Factsheet 511LP Eating And July 2020 Drinking
Eating anddrinkingFactsheet 511LPJuly 2020Keeping physically and mentally well will help people with dementiato manage their symptoms. A healthy, balanced diet can help withthis. However, people with dementia often have problems witheating and drinking.This factsheet looks at different ways that dementia can affecteating and drinking, and the difficulties a person with dementiacan have. Throughout it, you’ll find tips to support someone withdementia to eat and drink well. This includes day-to-day supportthat carers and other people can provide.
2Eating and drinkingContentsnn Why eating and drinking is important for a person with dementia— Eating and drinking: general tips for carersnnPoor appetite— Encouraging appetite: tips for carersnnDrinking— Ensuring the person drinks enough: tips for carers— AlcoholnnChanges in eating habits and food preferences— Coping with changing eating habits: tips for carersnnOvereating— Managing overeating: tips for carersnnPhysical difficulties and problems with a person’s senses— Problems with co-ordination— Chewing and swallowing— Constipation— Problems with eyesight— Taste and smell— Judging temperaturennEating experience— Improving the eating experience: tips for carers— Preparing foodnnLiving alone— Supporting someone who is living alone: tips for carersnnOther useful organisations
3Eating and drinkingEating and drinkingWhy eating and drinking is important for a person with dementiaA healthy, balanced diet can help improve a person’s quality of life. However,common symptoms of dementia (such as memory loss and difficultieswith thinking and problem-solving) can make it more difficult to eat anddrink well. People with dementia often have physical difficulties includinghearing and sight loss that can also cause problems with eating and drinking.Although eating and drinking difficulties are fairly common in peoplewith dementia, each person’s difficulties will be unique to them and theirsituation. A person with dementia may struggle to recognise the food anddrink in front of them. They may also be unsure how to begin eating. Theseproblems may start because:nnof changes that dementia causes in the brainnnthe person is given unfamiliar foodnnthe food is presented differently.They may not eat or drink for these reasons, even when they feel hungry.This can lead to weight loss.Respecting the preferences of a person with dementia will support them toeat and drink well. Similarly, eating and drinking can be made more difficultif a person’s routine and diet are changed.For example, if a person is not used to spicy foods, they may not enjoythe sensation of eating heavily spiced meals. The person may be used tohaving different portion sizes, eating more or less regularly throughout theday, and may also not eat some foods because of their religious beliefs.By understanding a person with dementia’s preferences, you can supportthem to eat and drink.
4Eating and drinkingAs dementia progresses, the person is likely to need more support to meettheir needs. While eating a balanced diet is recommended, sometimes it ismore important to make sure they are eating enough, even if that meanseating unhealthy foods. They may also need more support with drinking(see ‘Drinking’ on page 8).Eating and drinking: general tips for carersIt’s important to remember that people with dementia don’t need a specialdiet. You may find these tips helpful in supporting someone with dementiato eat and drink well:nnKeep in mind that problems with eating and drinking are common forpeople with dementia.nnThere are approaches you can try. Aim for the least stressful solutions –common sense and a creative approach often help.nnRemember the person – think about what they like and don’t like, andbear in mind their life history including past routines.nnLook for non-verbal clues such as body language and eye contact as ameans of communication.nnKeep calm and try not to rush the person. It’s important they don’t feelhurried and they are given enough time to eat.nnHelp them maintain as much independence as possible.nnRemember that you’re not alone. If you’re concerned about a person’sdiet, speak to the GP. A dietitian can also give advice on what is best in aparticular situation.nnFor more advice on a healthy, balanced diet, see the NHS website under‘Other useful organisations’ at the end of this factsheet.
5Eating and drinkingPoor appetiteA person with dementia may lose interest in food. They may refuse to eat itor may spit it out. The person may become angry or agitated, or behave ina challenging way during mealtimes.If a person isn’t eating enough, it can lead to weight loss and less musclestrength. They may also feel tired and weak. This can make them frailerand less able to recover from infections or viruses.A person may lose interest in, or turn down, food and drink because ofphysical difficulties, such as problems with chewing and swallowing, orconstipation. For more information see ‘Physical difficulties and problemswith a person’s senses’ on page 13.Other reasons include:nnDepression – loss of appetite can be a sign of depression which iscommon in people with dementia. There are effective treatments fordepression, including medication and other therapies. If you suspect thatthe person you are caring for has depression, consult the GP. For moreinformation see factsheet 444, Supporting a person with dementia whohas depression, anxiety or apathy.nnCommunication – the person with dementia may have problemscommunicating that they’re hungry, that they don’t like the food theyhave been given or that it’s too hot. They may be unsure what to do withthe food. They may communicate their needs through their behaviour.For example, they may refuse to eat or hold food in their mouth. Youcould try giving them a choice of food, or use prompts and pictures sothey can choose the food they would like. For more information seefactsheet 500, Communicating.nnPain – the person may be in pain or discomfort, which can make eatingdifficult. They may have problems with their dentures, sore gums orpainful teeth. Oral hygiene and regular mouth checks are important. Formore information see factsheet 448, Dental care and oral health.
6Eating and drinkingnnTiredness and concentration – tiredness can cause people withdementia to not eat or give up partway through a meal. It can also leadto other difficulties such as problems with concentration or with coordination. A person with dementia may have difficulties focusing on ameal all the way through. Try to support the person to eat when they aremost alert.nnMedication – changes to medication or dosage can result in appetitechanges. If you think this may be the case, speak to a pharmacist orthe GP.nnPhysical activity – if the person is not very active during the day, theymay not feel hungry. Encouraging them to be active will be good for theirwellbeing and may increase their appetite. Equally, if the person is veryactive or restless – for example, walking about or fidgeting – they mayuse extra calories and may be hungrier than usual or lose weight morequickly. For more information see factsheet 529, Physical activityand exercise.Encouraging appetite: tips for carersThere are lots of ways to increase a person’s appetite and interest in foodand drink. Knowing the person will help, as everyone has their own needs,routines, likes and dislikes. Here are some ideas that may help:nnMake food look and smell appealing. Use different tastes, colours andsmells. The aroma of cooking – for example freshly baked bread – canstimulate someone’s appetite.nnTry not to overload the plate with too much food – small and regularportions often work best. Consider serving half portions to keep hotfood from going cold and losing its appeal.nnGive the person food they like. However, remember that a person’s foodpreferences can change as their dementia progresses. See ‘Changes ineating habits and food preferences’ on page 9.nnDon’t stop someone eating dessert if they haven’t eaten their savourymeal. They may prefer the taste of the dessert.
7Eating and drinkingnnTry different types of food and drink with varying temperatures andtextures, such as milkshakes or potato wedges.nnGive the person gentle reminders to eat, and remind them what thefood is.nnDon’t assume the person has finished because they’ve stopped eating.nnIf the person is agitated or distressed, don’t put pressure on them. Waituntil they are calm and less anxious before offering food and drink.nnUse eating and drinking as an opportunity for activity and socialstimulation. It may be an opportunity to talk about food from theirchildhood, and this could help to encourage their appetite. They couldalso help with preparing the food – see ‘Eating experience’ on page 16.nnIf the person doesn’t want to eat meals at set times or at a table, makefinger foods available such as sausage rolls, falafel, samosas, spring rolls,sandwiches, slices of fruit and vegetables so they can snack on theseinstead. Some full meals could be served as finger foods, for exampleroast dinner, as long as they’re presented in easy-to-hold pieces.nnLook for opportunities to encourage the person to eat. For example, ifthey’re awake for much of the night then night-time snacks may be agood idea.nnIf the person refuses food, try again a bit later. Remember that thesereactions are not a deliberate attempt to be ‘difficult’.nnIf they continue to refuse food and you’re concerned about the effect ofthis on their health, speak to a pharmacist or the GP.
8Eating and drinkingDrinkingSomeone with dementia may become dehydrated if they’re unable tocommunicate or recognise that they’re thirsty, or if they forget to drink.This can lead to headaches, increased confusion, urinary tract infectionsand constipation. These can make the symptoms of dementia worse.As people get older the sensation of thirst changes. This can mean theydon’t feel thirsty even though they’re not drinking enough. Someone withdementia may experience similar changes. They may be less able or likelyto get themselves a drink.Placing a drink in front of someone doesn’t always mean they will drink it.Also, an empty cup doesn’t always mean that the person has finished thedrink. It may have been spilled, drunk by someone else, or poured away.Ensuring the person drinks enough: tips for carersnnEncourage the person to drink throughout the day. The recommendedamount is one and a half to two litres a day, which is around eight to 10glasses, or 10 to 13 cups per day.nnGive the person a drink whenever they are eating something.nnUse a clear glass so the person can see what’s inside, or try a brightlycoloured cup to draw attention instead.nnIf possible, offer the person the cup or put it where they can see it clearly.nnOffer different types of drink throughout the day such as tea, coffee, hotand cold milky drinks, fruit juice or smoothies, soup, squash and water.nnMake sure the cup or glass is suitable – not too heavy or a difficult shape.nnEncourage the person to eat foods that have a high liquid content, suchas gravy, ice lollies, milk jellies and yoghurt.nnNutritionists have created sweets called Jelly Drops , which mayhelp people with dementia to get more water into their diet. For moreinformation go to www.jellydrops.com
9Eating and drinkingAlcoholPeople with dementia can become more confused after they drink alcohol.You may need to limit the amount of alcohol the person drinks. A personwith dementia may drink too much alcohol because they’ve forgotten howmuch they’ve had. If this happens, you could keep alcohol out of sight. Youcould also give the person low-alcohol or non-alcoholic substitutes, orwatered-down alcoholic drinks.People who have dementia related to past alcohol use should not drinkalcohol. For more information see factsheet 438, Alcohol-related braindamage (ARBD). Also, alcohol doesn’t mix well with certain medicines. If indoubt, ask the GP for advice.Changes in eating habits and food preferencesPeople with dementia can experience changes in eating habits, both interms of how much food they eat and when and what food they prefer.They may begin to develop changes in how they experience flavour. Theymay start to enjoy flavours they never liked before, or dislike foods theyalways liked.Sometimes people with dementia make food choices that don’t matchtheir usual beliefs or preferences. For example, a person who has been alifelong vegetarian may want to eat meat for reasons including:nntheir preference has changednnthey remember that they used to eat meat (before they becamevegetarian)nnthey have forgotten they don’t eat meatnnthey see you or someone else eating meat and want the same, withoutknowing what it is.For similar reasons, people who have other beliefs may start to wantsomething different that they previously wouldn’t have eaten. For example,a person who does not eat pork for religious reasons may start to wantpork. It can be difficult to know what to do in these situations.
10 Eating and drinkingCoping with changing eating habits: tips for carersnnIf a person has a preference for sweet foods, fruit or naturally sweetvegetables may be a healthier option if the person isn’t losing weight.Adding small amounts of honey or sugar to savoury food can also help.nnUse herbs and spices, sauces and chutneys to enhance flavours.nnAdd small amounts of syrup, jam or honey to puddings to increasesweetness.nnBe led by the person on what they’d like to eat, even if the foodcombinations seem unusual.nnBe led by the person on when they prefer to eat. Some people like alight lunch and larger evening meal and others prefer a main meal inthe middle of the day. This may be different to when they’ve previouslywanted to eat.nnTry food the person has never eaten before but remember the person’spersonal preferences and practices. Their beliefs should be respecteddespite changes in eating habits.nnTry to use what you know about the person and, if they’re showing adifferent preference, consider what might be the reason for this.nnAlso be aware of any impact on the person’s digestion. For example, ifthe person has always been vegetarian but asks for meat, offer meatsubstitutes instead. These may be easier for them to digest.nnAlways try to do what’s in the person’s best interests, even if this isdifferent to the best interests of those around them.nnThe charity Vegetarian for Life campaigns for the respect and protectionof people’s vegetarianism and veganism in care homes. For moreinformation see ‘Other useful organisations’ on page 18.
11 Eating and drinkingAs dementia progresses, a person may put things that aren’t food intotheir mouth, such as napkins or soap. There could be a number of reasonsfor this. For example, the person may no longer recognise the item or whatit’s for, or they may be hungry and mistake the item for food.It can be helpful to:nnmake sure everyone involved in the person’s care is aware of thisbehaviournnwhere possible, remove non-food items which could be mistaken forfood, and lock away any harmful substances like cleaning productsnnbe vigilant and remove small items that may be easily placed inthe mouthnnensure food is available and easily accessible throughout the daynnduring mealtimes, remove all non-food items from the dinner table, suchas napkins and flowersnnseason meals in the kitchen, so that the salt and pepper shakers andspice containers are not on the table.
12 Eating and drinkingOvereatingSome people with dementia may eat too much or too often. They mayhave forgotten that they’ve recently eaten or be concerned about whenthe next meal is coming. If a person is overeating, they may also eat foodsthat aren’t appropriate. They might be frequently asking or searching forfood. This can be a stressful situation for them and the people around them.People with certain types of dementia – such as frontotemporal dementia– may be more likely to experience excessive eating and other changesto eating behaviour. These may include changes in dietary preference andobsession with particular foods. For more information see factsheet 404,What is frontotemporal dementia (FTD)?Someone with dementia may also drink too much alcohol – for moreinformation see ‘Alcohol’ on page 9.Managing overeating: tips for carersnnMake sure that the person has something to do, so that they don’t feelbored or lonely.nnDivide the original portion into two and offer the second one if theperson asks for more.nnFill most of the plate with salad or vegetables.nnMake sure the person is well hydrated as they may be mistaking thirst forhunger. Offer them a drink with their meal if possible.nnLeave bite-sized fruit or healthy snacks, such as chopped bananas,orange segments or grapes, within reach for the person to snack onwhen they want to.nnOffer the person a low-calorie drink instead of more food.nnConsider not having certain foods in the house, or substituting them withlow-fat or low-calorie versions.If the person has developed a strong preference for particular foods, andis not eating enough of other foods, or if they are struggling with excessweight gain, ask the GP for referral to a dietitian.
13 Eating and drinkingPhysical difficulties and problems with a person’s sensesSome physical difficulties and problems with a person’s senses will besymptoms of dementia. But people with dementia can also have problemssuch as constipation and sight loss.Problems with co-ordinationPeople with dementia may have difficulty picking up items such as cutleryor a glass. They may also have trouble putting food into their mouth. Aperson with dementia may not open their mouth as food approaches andmay need reminding to do so. Some people may also have other conditionsthat affect their co-ordination, such as Parkinson’s disease. This couldlead them to avoid mealtimes because they are embarrassed by theirdifficulties or want to avoid struggling.Some of the tips on page 6 for encouraging people to eat – such as tryingfinger foods – may help someone who has difficulties with co-ordination.You may find these other ideas helpful:nnIf the person is struggling with using a knife and fork, cut up food intosmaller pieces so it can be eaten more easily, perhaps with a spoon.nnIf the person seems to have difficulty using cutlery, you may need toprompt them and guide their hand to their mouth to remind them of theprocess involved.nnIf you are able to, speak to an occupational therapist about aids andequipment that can help, such as specially adapted cutlery, lipped (highsided) plates or non-spill cups.Chewing and swallowingA person with dementia may have difficulties with chewing food. They mayforget to chew or they may get tired easily. Certain foods, such as hardvegetables or dry biscuits, may be more difficult for the person to chew orswallow. The person may leave these on the plate.
14 Eating and drinkingAs dementia progresses, swallowing difficulties (called dysphagia) becomemore common, although they will vary from person to person. Difficultiesmay include the person chewing continuously or holding food in theirmouth. Swallowing difficulties can lead to weight loss, malnutrition anddehydration. If the person is drowsy or lying down, they may struggleto swallow safely which may cause them to choke. You may find theseideas helpful:nnMake sure the person is fully awake, comfortable and sitting uprightbefore you offer food and drink.nnAvoid foods that the person has difficulty chewing.nnGood oral hygiene is important. If the person has painful gums or teeth,or has mouth ulcers, then chewing will be uncomfortable and difficult.If the person wears dentures, make sure they are comfortable andfitted properly. For more information see factsheet 448, Dental care andoral health.nnIf the person is having difficulties chewing or swallowing, talk to the GPabout referral to a speech and language therapist. They can diagnoseswallowing difficulties and give advic
Eating and drinking Factsheet 511LP July 2020 Keeping physically and mentally well will help people with dementia to manage their symptoms. A healthy, balanced diet can help with this. However, people with dementia often have problems with eating and drinking. This factsheet looks at different ways that dementia can affect
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