Eating and drinking in dementia

Nutrition and Dietetics

This leaflet offers practical advice on how you can help someone with early stage dementia to overcome problems with eating and drinking. If you have any further questions, please speak to a Health Care Professional caring for your relative or friend.

Many people with dementia have problems with eating and drinking. Food plays a very important part in our lives, so it can be upsetting to see someone we love lose interest in food and lose weight as a consequence.

Common eating and drinking challenges in dementia

There are many reasons why eating and drinking can be challenging in people with dementia. They may:

• Forget to eat or drink or forget that they have already eaten or had something to drink.
• Have reduced or limited feeling of hunger and, or thirst.
• Experience altered sense of taste and smell.
• Have changes in food preferences and eating habits. For example, the person may prefer sweet foods, which may be different from their previous likes and dislikes.
• Find it difficult to perform tasks such as shopping, food preparation and cooking.
• Have difficulty in hand-eye coordination which can reduce the ability to use cutlery.
• Lose the ability to recognise food and drinks.
• Experience difficulties in chewing and swallowing.
• Have increased energy needs due to increased walking with purpose and repetitive movements.
• Become easily distracted at mealtimes.

Setting the scene for mealtimes

A calm, familiar and sociable environment can help people with dementia to feel more comfortable eating and drinking. You could try:

• Remain as relaxed as possible around mealtimes.
• Make sure they are sitting upright, supported and comfortable position.
• Minimise distraction. For example: turn off loud televisions and radios. Try to play some relaxing music to create a calm environment.
• Make meals an activity.
  • Encourage them to get involved in meal preparation, setting the table and cleaning up.
  • Talk about cooking smells, favourite foods, memorable meals or recipes.
  • Show them the food and drink, explain what they are and let them smell them to aid recognition.
• Keep the table settings simple to keep focus on the food.
  • Avoid using patterned tablecloths.
  • Avoid distracting items on the meal table such as vases or lots of condiments.
• Make food easier to see.
  • Use plain coloured crockery that contrasts with the food and table such as red, yellow or blue.
  • Keep the room bright and well lit.
• Use adapted cutlery and special cups for those who struggle to grip standard cutlery and cups.
• Serve meals when the person with dementia feels comfortable and ready. For example: not anxious or lying down.
• Use pre-warmed ceramic plates or a plate warmer and insulated cups to keep food and drinks warm.
• Make mealtimes a social activity – eating together allows connections with others. It also helps indicate to them that it is time to, see what they will be eating and how to eat.

Encourage a person with dementia to eat and drink

Positive reinforcement and encouragement are needed for people with dementia who have difficulties in eating and drinking. You could try:

• Involving the person by asking them what they would like to eat and drink and offer food and drinks the person likes.
• Prompt the person using a sign or notice in the kitchen to help the person find food, crockery and cutlery.
• Encourage the person to eat independently.
• Sit at eye level or slightly below the person you are assisting. Sit at one side or slightly in front of them and maintain eye contact.
• Gently place your hand over the person’s hand to help guide the cutlery to their mouth at the start of a meal.
• Do not worry about mess. Use a napkin, apron, or small tea towel or hand towel to protect clothing from spillages whilst maintaining dignity.
• Allow plenty of time for a meal. If additional time is needed to finish meals, provide one small course at a time to keep food warm and avoid confusion. Extra portions can always be served.
• Consider offering three small meals and three snacks during mid-morning, mid-afternoon and supper time rather than three main meals if the person has a poor or small appetite.
• Use directed verbal prompts. Useful phrases include:
  • “How is your tea?” to encourage the person to drink.
  • “How are you enjoying the…?” to encourage the person to continue to eat.
• Do not worry if food and drinks are refused. Simply offer something again in 30 minutes to an hour.
• Ensure drinks are accessible throughout the day. Offer small amounts of fluid frequently. Encourage high-moisture foods. For example: ice lollies, fruit, yogurt, jelly, custard, soup or sauce.

Change in food preferences

What if a food that has been enjoyed for years is now refused?

Dementia can affect how flavours are recognised. Taste and smell reduce naturally with age. People with dementia may enjoy strong flavoured foods. Foods previously enjoyed may now taste bland. You could try:

• Keep an open mind.
  • Do not exclude any food and try a wide range until you find out what that person enjoys now.
  • Keep a list of current preferences and retry foods again from time to time.
• Enhance taste and smell by adding extra flavours.
  • For savoury food try adding: spices, herbs, onion, garlic powder or puree, lemon or lime juice, vinegar, marmite, Bovril, mustard, ketchup, tomato puree, Worcestershire sauce
  • For sweet food try adding: sugar, honey, maple syrup, jam, natural flavourings, balsamic vinegar

What if a preference for sweet foods develops?

It can be difficult to incorporate sweet foods into a balanced diet. You could try:

• Include naturally sweet vegetables. For example: carrots, parsnips, sweet potato, peppers or sweetcorn.
• Serve food with sweet and sour sauce, sweet chilli sauce, ketchup, pickles or chutneys such as apple, cranberry or redcurrant.
• Add fruit to savoury casseroles. For example: lamb and apricots or pork and apple.
• Encourage milk-based puddings. For example: custard and stewed fruit, rice pudding, trifle, mousse, ice cream, crème brûlée, evaporated milk, condensed milk or cream with canned, frozen or fresh fruit.

Finger Foods

Finger foods can be picked up and eaten by hand easily. They may help people who find it difficult to use cutlery, are too distracted to sit at the table or walk a lot during mealtimes. Storing foods and drinks in picnic-style containers are easier for them to carry around. Some finger foods ideas are listed below.

Breakfast and fruit

• Toast, bread fingers, buttered muffins, crumpets and brioche.
• Soft cereal bar, waffle or pancake
• Sausages, pieces of firm omelette or hard-boiled eggs
• Fruit segments, berries, seedless grapes or dried fruit

Main meal and savoury snacks

Starchy carbohydrate

• Sandwich fingers
• Potato – chips, wedges, waffles, new, roast or jacket
• Bread, chapattis, crumpets or tortillas,
• savoury biscuits or bread sticks
• Yorkshire pudding or Pasta muffins

Vegetables

• Cherry tomatoes, tomato wedges
• Vegetable slices/ or sticks with dips. For example: carrots, celery, peppers
• Button mushrooms, broccoli or green beans

Protein

• Cubes or slices of cooked meat, meatballs, or chicken nuggets
• Fish fingers, fish cakes, breaded fish or crab sticks.
• Mini burgers, sausages or pigs in blankets
• Buffet type food. For example: mini quiche, small slice of pizza, small pork pie, sausage roll, small scotch egg or samosa
• Hardboiled eggs, pieces of firm omelette or Spanish omelette
• Cheese cubes

Pudding and sweet snacks

• Mini fruit pie, egg custard tart, jam tart
• Sponge pudding cut into chunks.
• Cold bread and butter pudding squares
• Cereal bar or flapjack, buttered malt loaf or fruit loaf slices
• Buttered tea cakes, crumpets, muffins or scones
• Small cake, buns, muffins, small cookies
• Pancake rolled with filling.

Ideas for sandwich fillings and spreads

Pate, cheese spread, cream cheese, tuna mayonnaise, egg mayonnaise, nut butter, cheese mayonnaise, fish or meat paste

Chewing or swallowing difficulties

• Chewing problems may develop as a result of forgetting to chew, mouth pain, dental caries, or ill-fitting dentures. Try:
• Choose food that is soft enough to be broken up with the flat edge of a fork. For example: eggs, fish, mash potatoes, banana.
• Avoid foods that are dry, crusty, flaky, sharp or rough.
• Soak cereals or biscuits in milk.
• Moisten food by adding sauces or gravy to savoury food and custard or cream to sweet food.
• Maintain good mouth and tooth care.

Swallowing problems may develop as a result of the inability to recognise food and coordinate swallowing and feeding.

If you notice the following symptoms occur when eating and drinking, please contact your GP to request a speech and language therapist referral for individual advice on safe and appropriate texture modification.

• coughing or choking
• feeling a sticking sensation in the throat
• bring food back up.
• a change in the sound of the persons voice whilst, or soon after eating. For example: voice sounds ‘wet.’

Adding extra energy and protein

Eating and drinking problems associated with dementia may lead to weight loss and malnutrition. There are different ways to boost the calorie and protein content of the diet.

Fortifying meals

• Use full fat products and choose high calorie items.
• Add butter, cream and dried milk powder (supermarkets own brand or Marvel) to mash, porridge, soups, sauces or milky puddings.
• Add cheese to sauces, scrambled eggs, pasta or mash.
• Thickly spread butter, jam, marmalade, nut butter and/or condensed milk on bread, toast, scones or crumpets
• Add sugar, jam, syrup or honey to porridge, custard, rice pudding or semolina.

Encourage nourishing snacks between meals

• Cheese and fruit. For example: pineapple, grapes
• Cheese and crackers
• A handful of unsalted nuts
• Nut butter on bread or toast.
• Semolina, tapioca, chia or rice pudding
• Thick and creamy yogurt or full fat Greek yogurt
• Malt loaf with cream cheese
• Cereal bar or Flapjack
• Toasted teacake with cream cheese and jam
• Tub of custard

Encourage nourishing drinks

• Aim for 6 to 8 glasses of fluid each day.
• Have one pint of full cream milk each day.
• Fortify your usual milk by adding four tablespoons of dried milk powder to one pint of full cream milk.
• Encourage milky drinks. For example: milky coffee, hot chocolate, malted drinks such as Ovaltine and Horlicks,
• Encourage milkshakes or smoothies made with fortified milk, cream, ice cream and, or yogurt.

Oral nutritional supplements

There are a variety of supplement drinks (shakes and soups) available from the chemist or supermarket such as Complan and Meritene (previously known as Build-up). If your friend or relative requires further support, a referral to a dietitian can be made via your GP. They can offer more tailored and practical advice on how to improve the diet of someone who has a small appetite. They may advise on a variety of supplements available on prescription from your friend or relative’s GP. These have extra energy, protein, vitamins and minerals added to them and can help to provide extra nutrition when appetite is poor.

Shopping and meal delivery services

If the person you care for has difficulty shopping, online shopping or local volunteer services may be helpful. Ready meals from the supermarket can be kept in the fridge or freezer and used as required. Some companies will deliver frozen foods to your door:

Wiltshire Farm Foods
147 Stockton Street, Middlesbrough, TS2 1BU
Telephone: 01642 643999 Monday to Friday 9am until 5pm

Oakhouse Foods
Unit 1, Shires Bridge Business Park, Easingwold, YO61 3EQ
Telephone: 01904 948949 Monday to Friday 9am until 5pm

Parsley Box
Orchard Brae House, 30 Queensferry Road, Edinburgh, EH4 2HS
Telephone: 0131 3260131 Monday to Saturday 9am until 6pm

Millennium Meals
54 Borough Road, Middlesbrough, TS1 2JH
Telephone: 01642 228237 Monday to Thursday 7:45am until 11:45am, Friday to Sunday 8:30am until 10:45am

Patient Experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the patient experience department of any special requirements, for example; braille or large print by emailing: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

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