia.

How Dementia Affects Nutrition

Dementia can impact nutrition in several ways, primarily due to cognitive and physical changes that alter eating habits and food intake. Below are some key ways dementia influences nutritional status:

1. Memory Loss and Forgetfulness

• Individuals may forget to eat or drink, struggle to recognise food, or believe they have already eaten when they have not.
• They might leave meals unfinished or lose track of mealtimes altogether.

2. Difficulty with Meal Preparation

• Dementia can impair the ability to plan and cook meals safely, and can impact all levels of cooking preparation, such as writing a list, shopping for ingredients, knowing how to put those ingredients together in a meal and may also be unable to safely use kitchen equipment.
• Individuals may struggle to follow recipes, use kitchen appliances, or even remember how to perform basic tasks like boiling water.

3. Sensory and Perception Changes

• Changes in vision and smell can make food less appealing; often, taste changes can lead to very unusual preferences for food, such as disliking savoury sauces and instead preferring sweet sauces on savoury meals (due to the ability to recognise sweet foods being the last thing to deteriorate).
• Some people may confuse items (e.g., thinking a fork is a comb) and this can prevent them from eating appropriately.
• Depth perception can change, meaning a glass of water in a clear glass becomes difficult to see and distinguish from the background, leading to dehydration.
• The ability to see food on a plate can also be altered; food on a patterned plate or a plate with little contrast will blend in, and so may not be recognised as food.

4. Swallowing Difficulties (Dysphagia)

• As dementia progresses, muscle control can weaken, leading to difficulties in chewing and swallowing.
• This increases the risk of choking, aspiration pneumonia, and reduced food intake due to fear or discomfort.
• Many individuals with dementia will require a modified diet or thickened, which in and of itself can be unappealing and reduce dietary intake.

5. Altered Taste and Appetite

• Some individuals lose their sense of taste or develop a preference for very sweet or salty foods as mentioned above.
• Appetite fluctuations are common, with some people overeating while others lose interest in food entirely.

6. Behavioural and Psychological Symptoms

• Agitation, confusion, or resistance to care can make mealtimes challenging.
• Some individuals may refuse food due to paranoia or distrust.

Managing Nutritional Challenges in Dementia

Addressing these challenges requires a tailored approach that considers the individual’s preferences, abilities, and stage of dementia. Below are some practical strategies to help manage nutritional difficulties:

1. Establish a Routine

• Serve meals at consistent times each day to create structure.
• Use visual cues, such as setting the table or gentle reminders, to prompt eating.

2. Adapt Food Presentation

• Use contrasting plate colours (e.g., a red plate for yellow foods, a blue plate for orange foods) to help distinguish food from the dish.
• Offer finger foods if utensils are confusing, such as sandwiches, cheese cubes, or fruit slices. Finger foods can also be helpful if the individual finds it difficult to stay still and prefers to eat whilst moving around.

3. Enhance Flavour and Texture

• If taste perception is diminished, use herbs and spices to make food more appealing.
• You may want to consider using sweet sauces if the individual has a sweet tooth, even if that sauce does not necessarily go with the meal (for example, some people may like custard on pies, or sweet condiments like jam or ketchup on foods which it would not usually go)
• For those with chewing or swallowing difficulties, modify textures (e.g., pureed or soft foods) as per guidance from a Speech and Language Therapist while keeping meals nutritious.

4. Encourage Hydration

• Dehydration is common in dementia. Offer fluids regularly, including water, soups, and hydrating fruits like melon.
• Some specifically designed foods, such as Water Drops or Jelly Drops can also be useful if the individual likes sweet foods.
• Use solid, primary colour cups (such as a red or yellow cup) to help with the individual being able to recognise the fluid.
• Adapt cups by adding straws, beaker lids or two handles to help with independence.

5. Supervise and Assist Without Rushing

• Allow plenty of time for meals to reduce stress.
• Ask questions such as “are you enjoying this food?” or “isn’t this delicious!” if the individual stops showing interest in the meal.
• Offer gentle prompts or hand-over-hand guidance if needed, but avoid forcing food.
• Offer other foods which are commonly accepted if food is rejected at mealtimes.

6. Monitor Weight and Nutritional Intake

• Regular weight checks can help identify malnutrition early- aim to weigh at least once per week.
• Refer to a dietitian, or see your GP for a referral if weight starts becoming a concern (a weight loss of 5% or more)

7. Address Swallowing Difficulties Safely

• Consult a speech and language therapist for tailored advice on safe swallowing techniques.
• Adjust food textures as recommended (e.g., thickened liquids or soft, moist foods).

8. Create a Calm Mealtime Environment

• Reduce distractions like loud noises or TV to help focus on eating.
• Keep the setting familiar and comfortable to minimise anxiety.

9. Involve the Person in Food Choices

• Where possible, allow the individual to select foods they enjoy to maintain a sense of independence. Asking what they would like out of a few set options can help them better make a decision, rather than asking them an open question such as “what do you want?”.
• Adapt meals to past preferences, as familiar foods may be more readily accepted.

Conclusion

Nutritional challenges in dementia are complex and multifaceted, but with thoughtful strategies, they can be managed effectively. By understanding how dementia impacts eating behaviours and adapting care approaches accordingly, caregivers can help maintain adequate nutrition, prevent complications, and support overall wellbeing.

If you are caring for someone with dementia and are concerned about their nutritional intake, consulting a dietitian or healthcare professional can provide personalised guidance. Small adjustments can make a significant difference in ensuring that mealtimes remain a positive and nourishing experience.