Preventing Malnutrition in Dementia

Written by Caroline Mitchell-Wemyss, Care Manager, Dementia Post Diagnostic Support (NHS Fife)

Nutrition is not often the first topic that comes to mind when we think about dementia care. Understandably, it can take a back seat to other concerns such as change in memory, mood and independence. Despite this, I often work with people experiencing difficulty in maintaining good nutrition due to cognitive change.

Being aware of some of the most common reasons may help remove the stress from mealtimes and help them to become a happier experience. The main causes for a reduction in appetite and dietary intake can include:

Change in Appetite – depression, pain, reduced physical activity and constipation can all contribute towards a lack of appetite and are prevalent in people with dementia. Some medication can cause a loss of appetite or side effects such as nausea.

Change in Taste – taste buds can ‘dull’ with age and savoury food may seem bland or tasteless. Some people may also start enjoying food that they would not have usually eaten. Eating is a sensory experience but eyesight and smell recognition can deteriorate in a person with dementia, making mealtimes much less enjoyable.

Physical Changes – difficulties with chewing and swallowing can also occur as dementia progresses or be caused by other medical conditions. Tooth pain or ill fitting dentures can understandably cause reluctance to eat.

Cognitive Changes – due to changes with memory and insight, a person with dementia may forget to eat or not recognise when they are hungry or thirsty. There can be difficulty preparing food or forget to eat if food is not readily accessible or visible. Using cooking apparatus or cutlery can become increasingly challenging as dementia progresses.

Environment – Excess noise and lighting can create a distracting and unsettling environment for mealtimes. Colour perception may be impaired which can cause difficulties at mealtimes. For example, white rice on a white plate may not be visible and the meal is left uneaten.

It’s important to remember that dementia symptoms can manifest in different ways in each individual – no two experiences will be identical. The most valuable advice is to find out what matters to the person – their likes, dislikes, routines, fears, what makes them happy – and work as partners to make the necessary changes to ensure a healthy and varied diet.

Other tried and tested tips include:

  • Keep the environment as relaxing and comfortable as possible – maybe some quiet music in the background and warm (but not too dark) lighting.
  • Try using contrasting coloured crockery and cutlery. Studies have shown that a highly contrasting red plates and cups can help increase appetite as well as food intake!
  • Appeal to the senses – ensure that food is presently attractively and smells nice. Delicious smells such as freshly baked bread can stimulate the appetite.
  • Equipment such as plate warmers or adapted cutlery can make it easier to eat – these can be purchased or a referral to Occupational Therapy can be made by the GP or other healthcare professional.
  • Small regular meals and snacks may be more suitable for a reduced appetite, rather than the traditional 3 meals a day.
  • Experiment with strong flavours such as spicy, garlicky or smoked foods or season meals with condiments to jazz it up a bit! To appeal to a sweet tooth, try naturally sweet foods such as carrot or sweet meals such as lemon chicken. Fruits can be added to dishes like salad or mild curries or you can add fruit sauces to savoury dishes to increase their appeal.
  • Helping with food preparation may also stimulate appetite. Food related activities for example chopping vegetables, stirring the pot or kneading dough can be an enjoyable experience that evokes memories and creates an interest in the food being cooked.
  • Meal times are a social occasion and eating with friends and family is an important source of mental and social stimulation.  Research shows that people eat more when in a group and engaged in conversation.
  • If sitting down for a meal is causing distress, try creating a ‘tasting plate’ of finger foods that offers variety and the opportunity to start and stop eating over a longer period of time.
  • Speech and Language Therapy or Dietetics can be great sources of help if there are swallowing difficulties or softer consistency diet is required. A referral can be made by your GP or other healthcare professional.
  • If you or a loved one has been diagnosed with dementia, why not look at Anticipatory Care Planning – you can document needs and wishes in relation to nutrition (and other aspects of care) to take control of the care and support that may be require in future.

If nutrition remains a concern despite trying these options, there are lots of different people available to help – GP, Post Diagnostic Support Worker or local Alzheimer Scotland Dementia Advisor, to name a few. Please don’t struggle alone – we’re here to help!

Caroline is a Care Manager with the Dementia Post Diagnostic Support team for NHS Fife, supporting people who have been newly diagnosed with dementia. She is a volunteer for Meal Makers and has a keen interest in the effects of nutrition on cognition.

Follow Caroline and the rest of Fife’s Dementia Post Diagnostic Team on Twitter: @DPDSFife

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