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Eating Well with Dementia
The proverbial saying, “You are what you eat” shows the importance of eating well for everyone. Eating well is more than just having a balanced nutrition intake; promoting an enjoyable eating experience is also as important. For individuals with dementia, having a quality, nutritious diet and enjoyable mealtime experiences can improve well-being and overall quality of life.
Eating Well with Dementia
The proverbial saying, “You are what you eat” shows the importance of eating well for everyone. Eating well is more than just having a balanced nutrition intake; promoting an enjoyable eating experience is also as important. For individuals with dementia, having a quality, nutritious diet and enjoyable mealtime experiences can improve well-being and overall quality of life.
Undernutrition Among Individuals with Dementia
Undernutrition among individuals with dementia is a prevalent issue that leads to increased frailty, susceptibility to falls, skin fragility, hospitalizations, and even mortality.[1] Undernutrition often worsens as dementia progresses, with weight loss typically seen prior to the onset of cognitive decline.[2],[3]
Contributing factors for undernutrition in dementia are complex. Some examples include reduced appetite and increased behavioural disturbances that disrupt eating patterns.[4] Insufficient intake of essential nutrients, weight loss, and dehydration can lead to increased agitation, confusion, and other disturbances in individuals with dementia.
It is important to understand the factors impacting eating behaviour and implement strategies to enhance the eating experience. Doing so will be essential to preventing undernutrition among individuals with dementia.
Undernutrition Among Individuals with Dementia
Undernutrition among individuals with dementia is a prevalent issue that leads to increased frailty, susceptibility to falls, skin fragility, hospitalizations, and even mortality.[1] Undernutrition often worsens as dementia progresses, with weight loss typically seen prior to the onset of cognitive decline.[2],[3]
Contributing factors for undernutrition in dementia are complex. Some examples include reduced appetite and increased behavioural disturbances that disrupt eating patterns.[4] Insufficient intake of essential nutrients, weight loss, and dehydration can lead to increased agitation, confusion, and other disturbances in individuals with dementia.
It is important to understand the factors impacting eating behaviour and implement strategies to enhance the eating experience. Doing so will be essential to preventing undernutrition among individuals with dementia.
Common Factors Influencing Eating Behaviours in Individuals with Dementia
Dysphagia (Swallowing Difficulties)
Dysphagia refers to the difficulty in swallowing, and the inability to transport food safely and effectively from the mouth to the stomach.
Individuals with dysphagia commonly experience difficulties in eating or drinking, swallowing saliva, or taking medicines. Considering these uncomfortable symptoms, individuals with dysphagia often experience decreased appetite or may refuse to eat.
Moreover, a study found that individuals with dementia who experience dysphagia show a high prevalence of impaired swallowing safety and efficacy, and significant airway protection impairments[5].
Causes of Dysphagia[6]
In general, dysphagia is caused by damage to the muscles or nerves that control swallowing. Muscle loss due to aging may impact teeth-grinding and tongue-pressing, leading to swallowing difficulties. In addition, symptoms of dysphagia are often attributed to nervous system damage caused by dementia or stroke[7].
The main symptoms of dysphagia occur when swallowing food, such as:
- Pain while swallowing
- Inability to swallow
- Food remains in the mouth, causing bad breath
- Food or drink coming out of mouth, or regurgitation
- A sensation of food getting stuck in esophagus, or “stuck up” in throat when eating
- Taking a long time and a lot of effort to chew or swallow
- Coughing, wheezing, throat clearing or phlegm
- Choking when eating or drinking
- Hoarseness
If you or your loved ones regularly experience difficulty swallowing or notice weight loss, regurgitation, or vomiting alongside dysphagia, it is important to consult your healthcare provider and ask for a referral to a speech and language therapist. If you or your loved ones experience an obstruction that affects breathing, seek emergency help immediately.
Decline in Cognitive Abilities
The eating process involves many neurodevelopmental capabilities such as information intake and processing, opinion forming, decision-making, and action coordination. In other words, when it comes to eating, many cognitive processes need to take place.[8]
Individuals need to decide what to eat, how often, and how much to eat, among other things. As such, cognitive decline caused by dementia can reduce appetite and disrupt the eating habits of individuals with dementia.
Some common challenges individuals with dementia face include:
- Difficulties in concentration: Individuals with dementia may have difficulty maintaining concentration, which can lead to skipping meals or struggling to stay engaged with their meals from start to finish.
- Memory loss and decline in functional abilities: Individuals with dementia may forget how to eat or whether they have already eaten. They may not recognize that the items in front of them are food, and they may experience difficulties in planning how to bring food to their mouth.
- Communication difficulties: Individuals with dementia may encounter difficulties in expressing themselves and communicating with others, leading to difficulties expressing their hunger or loss of interest in the food selection. They may communicate their needs through actions, such as refusing to eat or spitting out food.
- Responsive behaviours: Sometimes individuals with dementia may also display signs of frustration, agitation, or other challenging behaviours during meal times that can impact the eating experience.
Decline in Physical and Sensory Abilities
In addition to cognitive processes, individuals with dementia may experience declines in their physical and sensory abilities which can impact their eating habits.
Some examples of how cognitive processes can impact eating include:
- Physical abilities: Hand coordination is essential for various aspects of self-feeding, including removing food from its packaging, picking up utensils, and bringing food to the mouth. Individuals with dementia may encounter challenges in using utensils or unpacking food due to muscle weakness.
- Sensory abilities: Individuals evaluate and perceive sensory stimuli of food through the five human senses (sight, smell, taste, touch and hearing). Appearance, aroma, consistency, texture, and flavour all play a vital role in our enjoyment of food. However, dementia can cause loss of or distortions in sensory perception, significantly reducing the enjoyment of eating, appetite, and overall food intake.
Environmental Factors
The dining environment significantly influences the mealtime experiences of individuals with dementia, impacting their enjoyment of food and their dietary intake[9].
Some examples of how environmental factors can impact eating experience include:
- Overstimulation: Individuals with dementia often struggle to remain focused in environments with distractions, such as excessive noise or crowded dining spaces. These distractions contribute to behavioural symptoms and can negatively impact the eating behaviours of individuals with dementia.
- Inadequate lighting: Individuals with dementia may have impaired vision and a reduced ability to perceive contrast and colours. Insufficient lighting makes it more difficult to see and recognize food, leading to confusion and negative impacts on eating behaviours.
- Visually unappealing food: Unappealing food presentation can decrease the appetite of individuals with dementia. For example, an absence of vibrant colours in the food, or when food is not clearly visible on the plate can lead to reduced appetite for individuals with dementia. Furthermore, for individuals who require texture modified foods, blending meals together can result in a messy and unappetizing appearance that can also create a negative eating experience.
- Lack of variety in food choices and textures: Individuals with dementia may experience changes in their food preferences, including foods they have always enjoyed. Moreover, individuals with chewing or swallowing difficulties often require texture modified foods. A lack of variety in food choices and textures that cater to the individual’s preferences can negatively impact appetite and overall eating experience.
Useful Resources
- Alzheimer’s Society Canada: Meal Time – How dementia can impact meal time habits and routines
- Mayo Clinic: Dysphagia
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong: Normal Swallow & Abnormal Swallow
- CADENZA Training Programme, The Nethersole School of Nursing, The Chinese University of Hong Kong: Care techniques for dementia – How can dementia impact eating? (Chinese)
- DREAM: Nutrition Risk Factors
Common Factors Influencing Eating Behaviours in Individuals with Dementia
Dysphagia (Swallowing Difficulties)
Dysphagia refers to the difficulty in swallowing, and the inability to transport food safely and effectively from the mouth to the stomach.
Individuals with dysphagia commonly experience difficulties in eating or drinking, swallowing saliva, or taking medicines. Considering these uncomfortable symptoms, individuals with dysphagia often experience decreased appetite or may refuse to eat.
Moreover, a study found that individuals with dementia who experience dysphagia show a high prevalence of impaired swallowing safety and efficacy, and significant airway protection impairments[5].
Causes of Dysphagia[6]
In general, dysphagia is caused by damage to the muscles or nerves that control swallowing. Muscle loss due to aging may impact teeth-grinding and tongue-pressing, leading to swallowing difficulties. In addition, symptoms of dysphagia are often attributed to nervous system damage caused by dementia or stroke[7].
The main symptoms of dysphagia occur when swallowing food, such as:
- Pain while swallowing
- Inability to swallow
- Food remains in the mouth, causing bad breath
- Food or drink coming out of mouth, or regurgitation
- A sensation of food getting stuck in esophagus, or “stuck up” in throat when eating
- Taking a long time and a lot of effort to chew or swallow
- Coughing, wheezing, throat clearing or phlegm
- Choking when eating or drinking
- Hoarseness
If you or your loved ones regularly experience difficulty swallowing or notice weight loss, regurgitation, or vomiting alongside dysphagia, it is important to consult your healthcare provider and ask for a referral to a speech and language therapist. If you or your loved ones experience an obstruction that affects breathing, seek emergency help immediately.
Decline in Cognitive Abilities
The eating process involves many neurodevelopmental capabilities such as information intake and processing, opinion forming, decision-making, and action coordination. In other words, when it comes to eating, many cognitive processes need to take place.[8]
Individuals need to decide what to eat, how often, and how much to eat, among other things. As such, cognitive decline caused by dementia can reduce appetite and disrupt the eating habits of individuals with dementia.
Some common challenges individuals with dementia face include:
- Difficulties in concentration: Individuals with dementia may have difficulty maintaining concentration, which can lead to skipping meals or struggling to stay engaged with their meals from start to finish.
- Memory loss and decline in functional abilities: Individuals with dementia may forget how to eat or whether they have already eaten. They may not recognize that the items in front of them are food, and they may experience difficulties in planning how to bring food to their mouth.
- Communication difficulties: Individuals with dementia may encounter difficulties in expressing themselves and communicating with others, leading to difficulties expressing their hunger or loss of interest in the food selection. They may communicate their needs through actions, such as refusing to eat or spitting out food.
- Responsive behaviours: Sometimes individuals with dementia may also display signs of frustration, agitation, or other challenging behaviours during meal times that can impact the eating experience.
Decline in Physical and Sensory Abilities
In addition to cognitive processes, individuals with dementia may experience declines in their physical and sensory abilities which can impact their eating habits.
Some examples of how cognitive processes can impact eating include:
- Physical abilities: Hand coordination is essential for various aspects of self-feeding, including removing food from its packaging, picking up utensils, and bringing food to the mouth. Individuals with dementia may encounter challenges in using utensils or unpacking food due to muscle weakness.
- Sensory abilities: Individuals evaluate and perceive sensory stimuli of food through the five human senses (sight, smell, taste, touch and hearing). Appearance, aroma, consistency, texture, and flavour all play a vital role in our enjoyment of food. However, dementia can cause loss of or distortions in sensory perception, significantly reducing the enjoyment of eating, appetite, and overall food intake.
Environmental Factors
The dining environment significantly influences the mealtime experiences of individuals with dementia, impacting their enjoyment of food and their dietary intake[9].
Some examples of how environmental factors can impact eating experience include:
- Overstimulation: Individuals with dementia often struggle to remain focused in environments with distractions, such as excessive noise or crowded dining spaces. These distractions contribute to behavioural symptoms and can negatively impact the eating behaviours of individuals with dementia.
- Inadequate lighting: Individuals with dementia may have impaired vision and a reduced ability to perceive contrast and colours. Insufficient lighting makes it more difficult to see and recognize food, leading to confusion and negative impacts on eating behaviours.
- Visually unappealing food: Unappealing food presentation can decrease the appetite of individuals with dementia. For example, an absence of vibrant colours in the food, or when food is not clearly visible on the plate can lead to reduced appetite for individuals with dementia. Furthermore, for individuals who require texture modified foods, blending meals together can result in a messy and unappetizing appearance that can also create a negative eating experience.
- Lack of variety in food choices and textures: Individuals with dementia may experience changes in their food preferences, including foods they have always enjoyed. Moreover, individuals with chewing or swallowing difficulties often require texture modified foods. A lack of variety in food choices and textures that cater to the individual’s preferences can negatively impact appetite and overall eating experience.
Useful Resources
- Alzheimer’s Society Canada: Meal Time – How dementia can impact meal time habits and routines
- Mayo Clinic: Dysphagia
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong: Normal Swallow & Abnormal Swallow
- CADENZA Training Programme, The Nethersole School of Nursing, The Chinese University of Hong Kong: Care techniques for dementia – How can dementia impact eating? (Chinese)
- DREAM: Nutrition Risk Factors
Tips for Caregivers
Ensuring Appropriate Food & Drink Texture
It is common for individuals with dementia to experience difficulties in chewing and swallowing. Therefore, it is important to ensure that food and drink textures are suitable for your loved one. This can help enhance their appetite and reduce the risk of choking.
Learn More About the IDDSI Framework
The International Dysphagia Diet Standardisation Initiative (IDDSI) framework[1] is a helpful tool for caregivers and professionals who work with older adults, especially older adults with dysphagia or swallowing difficulties.
The IDDSI framework provides a standardized and consistent way to assess and label food and drink textures and consistencies. This helps ensure individuals receive the appropriate consistency based on their needs to prevent choking and aspiration.
The IDDSI framework categorizes food and drinks into different levels, making it easier for caregivers to understand and provide the right textures.
- Levels 0 to 4 are used for measuring the thickness of drinks.
- Levels 3 to 7 are used for measuring the texture of foods.
(Source from: International Dysphagia Diet Standardisation Initiative (IDDSI): https://iddsi.org/framework/)
While the IDDSI framework and testing methods provide valuable guidance, it is strongly recommended that caregivers consult with a healthcare provider for comprehensive clinical assessments and clinical recommendations.
Everyone has different needs and abilities. The clinician will base their recommendations on the individual’s specific circumstances to identify the most suitable food textures and drink thickness. This will ensure optimal nutrition and a positive eating experience for each individual.
Useful Resources
Improving the Eating Experience
Creating a favourable environment for eating and using appropriate feeding techniques can significantly enhance the mealtime experience and overall well-being of individuals with dementia.[11], [12], [13]
Tips For Improving the Eating Experience
- Create protected mealtimes:
Creating a calm and focused environment is essential in helping individuals with dementia focus on their meals and enjoy a more pleasant dining experience. Minimize distractions like noise, conversations, and electronic devices during mealtime. This can also help individuals concentrate on eating and reduce the risk of choking. - Ensure tidiness and adequate lighting:
Maintaining a clean and organized dining area with sufficient lighting is also helpful. Clutter-free and brightly lit dining areas enhance the dining experience by making the food and environment more visually appealing and comfortable for individuals with dementia. - Provide adaptive tableware and utensils:
Using adaptive feeding utensils and tableware designed for individuals with limited hand mobility allows them to eat independently and with dignity. This promotes a sense of autonomy and contributes to their overall well-being and eating enjoyment. - Modify taste and texture:
Paying attention to the taste, smell, and texture of the food is vital in improving an individual’s eating experience. Modifying food textures and consistencies, such as offering pureed or soft meals, helps prevent choking and makes eating easier for those with swallowing difficulties. Refer to the “Ensuring Appropriate Food and Drink Texture” section above for more information. - Improve food presentation:
Attractive food presentation can stimulate appetite and make the eating experience more enjoyable. This can also increase the likelihood for individuals to consume an adequate amount of nutrients. When preparing pureed food, consider using food-shaped molds or pastry bags to shape the pureed food into more natural forms for a more attractive appearance. - Provide opportunities for involvement:
Involving individuals with dementia in the meal preparation process can stimulate their interest in food. Caregivers can engage their loved ones in grocery shopping, selecting food, and preparing meals together. - Strengthen social bonds:
Involving individuals with dementia in social activities during mealtimes, such as sharing their food with friends and family, can promote a more positive eating experience and further improve appetite.
Feeding Techniques
Depending on the progression of their condition, individuals with dementia may require feeding assistance.[14]
Tips For Promoting a Positive Feeding Experience
- Emphasize independence and capabilities:
Offer minimal assistance and allow individuals to maintain their independence during meals. Caregivers can explore strategies like offering finger foods or providing verbal encouragement and visual cues to support an independent eating experience. - Ensure an upright sitting position:
Caregivers should ensure that the individual is sitting upright and not lying down when eating. Ensuring an appropriate eating position is critical in preventing choking. - Ask for consent:
Caregivers should ask whether the individuals agree to eat or not. If the individuals feel they are full or not able to eat, caregivers should not force them to eat. However, if this occurs on a prolonged or continued basis, caregivers should seek professional medical advice to maintain their physical health. - Slow down the pace:
Present only one food item at a time and align your pace with the individuals you are caring for. Avoid rushing through the meal, as rushing can increase the risk of choking. It is common to see individuals start and stop eating many times. If the individual does not want to eat, consider taking a break, engaging them in another activity, and returning to the meal later. - Direct attention:
Direct the individual’s attention to the food in front of them. Sit down and make eye contact with the individual while feeding. Pay attention for any signs of coughing or choking. In case of sudden emergency situations, caregivers should remain calm and seek emergency help immediately.
Ensuring proper nutrition and positive mealtime experiences contribute to the overall quality of life for individuals with dementia. By implementing these strategies, caregivers can create a more supportive environment that promotes better eating experiences and maintains the dignity and well-being of those under their care.
Useful Resources
Learn more about feeding techniques:
- Yee Hong Centre: Yee Hong CARE-Learning: Assisted Feeding Techniques (Cantonese video with English and Chinese Subtitles)
- Methodist Wellness Centre：Speech Therapy Series: Feeding Techniques for Dementia (Cantonese video with Chinese subtitles)
Learn more about adaptive utensils:
- Alzheimer’s Society U.K.: What equipment can improve the home of a person with dementia?
- Hong Kong Housing Authority Elderly Resources Centre: Make good use of assistive tools to help seniors enjoy eating again (Chinese)
Learn more about texture modified foods:
- Yee Hong Centre: Care Food
- Research Institute for Aging, Canada: Tips for Better Pureed Food
- Selkirk Mental Health Centre: Enhancing the enjoyment of texture-modified food
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong: Other – Introduction for soft diet (Chinese)
- Hong Kong Po Leung Kuk: Soft diet series (Video with Chinese subtitles)
- Hong Kong Po Leung Kuk: Soft diet series – Snacks: Turnip cake (Video with Chinese subtitles)
- The Hong Kong Council of Social Service: [HKCSS Channel] Stuffed hairy gourd with dried scallop and egg toufu @ Soft Meal Kitchen/Care Food Kitchen (Video with Chinese subtitles)
- Hong Kong Culture Homes: Demonstration on how to prepare soft meals (Cantonese video with Chinese subtitles)
Access more practical guides for caregivers:
- DREAM: Strategies for Mealtime Challenges
- Bournemouth University: The Eating and Drinking Well with Dementia Toolkit
- Alzheimer’s Society of Canada: The Meal Times
- The Caroline Walker Trust: Eating well: supporting older people and older people with dementia – Practical guide
- United Christian Nethersole Community Health Service: What should we pay attention to regarding eating and drinking of senior family members living with dementia? (Chinese)
- 656carer.com: Care in eating and drinking (Chinese)
Learn more about food nutrition:
- Research Institute for Aging, Canada: Sources of Key Nutrients for Older Adults
- Global Council for Brain Health: Brain Food: GCBH Recommendations on Nourishing Your Brain Health
- Research Institute for Aging, Canada: Recipes for Healthy Aging
- Tufts University: MyPlate for Older Adults
- Hong Kong Jockey Club Centre for Positive Ageing: Food and Nutrition
- DREAM: A Guide for Healthy Eating and Drinking
References
[1] Aziz NA, van der Marck MA, Pijl H, Olde Rikkert MG, Bloem BR, Roos RA. Weight loss in neurodegenerative disorders. J Neurol. Dec 2008;255(12):1872-1880.
[2] Atti AR, Palmer K, Volpato S, Winblad B, De Ronchi D, Fratiglioni L. Late-life body mass index and dementia incidence: nine-year follow-up data from the Kungsholmen Project. J Am Geriatr Soc. Jan 2008;56(1):111-116.
[3] Sturman MT, de Leon CF, Bienias JL, Morris MC, Wilson RS, Evans DA. Body mass index and cognitive decline in a biracial community population. Neurology. Jan 29 2008;70(5):360-367.
[4] Buchman AS, Schneider JA, Wilson RS, Bienias JL, Bennett DA. Body mass index in older persons is associated with Alzheimer disease pathology. Neurology. Dec 12 2006;67(11):1949-1954.
[5] Espinosa-Val, M. C., Martín-Martínez, A., Graupera, M., Arias, O., Elvira, A., Cabré, M., Palomera, E., Bolívar-Prados, M., Clavé, P., & Ortega, O. (2020). Prevalence, risk factors, and complications of oropharyngeal dysphagia in older patients with dementia. Nutrients. Retrieved April 24, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146553/
[6] Suh, M. K., Kim, H. H., & Na, D. L. (2009). Dysphagia in patients with dementia: Alzheimer versus Vascular. Alzheimer Disease & Associated Disorders, 23(2): p.178-184. Retrieved April 24, 2023, from https://journals.lww.com/alzheimerjournal/Abstract/2009/04000/Dysphagia_in_Patients_With_Dementia__Alzheimer.13.aspx
[7] Cipriani, G., Carlesi, C., Lucetti, C., Danti, S., & Nuti, A. (2016). Eating Behaviors and Dietary Changes in Patients With Dementia. American journal of Alzheimer’s disease and other dementias, 31(8), 706–716. https://doi.org/10.1177/1533317516673155
[8] Social Care Institute for Excellence. (2020). The eating environment for people with dementia. https://www.scie.org.uk/dementia/living-with-dementia/eating-well/eating-environment.asp
[9] The International Dysphagia Diet Standardisation Initiative (2023). The IDDSI Framework. Retrieved April 24, 2023, from https://iddsi.org/framework
[10] Social Care Institute for Excellence (SCIE). (2020). https://www.scie.org.uk/dementia/living-with-dementia/eating-well/eating-environment.asp
[11] Nutricia (2020). Top tips – Optimising the mealtime environment for people with Dysphagia. Retrieved April 24, 2023, from https://www.nutricia.co.uk/patients-carers/articles-stories/optimising-the-mealtime-environment-for-people-with-dysphagia.html
[12] Clarke, L. (2009) ‘Improving nutrition in dementia through menu picture cards and cooking activities’, Nursing Times, pp 16–18.
[13] St. Andrew’s Community Hospital [SAMH-SACS] (2022). General Safe Feeding Strategies for Elderly [Video]. YouTube. Retrieved April 24, 2023, from https://www.youtube.com/watch?v=cJtBRD-_vVg
Tips for Caregivers
Ensuring Appropriate Food & Drink Texture
It is common for individuals with dementia to experience difficulties in chewing and swallowing. Therefore, it is important to ensure that food and drink textures are suitable for your loved one. This can help enhance their appetite and reduce the risk of choking.
Learn More About the IDDSI Framework
The International Dysphagia Diet Standardisation Initiative (IDDSI) framework[1] is a helpful tool for caregivers and professionals who work with older adults, especially older adults with dysphagia or swallowing difficulties.
The IDDSI framework provides a standardized and consistent way to assess and label food and drink textures and consistencies. This helps ensure individuals receive the appropriate consistency based on their needs to prevent choking and aspiration.
The IDDSI framework categorizes food and drinks into different levels, making it easier for caregivers to understand and provide the right textures.
- Levels 0 to 4 are used for measuring the thickness of drinks.
- Levels 3 to 7 are used for measuring the texture of foods.
(Source from: International Dysphagia Diet Standardisation Initiative (IDDSI): https://iddsi.org/framework/)
While the IDDSI framework and testing methods provide valuable guidance, it is strongly recommended that caregivers consult with a healthcare provider for comprehensive clinical assessments and clinical recommendations.
Everyone has different needs and abilities. The clinician will base their recommendations on the individual’s specific circumstances to identify the most suitable food textures and drink thickness. This will ensure optimal nutrition and a positive eating experience for each individual.
Useful Resources
Improving the Eating Experience
Creating a favourable environment for eating and using appropriate feeding techniques can significantly enhance the mealtime experience and overall well-being of individuals with dementia.[11], [12], [13]
Tips For Improving the Eating Experience
- Create protected mealtimes:
Creating a calm and focused environment is essential in helping individuals with dementia focus on their meals and enjoy a more pleasant dining experience. Minimize distractions like noise, conversations, and electronic devices during mealtime. This can also help individuals concentrate on eating and reduce the risk of choking. - Ensure tidiness and adequate lighting:
Maintaining a clean and organized dining area with sufficient lighting is also helpful. Clutter-free and brightly lit dining areas enhance the dining experience by making the food and environment more visually appealing and comfortable for individuals with dementia. - Provide adaptive tableware and utensils:
Using adaptive feeding utensils and tableware designed for individuals with limited hand mobility allows them to eat independently and with dignity. This promotes a sense of autonomy and contributes to their overall well-being and eating enjoyment. - Modify taste and texture:
Paying attention to the taste, smell, and texture of the food is vital in improving an individual’s eating experience. Modifying food textures and consistencies, such as offering pureed or soft meals, helps prevent choking and makes eating easier for those with swallowing difficulties. Refer to the “Ensuring Appropriate Food and Drink Texture” section above for more information. - Improve food presentation:
Attractive food presentation can stimulate appetite and make the eating experience more enjoyable. This can also increase the likelihood for individuals to consume an adequate amount of nutrients. When preparing pureed food, consider using food-shaped molds or pastry bags to shape the pureed food into more natural forms for a more attractive appearance. - Provide opportunities for involvement:
Involving individuals with dementia in the meal preparation process can stimulate their interest in food. Caregivers can engage their loved ones in grocery shopping, selecting food, and preparing meals together. - Strengthen social bonds:
Involving individuals with dementia in social activities during mealtimes, such as sharing their food with friends and family, can promote a more positive eating experience and further improve appetite.
Feeding Techniques
Depending on the progression of their condition, individuals with dementia may require feeding assistance.[14]
Tips For Promoting a Positive Feeding Experience
- Emphasize independence and capabilities:
Offer minimal assistance and allow individuals to maintain their independence during meals. Caregivers can explore strategies like offering finger foods or providing verbal encouragement and visual cues to support an independent eating experience. - Ensure an upright sitting position:
Caregivers should ensure that the individual is sitting upright and not lying down when eating. Ensuring an appropriate eating position is critical in preventing choking. - Ask for consent:
Caregivers should ask whether the individuals agree to eat or not. If the individuals feel they are full or not able to eat, caregivers should not force them to eat. However, if this occurs on a prolonged or continued basis, caregivers should seek professional medical advice to maintain their physical health. - Slow down the pace:
Present only one food item at a time and align your pace with the individuals you are caring for. Avoid rushing through the meal, as rushing can increase the risk of choking. It is common to see individuals start and stop eating many times. If the individual does not want to eat, consider taking a break, engaging them in another activity, and returning to the meal later. - Direct attention:
Direct the individual’s attention to the food in front of them. Sit down and make eye contact with the individual while feeding. Pay attention for any signs of coughing or choking. In case of sudden emergency situations, caregivers should remain calm and seek emergency help immediately.
Ensuring proper nutrition and positive mealtime experiences contribute to the overall quality of life for individuals with dementia. By implementing these strategies, caregivers can create a more supportive environment that promotes better eating experiences and maintains the dignity and well-being of those under their care.
Useful Resources
Learn more about feeding techniques:
- Yee Hong Centre: Yee Hong CARE-Learning: Assisted Feeding Techniques (Cantonese video with English and Chinese Subtitles)
- Methodist Wellness Centre：Speech Therapy Series: Feeding Techniques for Dementia (Cantonese video with Chinese subtitles)
Learn more about adaptive utensils:
- Alzheimer’s Society U.K.: What equipment can improve the home of a person with dementia?
- Hong Kong Housing Authority Elderly Resources Centre: Make good use of assistive tools to help seniors enjoy eating again (Chinese)
Learn more about texture modified foods:
- Yee Hong Centre: Care Food
- Research Institute for Aging, Canada: Tips for Better Pureed Food
- Selkirk Mental Health Centre: Enhancing the enjoyment of texture-modified food
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong: Other – Introduction for soft diet (Chinese)
- Hong Kong Po Leung Kuk: Soft diet series (Video with Chinese subtitles)
- Hong Kong Po Leung Kuk: Soft diet series – Snacks: Turnip cake (Video with Chinese subtitles)
- The Hong Kong Council of Social Service: [HKCSS Channel] Stuffed hairy gourd with dried scallop and egg toufu @ Soft Meal Kitchen/Care Food Kitchen (Video with Chinese subtitles)
- Hong Kong Culture Homes: Demonstration on how to prepare soft meals (Cantonese video with Chinese subtitles)
Access more practical guides for caregivers:
- DREAM: Strategies for Mealtime Challenges
- Bournemouth University: The Eating and Drinking Well with Dementia Toolkit
- Alzheimer’s Society of Canada: The Meal Times
- The Caroline Walker Trust: Eating well: supporting older people and older people with dementia – Practical guide
- United Christian Nethersole Community Health Service: What should we pay attention to regarding eating and drinking of senior family members living with dementia? (Chinese)
- 656carer.com: Care in eating and drinking (Chinese)
Learn more about food nutrition:
- Research Institute for Aging, Canada: Sources of Key Nutrients for Older Adults
- Global Council for Brain Health: Brain Food: GCBH Recommendations on Nourishing Your Brain Health
- Research Institute for Aging, Canada: Recipes for Healthy Aging
- Tufts University: MyPlate for Older Adults
- Hong Kong Jockey Club Centre for Positive Ageing: Food and Nutrition
- DREAM: A Guide for Healthy Eating and Drinking
References
[1] Aziz NA, van der Marck MA, Pijl H, Olde Rikkert MG, Bloem BR, Roos RA. Weight loss in neurodegenerative disorders. J Neurol. Dec 2008;255(12):1872-1880.
[2] Atti AR, Palmer K, Volpato S, Winblad B, De Ronchi D, Fratiglioni L. Late-life body mass index and dementia incidence: nine-year follow-up data from the Kungsholmen Project. J Am Geriatr Soc. Jan 2008;56(1):111-116.
[3] Sturman MT, de Leon CF, Bienias JL, Morris MC, Wilson RS, Evans DA. Body mass index and cognitive decline in a biracial community population. Neurology. Jan 29 2008;70(5):360-367.
[4] Buchman AS, Schneider JA, Wilson RS, Bienias JL, Bennett DA. Body mass index in older persons is associated with Alzheimer disease pathology. Neurology. Dec 12 2006;67(11):1949-1954.
[5] Espinosa-Val, M. C., Martín-Martínez, A., Graupera, M., Arias, O., Elvira, A., Cabré, M., Palomera, E., Bolívar-Prados, M., Clavé, P., & Ortega, O. (2020). Prevalence, risk factors, and complications of oropharyngeal dysphagia in older patients with dementia. Nutrients. Retrieved April 24, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146553/
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