Mealtimes can be challenging when caring for someone with advanced dementia. Your loved one may no longer recognize food or remember how to use knives and forks. They may wander off the table when it's time to eat, and develop dangerous eating behaviors, such as the following:
- putting too much food in the mouth;
- eating too fast;
- swallowing without chewing; and
- attempting to eat non-edible items.
This has two negative consequences: weight loss and dehydration, as a result of not eating and drinking enough, and increased risk for life-threatening complications, including pressure ulcers, infections and aspiration pneumonia.
Following are tips by dementia care experts to ensure older people with the disease receive all the nutrients they need, within a safe and pleasant mealtime experience.
Keep Mealtimes Simple for Your Dementia Elder
Your first step is to make eating and drinking as simple as possible, while still fostering independence. Here is how you can do this:
- Give verbal prompts: “Please, take your spoon. Take some pureed fruit, and bring the spoon to your mouth.”
- Remind your elderly loved one to eat their food one small piece at the time.
- Use color contrast to help find food more easily. Colored items, like carrots and tomatoes, are easier to see on white plates, but other items, like mashed potatoes, are easier to see on colored plates.
- Do things your loved one can't do. Open the milk carton, cut the meat, and so on.
- Give them finger food if they are unable to use knife and fork.
Make Mealtimes Safe in Advanced Dementia
Often older people with advanced dementia can't open their mouth, chew or swallow well. As a result, they are more likely than other older people to choke. Furthermore, food particles and fluids can go into their lungs, rather than the stomach, resulting in aspiration pneumonia, a leading cause of death in the elderly.
To prevent this from happening, consider these tips:
- Spoon-feeding is likely to be the only way you can now feed your loved one. Before starting, have them sit upright and make sure they are well alert.
- Sit at their eye level and moisten their mouth with some water. This will help you test their swallowing ability. If they can swallow, offer them half teaspoon of food.
- Place only the spoon's tip into their mouth and give them plenty of time to taste, chew and swallow.
- If they cannot open their mouth, place your thumb just below your loved one’s lower lip and your index above the upper lip. Then, squeeze gently, and release.
- You can also help with swallowing by gently massaging their throat, from the base of the neck upwards.
- Encourage swallowing a second time before offering other food. This will help ensure their mouth is empty. For the same reason, you should offer small sips of water every three/four spoonfuls.
- Adding thickeners to liquids further reduces your elderly loved one's risk of choking.
What Food for Older People with Advanced Dementia?
When chewing difficulties are present, experts recommend soft foods, such as mashed potatoes, stews, eggs and soups. These should be replaced with pureed food if there are swallowing problems, because, in this case, soft foods increase the risk of choking.
If your loved one can still eat normal food, consider replacing the evening meal with a breakfast style dinner that includes bread, jam, boiled eggs, muffin, fruits and cheese. Research published in the Journal of Gerontology: Medical Sciences found this increases significantly the amount of food elders with dementia eat.
Dementia Elders Benefit from Relaxed and Comfortable Mealtimes
Ensuring a calm and pleasant environment is also important. In this regard, researchers at Edith Nourse Rogers Memorial Veteran’s Hospital, Massachusetts, recommend
- minimizing distractions (e.g., television, too many people in the room, etc.);
- playing gentle music softly in the background; and
- ensuring the room is well lit.
Another couple of important points are worth considering. You'll probably find that patterned tablecloths and napkins are not well received. This is common among people with advanced dementia because bold, busy patterns generate confusion. The same goes for unpleasant odors, loud noise and glare.
Lastly, consider that, although your efforts are mainly directed towards ensuring your loved one eats and drinks enough, mealtimes are also invaluable opportunities for social interaction and closeness. So, talk with them in a positive and pleasant tone of voice even if they are no longer able to understand or speak. And, most importantly, show them your love and affection. Give them hugs, gently stroke their hands and praise them often.
Selected references:
Bothman S. Geriatric treatment network. Mealtimes strategies for persons with dementia. Treatment Network. Fall 2004; 4(4).
Crooks M, Steiner P, Uthoff S, Betterley C, Jolly C, Nelson D. Share family meals. Iowa State University, University Extension. October 2003.
Hellen CR, Alzheimer’s disease activity-focused care. Butterworth Heinemann, Second Edition. 1998.
Paquet C, St-Arnaud-McKenzie D, Ma Z., Kergoat M-J, Ferland G, Dubé L. More than just not being alone: the number, nature, and complementarity of meal-time social interactions influence food intake in hospitalized elderly patients. The Gerontologists, 2008; 48(5):603-11.
Young WH, Greenwood CE, van Reekum R, Binns MA A randomized, crossover trial of high-carbohydrate foods in nursing home residents with Alzheimer’s disease: Associations among intervention response, body max index, and behavioral and cognitive function. Journal of Gerontology: Medical Sciences. August 2005; 60A(8):1039-45.
Lorena Tonarelli - Internationally published healthcare journalist, medical writer, author and editor.
