Meal Appeal: Help Loved Ones with Dementia Get the Nutrition They Need

Know what can help

While preparing the meal:

• Bring the care recipient into the kitchen while you’re preparing a meal
• Bump up the nutrition. Powdered protein, healthy fats, pureed vegetables can be slipped into soft foods and whole wheat baked goods. Use nut flours for breading, baking and thickening
• Cut out empty calories, such as sugar and processed foods
• Add preferred spices or flavors
• Cut chewy food into small pieces
• Limit salt
• Prepare nutrient dense food
• Switch to finger food such as fish sticks, chicken strips, burgers and green beans when you see that your loved one is becoming unable to use fork, knife or spoon

People with dementia do not always see their surroundings or the food on the plate as others do. To make mealtime easier for your loved one to manage:

• Eat in a quiet, simple area.­ Busy, ornate rooms are distracting
• Sit at a small table opposite your loved one. Even if it is not your mealtime, set a place for yourself and put a little food on the plate. Companionship improves appetite and gives you the opportunity to assist
• Eat with minimal talking, no electronics or preventable noise. Doing more than one thing at a time can be confusing for people with dementia
• Put food on a red plate. Boston University researchers found people with Alzheimer’s ate 25% more food when it was served on a red plate versus a white plate
• Consider using tableware designed for dementia patients. Plastic cups with handles, curved handles on forks and knives, plates with a high lip to keep food from sliding onto the table will make it easier for your loved one to manage food
• Avoid patterned china, which can make it harder to tell the difference between food and plate
• Don’t use patterned tablecloths, which can make it appear that the plate and the tabletop are one. Easy fix: Put a single-color, contrasting placemat under the plate
  
• Skip proper table settings. A spoon, knife, or glass that won’t be used adds to the visual clutter that makes eating harder
• Remove centerpieces, candles, salt shakers, serving dishes
• Use unbreakable cups, spill-proof if needed
• Be flexible about meal times. Eating dinner at 10 p.m. is better than not eating at 6

When serving:

• Serve the nutritious food first
• Try small portions on a salad plate
• If using a dinner plate, serve one or two foods at a time. More can be overwhelming
• Turn your loved one’s plate so that the food favorite is furthest from the hand your loved uses to eat. People with dementia often eat the closer food first
• Make sure temperature is not too hot. People with dementia are not always able to tell extreme heat or cold
• Know that tastes can change suddenly for people with dementia. Smells and textures can also become bothersome. A favorite food may be rejected or a previously disliked food may become acceptable
• Be aware that intense smells can be distracting
• Flatter the food. Use short and tempting phrases. “This fish is delicious!”

At the table:

• Make eye contact. Smile and look them directly in their eyes for a minute or more. Wait for the person to smile in return. As the disease progresses, returning the behavior may not come easily or quickly, but it may register and comfort. Repeat throughout the meal (and during the rest of the day)
• Others at the table should follow the same guidelines. The more people, noise, dishes and silverware, the harder it is for someone with dementia to decipher and focus on food
• Model the action. If the person in your care is having trouble handling food or utensils, say “watch me” and demonstrate
• Allow lots of time to eat
• Don’t worry yourself or your loved one over fallen food
• Remind the person for whom you care to chew thoroughly and swallow carefully. Monitor for choking
• If your loved one won’t eat, put the food in the fridge and try again later

After eating:

Jot down everything your loved one ate, how much and at what time. Measure the food when you put it on the plate and estimate how much is left. This will let you make sure the daily intake is enough, make it easy to spot a pattern or change and give you a record to share with the doctor.

Top tips

• While many people with dementia may forget to eat without reminders, others don’t recall the meal they just ate and believe it’s now time to eat. If this happens, it may help to break the meal into several small “meals”, serving as requested. Start with the most nutritious item.
• Look beyond the dementia for issues that may be affecting appetites. Among the possibilities: medication side-effects that dull hunger or leave a metallic taste, a re-occurring headache, mouth or stomach ulcers and ill-fitting dentures.
• Notice if a flavor or texture falls out of favor. Replace with an equally nutritious but much different alternative. For instance, collard greens, raspberries, sweet potatoes, okra and tomatoes all have more than 12 mg of vitamin C. 
• Accept that some days will be more successful than others.
• DISCUSS: Communicating with someone who has dementia