For most of us, meal times are pleasurable experiences, whether we crave comfort foods, new cuisine or self-prepared creations. For the person with dementia, however, meal times can be frustrating, confusing and extremely stressful, with the potential of reduced appetite, weight loss and even malnutrition. It is not unusual for nursing home residents to resist eating at such times, often resulting in additional stress between residents and their caregivers or family members, who are trying hard to persuade them to eat.
In addition to any physical problems or medication issues that may affect appetite and eating ability, people with dementia may forget whether they have eaten, be unable to recognize some foods or to use cutlery, have difficulty chewing or swallowing, be easily distracted while eating and/or be unable to communicate their food likes and dislikes. They may prefer only a few foods, or certain types of foods---for example, ice cream, or cookies, cake or chocolate candy.
Although there are a number of challenges to be faced, there are steps that can be taken to maximize both food intake and more pleasure in eating, while helping to maintain the resident’s independence and dignity:
Food We Enjoy Is Food We Are More Likely to Eat
- For people with dementia, knowing what they like to eat is even more important than knowing what they don’t like to eat. Even when they can’t remember the name of a food, pleasurable associations are often retained, with the sight and/or the taste of particular foods. If they like the food, they are much more likely to eat it.
- Most nursing home residents do not need special diets and restricting food options can increase the risk of weight loss. It is the position of the Academy of Nutrition and Dietetics that “…the quality of life and nutritional status of older residents in long-term care facilities may be enhanced by a liberalized diet.”
- Liberalized diets are also recommended for most residents with diabetes. In general, no concentrated sweets or no sugar added diets are no longer considered appropriate for older adults living in health care communities.
Residents should never be forced to eat. It is also very important not to take food away too quickly, as many residents will eat if given enough time.
- If a resident doesn’t seem willing to eat at mealtimes, they may respond to being offered snacks throughout the day (a piece of fruit, a cookie, some pudding, a peanut butter and jelly sandwich). It is preferable that residents eat food they enjoy, rather than relying on supplements, which are rarely if ever as satisfying.
- Apart from their nutritional value, having a variety of snacks available can bring pleasure to residents. A piece of chocolate, a lollipop or some ice cream makes people feel good!
- Many people with advanced dementia, who can no longer use utensils, are able to feed themselves if they have finger food they like, presented to them in an encouraging way. Being fed by someone else is often an uncomfortable and sometimes embarrassing experience, and can cause people to further lose interest in eating. While not everyone is able to benefit from finger food, those who can often take more interest in eating, and sometimes find it easier to take meals in the social setting of the dining room.
- Most foods can be prepared as finger food when approached the right way. Think wraps, meatballs, mini quiches, scones, crackers with cream cheese, pound cake, fruit slices, French toast, cooked carrot sticks, potato wedges, peanut butter sandwiches, fishcakes---the possibilities are endless.
- Most importantly, there is not a ‘one size fits all” approach. Plans should be customized, based on each resident’s preferences and comfort.
A Comfortable Environment Makes a Big Difference
- Help the resident be comfortable when seated for meals, i.e., fully awake, sitting upright with necessary aides in place (glasses, hearing aid, dentures). The food should be positioned so that it can be easily seen.
- The dining area should be quiet and calm. Noise and other distractions can interfere with attention span. Soothing music may help. The important thing is to observe residents in the dining area, and if the music is causing anyone distress, change it to something else or turn it off. If there is a TV, it should not be on during mealtimes.
- When using placemats or tablecloths, they should be a different color than the plates. This helps residents see the edges of the plate more clearly, making it easier for residents to feed themselves.
- Plates should not be overcrowded. Offering only one course at a time can be helpful and less confusing for the resident.
If a staff member or family member is able to eat along with a resident, this may increase the likelihood that they will eat. When you share a meal with a resident, try to eat a similar food to encourage positive feelings of comfort and familiarity.
- Have a warm, damp cloth available to wipe their hands. Feeling sticky or uncomfortable may make it harder to eat, or just plain discourage someone from eating.
For most people, food is a source of pleasure. For the person with dementia, it is one of the few pleasures still available to them, so it is all the more important that meals be a priority.