Dementia and Changing Eating Habits

Christmas time can sometimes be tricky to manage for people living with dementia and their carers with changing environments, sensory overload and lots of different and often rich food on offer. This blog looks at why eating habits might change for people living with dementia and some tips to encourage good nutrition.

Dementia is mostly associated with changes to memory and cognition. However, brain changes can also affect sensory functions, regulation of appetite and both voluntary and involuntary digestive processes, for example swallowing.

Depending on the areas of the brain which are damaged, people living with dementia may experience a range of changes or difficulties with eating and drinking, especially as the condition progresses.  This blog will consider some of the possible changes and some strategies that family members or carers might be able to implement to encourage appropriate nutrition and hydration.

It’s important to stress that this won’t be a part of every dementia journey but being prepared for what may come is the best step towards continuing to live well alongside a diagnosis of dementia.

Sensory Changes - Taste

Our sense of taste changes and develops at different stages of our lives, due to a combination of age, experiences and sometimes illnesses. We also know that changes to the sensory cortex within the brain can be experienced by people living with dementia and that too can result in changes to taste. A person may dislike foods that were previously favourites, revert back to foods favoured at an earlier time of life, or perhaps start to show preference for sweet foods.

Some strategies to support the person:

• Offer a variety of foods to establish which flavours are most tolerable, try different seasonings to alter flavours, different smells and colours to stimulate and encourage eating.

• People may combine unusual flavours together or revert to a very limited diet. While encouraging a nutritious diet is important, it is also OK to allow them to eat the foods that they are drawn to.

• If they develop a sweet tooth, then often adding a sweeter sauce, like apple sauce or ketchup to savoury meals can encourage them to eat. 

• The sense of smell is closely connected to taste. Try to avoid additional strong smells in the environment while eating, for example scented candles, strong cleaning products etc. These can overwhelm and the person may associate the stronger smells with the food in front of them and then not recognise it as a food item. Smells may also be misinterpreted, leading the person to not want to eat as the smell does not match the food item.

• Be aware of food temperature as well as taste because increased sensitivity to both hot and cold might distract from the taste of the food and discourage eating.

• Keep on top of dental hygiene. If they become sensitive to the taste of regular toothpaste, try flavourless toothpastes or a mouthwash may be used as an alternative. Some people may not eat if they have dental issues, pain or sore gums, so regular check-ups are important. Poor dental hygiene can affect the taste of foods, so it is important to keep up dental hygiene in order that nutrition is not affected.

• Sometimes medication can alter taste as well as appetite, so it is worth checking if that is a side-effect with the pharmacist.

Brain changes

It is not only sensory changes that can affect the eating habits of people living with dementia. We know that in many forms of dementia, the short-term memory is likely to be impacted first. In relation to nutrition, this may lead to a person simply:

• Forgetting to eat

• Forgetting how to eat

• Forgetting how to prepare food

• Forgetting when to eat

• Not remembering if they have already eaten and so eat again

However, it is not just as simple as a memory recall issue. The hypothalamus and brain stem control and regulate various bodily functions including thirst, hunger and the sense of feeling full after eating. If there is damage to these areas, then signals between brain and gut may be interrupted and, in some cases, a person may lose the ability to recognise if they are hungry or they may eat excessively. Finally, the limbic system in the brain influences our emotions, behaviours and motivation. Sometimes, if damage occurs in this area, people may experience changes in their motivation to eat or how they feel in response to eating.

Some strategies to support the person with dementia:

• Use memory aids, clocks and alarms to set reminders for regular mealtimes. Routine is really important for people living with dementia.

• Store food so that it is easy to see and find; labels on cupboards or open shelves can be helpful. If the person lives alone, have someone support them to regularly check that things are still in date.

• Try to maintain some independence and support the person to continue to prepare meals. Some people may manage with prompts and sequencing support. Others may need reduced steps to prepare something e.g. buy a cake mix to bake a cake rather than complete from scratch or frozen vegetables rather than peeling and chopping. If purchasing ready meals, stick an easy-read label with clear heating instructions on the top.

• Check the dining environment is calm and relaxed, avoid overstimulation at mealtimes so the focus is on eating and allow plenty of time for meals.

• If the ability to eat or feed themselves becomes difficult, try changing the cutlery and crockery. Colour and contrast is important visually. If they are unable to see the food on the plate it will not be eaten. For example, a white sandwich is more visually recognised on a blue or red plate than a white one. Weighted cutlery or large grip cutlery can be helpful for some people. For others coordinating both left and right hands with cutlery may be difficult so try just a spoon or fork. If using cutlery or sitting at the table is difficult, then finger foods are often more successful.

• Limit the food items on the plate and offer smaller portion sizes. Some people may prefer to eat several small meals rather than one large meal. Try different options to find what works best.

• If the person tends to overeat, try to store food out of sight to reduce temptations but have healthy snacks such as fruits available. Serve smaller portions as the main meal if they are likely to snack through the day.

• It is also possible that the person may forget if they previously followed a particular diet for medical, ethical or religious reasons. If this was important to them, or particularly if it was for medical reasons e.g. diabetes or coeliac disease, then they should be encouraged to continue any diets, everything should be done in the person’s best interests.

• Sometimes, in later stages of dementia, a person may also experience difficulties swallowing. This may be because they forget to swallow and hold food in their mouth or because of brain changes which affect the swallow reflexes. This can present a risk of coughing or choking when eating, so seek advice from a speech and language therapist regarding appropriate food choices.

Everyone experiences dementia differently, so not all of these changes will affect everyone. Whilst it is important to encourage good nutrition, it is also important to recognise that, for people with dementia, mealtimes might look different and that is OK.

Make any adaptations to support the person to remain as independent as possible, offer healthy choices and be aware of their environment. If you have concerns about someone’s nutrition, it is a good idea to keep a food diary for a short period of time and then speak to the GP who may refer to a nutritionist for further advice. The Wayfinding team at Sage House is also available for any further support.

For more advice on making the festive period as enjoyable as possible while living with dementia, you can read our other blogs, including Managing Socials Interactions with Dementia, Tips for a Dementia-Friendly Christmas and our Video Tips for a Dementia-Friendly Christmas.