Improving Mealtime for Individuals with Dementia

When we recently featured the winning designs for the Stanford Center on Longevity MindDesign student design challenge, I was particularly struck by the first-place winner’s design. “EatWell” was, simply, a table setting that had been redesigned to make eating easier and more enjoyable for individuals with dementia.

Those of us who work in senior care know that problems with eating are a common issue for individuals with Alzheimer’s disease or other types of dementia. Since we can’t all go out yet and buy Sha Yao’s award-winning table setting, I thought I’d share a few facts bout eating problems associated with dementia, as well as simple tips for family caregivers.

Causes of Eating Difficulties

There are several reasons that eating can become problematic for an individual with dementia. For example, such individuals often lose the ability to be able to tell when they are either hungry or full. The senses of taste and smell may change, so once familiar and enjoyed foods are suddenly rejected.

Cognitive problems certainly play a large role. Individuals may forget how to use table utensils or forget the sequence of steps in the eating process. They may often forget whether they have eaten a meal, causing meals to be skipped or for overeating to occur. With declining cognition, motor problems also occur, and such tasks as cutting food into bite-sized portions or pouring a glass of water may be impossible to perform.

Physical problems can also affect eating behavior. Improperly fitted dentures, for example, can lead to loss of appetite or avoidant behavior at mealtimes. Certain medications can also affect an individual’s appetite or fluid intake, as can lack of exercise.

Whatever their cause, mealtime problems can lead to malnutrition or dehydration in old adults, which, in turn, increase dementia symptoms. If eating problems are suspected, family members should check to see if there have been any recent changes in weight and watch for any pattern of missed meals.

Tips for Better Eating

Mealtimes should not be a battleground for either the affected individual or for family members. But there are ways to make the process more productive and enjoyable for everyone. If you are facing this situation, try the following tips:

1. Serve foods that are don’t require utensils, if a loved one has difficulty with knife and fork. Sandwiches, drumsticks, whole or slice fruits, and tater tots are examples of foods that can be eaten by hand and without muss or fuss. Make lunchtime a picnic!

2. Keep the menu simple. Only place a couple of foods out at one time. Too many options can make food selection confusing.

3. If getting sufficient calories is a concern, supplement mealtime calories with a couple of high-calorie drinks throughout the day. For example, blend a milkshake with fresh fruit and ice cream, and sneak in a little protein power.

4. During meals, don’t rely on empty calories, but consider richer substitutions or additions during meals, such as using half and half instead of milk in scrambled eggs or adding butter or olive oil to grilled vegetables.

5. To reduce the threat of dehydration, offer water and clear fluids frequently during the day. A cup of warm broth in winter or a cold soup in summer can supplement water and fruit drinks and provide additional calories. Avoid caffeinated drinks.

6. If mealtimes at the table are disruptive, choose your battles. Pull out a TV tray and let your loved one eat by the window and enjoy a favorite view. Make meals something to enjoy and not to dread. Talk about pleasant subjects and avoid a tug of war about eating.

7. Some individuals respond well to eating several smaller meals throughout the course of the day, rather than three larger ones. Experiment to see what works best.

8. Engage your loved one in meal preparations to interest them in eating. Let them help prepare the meal, if they are able, or set the table.

9. Make sure that your loved one gets some exercise of physical activity to improve the appetite. Even simple activities such as gardening or short walks will help.

10. Reduce distractions and confusing table settings. An individual with dementia may have difficulty distinguishing the plate from the table or the food from the plate. Use white plates on a colored placemat. Avoid patterns that can be distracting, as well as other distractions, such as loud TV sets.

Not to compare older adults to children, but often you can use some of the same principles you may have used when your children were finicky eaters. Forcing someone to eat is not the best strategy. But making mealtimes something to look forward to, while “sneaking” in some extra nutrition, can go a long way toward ensuring proper nutrition.