Eating and drinking in dementia

Patient, families and carers information factsheet

This leaflet contains useful information to assist with eating and drinking challenges in dementia.

What are the most common issues?

People living with dementia may have:

• Problems with coordination, such as finding it hard to use cutlery or prepare food.
• Difficulties chewing or swallowing (known as dysphagia). This may include holding food in the mouth, coughing or choking when eating or drinking.
• Changes in appetite or taste which may affect how much or what they want to eat.
• Forgetting to eat or drink, not recognising feelings of hunger or thirst.
• An environment that is not stimulating or engaging, which may make it harder for the person to focus on eating. Or the opposite, becoming easily distracted by noise, movement or too much activity around them.
• Poor mouth care, dental problems or pain, which can make eating and drinking uncomfortable and reduce how much the person eats.

Low appetite

• Gentle reminders: Offer gentle prompting to eat and drink as people with dementia may forget mealtimes.
• Favourite foods: Give foods and drinks the person usually enjoys, keeping in mind that taste and preferences may change over time.
• Small frequent meals: Provide little and often, such as five or six small meals or snacks if large portions feel overwhelming.
• Fortify meals: Add extra nourishment to meals like additional oil in cooking, cream to pudding or cheese on top of meals.
• Nourishing drinks: Offer high?calorie drinks between meals, such as homemade smoothies, milkshakes, Horlicks, or hot chocolate.
• Mealtime support: Provide help with eating and drinking when needed, such as cutting up food, offering hand?over?hand support or sitting together during meals.

Low fluid intake

• Preferred drinks: Offer drinks the person enjoys. Learn their likes and dislikes and keep a note of them, keeping in mind the persons preferences may have changed.
• Visible cups: Use clear glasses so they can see the drink, or bright cups that catch their attention.
• Drinking aids: Provide helpful equipment if needed such as beakers, lidded cups or easy?grip handles*.
• Hydrating foods: Offer foods with high fluid content like yoghurt, custard, soup, puréed fruit or jelly*.
• Fluids with medication: Encourage extra sips of fluid when taking medicines.
• Frequent prompts: Keep drinks available at all times and gently remind the person to drink throughout the day.

*Please speak ensure that these strategies are confirmed with the Speech and Language Therapist if there are swallowing concerns.

Difficulties chewing or swallowing

• Soft, moist foods: Offer foods that are easy to chew and swallow, such as soft, moist meals and snacks.
• Avoid difficult textures: Try to avoid foods that are hard, dry, tough, chewy, stringy, or sticky, as these can be challenging.
• Small, slow mouthfuls: Gently encourage taking small bites and eating slowly to reduce the risk of choking. Avoid talking while eating or drinking to help focus on swallowing safely.
• Upright posture: Support the person to sit upright when eating or drinking and remain upright for at least 30 minutes afterwards.
• Regular mouth care: Ensure daily mouth care. Check that dentures are clean, comfortable and fitted correctly.
• Coughing soon after eating or drinking: choking episodes or repeated chest infections may indicate a **serious swallowing problem. **

A GP should be contacted for a referral to the Speech and Language Therapy team if there are concerns regarding swallowing.

Problems with co-ordination

• Encouraging independence: If the person spills food/drink and is not bothered by it, allow them to continue. The aim is to eat something and encourage independence where possible whilst maintaining their dignity.
• Unhurried mealtimes: Make sure they have plenty of time to eat and drink without feeling rushed.
• Finger foods: Offer foods that can be picked up easily, which may feel more manageable than using cutlery.
• Contrasting tableware: Use plain, colourful plates and cups that contrast with the table or tray to help the person see the items clearly. For example, a blue plate on a red tray.
• Adapted equipment: Consider items designed to be easier to hold, like easy?grip cutlery or a non?slip mat under the plate to stop it sliding. If you are struggling with this, an Occupational Therapist may be able to help.

Creating the right environment

• Hand washing: Support the person to use the toilet and wash their hands before meals to minimise distractions and prepare for mealtimes.
• Reduce distractions: Keep the environment calm by avoiding conversations, TV or loud music. Soft, familiar music may help reduce agitation for some people.
• Comfortable setting: Serve meals and drinks in a place where the person feels relaxed and comfortable.
• Clear tables: Remove unnecessary items from the table to avoid overstimulation and help the person focus on eating.
• Routine or flexible timing: Some people benefit from regular mealtime routines, while others may eat better when meals are offered during times they are most alert and hungry.
• Plenty of time: Allow unhurried time for meals so the person does not feel rushed.
• Social eating: If the person enjoys company, eating with others can prompt and encourage them. Consider lunch clubs or day centres where they can share meals socially.

Advanced dementia

• As dementia reaches the later stages, people may have increasing difficulties with eating and drinking.
• Some may eat very little or may stop eating and drinking altogether. At this stage, the focus may change to comfort and quality of life, rather than on how many calories a person is having. Extra calories are unlikely to change the course of the illness or extend life.
• Trying to force someone to eat or drink can cause distress, discomfort and anxiety for both the person and those caring for them. This includes the use of prescribed nutritional drinks which should not usually be started at this stage and tube feeding which is generally not recommended for people with severe dementia. Research shows that tube feeding does not help people with severe dementia live longer, gain weight or become better nourished.
• Decisions about eating and drinking are made with the person whenever possible. If they are unable to decide, their family, carers and the healthcare team will make decisions together. The team will always act in the person’s best interests, keeping comfort and quality of life at the centre of care.

Contact our Service

Please do not hesitate to contact the Dietitian on 020 7288 5552 (Monday to Friday, 9am to 5pm) if you have any dietary questions or concerns.