Our Sunday “family dinner days” with Dad were somewhat different than standard visits throughout the week. At that time, Dad had advanced Alzheimer’s disease. My older sister, her children, and I would visit with him at his long-term care home. We would dine together on what we called “outside food” (something not featured on the facility’s dinner menu). While we enjoyed our time together, these meals provided another purpose. We could better watch what Dad was eating and how he was eating. During your journey as a dementia caregiver, observing your loved one's nutrition will be important as well.
5 Reasons Why Someone with Alzheimer’s May Not Eat Enough
Usually, Dad came to dinner with a healthy appetite. However, this may not always be the case. Someone with Alzheimer’s disease may not be hungry or even eat enough food during the day. Why does this occur? When Dad did not seem to be hungry, we had to do some detective work to try to find a reason why he wouldn’t eat. The answer might not always be clear so take these seven possibilities into account:
- Reduced appetite. Are your loved one’s current medications producing a negative result? Consult with their doctor to see if loss of appetite could be a side effect. If so, ask if there are other medications your loved one could try instead.
- Missing socialization. Eating a meal often serves as a social activity. People gather around a table to chat, laugh, and enjoy good food and drink. Lonely seniors may not feel hungry and leave food on their plate.
- Too much on the plate. A full plate can seem overwhelming for someone with Alzheimer’s or dementia. Deciding where to start eating can be difficult. In this case, make things easier for the senior by serving the meal in courses. Begin with the salad, spoon out some mashed potatoes and gravy, and then offer several slices of meat.
- Confusion with cutlery. While you would reach for a spoon to eat soup, seniors with Alzheimer’s or dementia may grab a fork instead. Or they may choose to bypass the cutlery completely and eat with their hands. Adaptive cutlery (angled or weighted forks, knives, and spoons) can help seniors with reduced physical motor skills to eat.
- Filling up on dessert. Clear the plates away before serving dessert. Seniors with Alzheimer’s or dementia may act like a small child – beelining for the dessert first and not having room for the meal.
8 Ideas to Encourage Nutritious Eating Habits for Those with Alzheimer’s
Once you have an idea of why your loved one isn't eating the food they should, try one of these strategies to encourage proper nutrition:
- Consider sensory stimulation. Think quiet and calm. There was a small, private room at Dad’s long-term care center which worked well for our family dinners. Create a soothing atmosphere when setting the table. Limit distractions during a meal by doing things like replacing a patterned tablecloth with a solid color.
- Make eating a social event. Enjoy each other’s company and engage in conversation. Sit and eat with your loved one to oversee the quantity and the types of food he or she is consuming.
- Focus on nutrition first. A healthy, well-balanced diet is an important part of a brain-healthy lifestyle. Consult with your senior’s doctor about any dietary restrictions. Include fresh fruit or whole wheat bread on the menu to help a senior suffering from constipation.
- Limit coffee and teas. Caffeinated coffee and tea act as diuretics and increase dehydration. Encourage your loved one to consume these drinks sparingly and offer water after caffeine consumption.
- Drink water. Hydrated seniors can better manage constipation and avoid urinary tract infections (UTIs). Seniors should try to consume about 1 and ½ ounces of water for each pound in weight every day.
- Serve multiple meals a day. People with late-stage Alzheimer’s and dementia may not remember their most recent meal. Eating regularly and repeatedly can help seniors control hunger pangs, reach their daily intake of food required, and balance energy levels.
- Recognize possibly hazardous foods. With cognitive decline, food can become unrecognizable and swallowing may become an unfamiliar act. Watch for your senior accumulating “pockets” of food inside their cheeks. Remove foods that are choking hazards such as grapes. Introduce soft foods, smoothies, or protein shakes into their diet. In our case, Dad loved fresh strawberries. Given the chance, he would eat these whole so we needed to slice off the berry stems before serving.
- Schedule regular dental checkups. Damaged teeth or loose dentures can be problematic. Keep up with regular dental appointments. If mom or dad can’t explain an oral problem to a dentist, you may have to step in and explain the problem.
3 Strategies for a Stress-Free Meal
It may seem difficult to believe, but meals can be stress-inducing times for those with Alzheimer's disease. How would you feel seeing food on a plate in front of you but not being able to enjoy it? Once again, caregivers can take steps to reduce the increased pressure a loved one may feel by trying the following:
- Encourage finger foods. Pizza was one of our favorite foods we brought in for Dad because he could easily grasp and hold the pizza in his hands. Other experiments included sandwiches, Chinese eggrolls, sausage rolls, soft-shell tacos, and chicken fingers.
- Wait to clean up. Without using cutlery, eating can get messy! Resist the temptation to clean up throughout the meal. Mom or dad will focus on the served meal. Any pauses for face or hand-wiping will confuse and heighten anxiety.
- Watch for bones. Dad always enjoyed having his fish for dinner. Before serving him the catch of the day, we had to remove all the bones. Those with Alzheimer’s disease may crunch into these bones without thinking, causing smaller bits of bones to get caught in the throat and cause choking.
5 Signs of Chewing and Swallowing Difficulties for Seniors
Family caregivers need to be attentive to how the senior is chewing and swallowing food. There are visual and auditory cues which point to obvious difficulties.
- Coughing. This is the most common sign. Coughing (in short or long sessions) will occur during or after eating. A similar sign could be the frequent clearing of the throat.
- Holding food in the mouth. Your loved one may simply hold food in his or her mouth and not do anything further with it.
- Grimacing when swallowing. This is a sure sign that the food going down is causing some pain.
- Refusing to swallow. Does mom or dad appear to be eating, but not swallowing? They may also spit out lumps of food instead of swallowing them.
- Eating very fast. In this case, your loved one may be forgetting to chew between bites.
For any of these cases, family caregivers can gently pull the plate away from their loved one and offer a glass of water to drink instead. Is the choking more severe? Perform the Heimlich Maneuver and call for medical help immediately.
Alzheimer’s Nutrition Tips
Watching how a person with Alzheimer’s or dementia is eating isn’t enough. Family caregivers must also watch what they are eating. Good nutrition becomes even more critical for seniors with Alzheimer’s or another form of dementia.
The 7 Basics of Good Nutrition
- Eat a variety of foods from each food category. Not all of these foods need to be on the dinner plate. Caregivers can look to augment meals with healthy daily snacks. Peel an orange and separate it into segments, offer cheese and crackers, or pour a glass of milk for your senior. The five major food groups including the following:
- Vegetables and legumes/beans
- Grain (cereal) foods, mostly wholegrain and high cereal fiber varieties
- Lean meats, poultry, fish, eggs, tofu, nuts and seeds
- Milk, yogurt, cheese (mostly reduced fat) and alternatives
- Maintain a healthy weight by balancing food with exercise.
- Avoid fried foods since these can be heavy with saturated fat and cholesterol.
- Reduce sugar.
- Limit salt.
- Drink ample water. Eight eight-ounce glasses or one and a half ounces of water for each pound in weight daily.
- Create a diet with foods high in antioxidants like beans, berries, pecans, spinach, and dark chocolate.
If you can’t get everybody together for a family dinner with mom or dad, visit them at home or their care community in the meantime. Watch how mom or dad eats and handles a regular meal. At best, mom or dad will be able to eat independently and manage many foods. If not, bring this matter to the attention of your family, your parents' caregiver, or their long-term care staff. Work together to encourage better nutrition for your loved one. Proper nutrition is the basis for personal health and wellness. Ensure that what’s on your loved one’s plate (and how they eat it) is a priority on your own caregiving plate.