Eating and Nutritional Challenges in Patients with Alzheimer's Disease: Tips for Caregivers

Overview

Is a special diet recommended for people with Alzheimer’s disease?

It’s important for all people to eat highly nutritious, well-balanced meals to maintain health as much as possible. People living with Alzheimer’s disease do not need a special diet unless other medical conditions, such as diabetes, high blood pressure, or high cholesterol, need to be controlled.

Do the changes that occur in people with Alzheimer’s disease make healthy eating more difficult?

Yes. First, the normal aging process itself can change eating habits. For example, a person’s sense of taste and smell may change as one ages, which can affect what he or she chooses to eat and impact overall health. There can also be problems with teeth or gums or dentures that make eating more uncomfortable. Diseases affecting vision are also common in the elderly. This can make preparing, recognizing, and enjoying foods more difficult.

In addition to these typical age-related changes, the changes in a person’s ability to function as Alzheimer’s disease progresses makes maintaining health even more difficult. Persons with Alzheimer’s disease may:

• Forget to eat and drink
• Forget the steps involved in cooking
• Lose their appetite due to the medications they are taking, change in medication dosage, or due to depression
• Forget how to hold and use utensils
• Have difficulty communicating their desire for foods they would like to eat or recognize that they are hungry or thirsty
• Develop difficulty chewing and swallowing

What can caregivers do to improve and encourage better eating and drinking habits in persons with Alzheimer’s disease?

Each person may be helped with different tactics, depending on the main reason they are not maintaining good nutrition. Here are some tips.

For loss of appetite:

• Offer a variety of different colored foods with pleasant aromas.
• Offer smaller portions, but more frequent foods, drinks, and snacks.
• Try a wide selection of different foods (remember, tastes and likes may change with age).
• Use herbs and spices, sauces, gravies, or broths to add flavor to foods.
• Serve food warm to keep its appeal.
• Ask the doctor about liquid diet supplements or medication to stimulate appetite.

For difficulty chewing or swallowing:

• Talk to a speech and language therapist if the person is having difficulty swallowing, as the individual may benefit from a swallowing evaluation. Also talk with a dietitian for tips to make sure that the person is getting enough nutrition.
• Offer soft, moist foods, such as scrambled eggs, oatmeal, yogurt, cottage cheese, mashed potatoes, applesauce, soups, baked fish, juices, milkshakes and smoothies.
• For other food types, grind the food or cut into small, bite-sized pieces.
• Make sure the person is sitting up straight, with head leaning slightly forward.
• Check the person’s mouth after each meal to make sure all food has been swallowed.
• Learn the Heimlich maneuver in case choking leads to the person’s airway becoming blocked. Call 911 for assistance if choking occurs.

For difficulty using hands to hold utensils and cups:

• Serve the food already cut into ½ inch pieces so the person can eat it with a spoon.
• Offer “finger foods” that don’t need utensils to eat, such as sandwiches, cheeses, hamburgers, hot dogs, miniature quiches, slices of fruits, spring rolls, potato skins.
• Talk to an occupational therapist who can offer specially designed utensils and cups that will make eating and drinking easier.

For the person who is agitated, angry or irritable:

A person with dementia may experience behavior changes that can include agitation and anger. These behaviors can manifest in such ways as refusing to eat or spitting out food. Trying to figure out why the person is acting out this way and what to do about it can be challenging. Some possible reasons for their behavior include:

• They don’t like the food or beverage.
• The food or drink is too hot.
• They don’t like the people or the eating area they are in.
• They are frustrated by the difficulties they are having.
• They feel rushed to finish their meal.
• They don’t want help eating or drinking.

What to do? Don’t rush the person to start or finish eating. If the person has difficulty speaking, look at his or her body language and eyes for clues as to what he or she might want or need. Never put pressure on the person to eat or drink. If the person is showing signs of anger or irritation, wait for them to calm down and then offer some food and beverage.

For people who have vision problems:

• Explain the foods on the plate and where they are located (comparing to the face of a clock, ie, herb-roasted chicken is at 6:00 o’clock position, mashed potatoes with gravy are at the 3:00 o’clock position)
• Describe the beverage and its location in relation to the plate.

For people with severe dementia:

• A person with severe dementia may forget how to eat. For example, he or she may forget how to open their mouth as food approaches. Use yourself as a model for showing the person how to open your mouth to receive the spoonful of food. This person may need help with the physical act of eating.
• Remove decorations that look like food or could be confused for food, such as wax or plastic fruit or laundry soap packets.

Are there other general tips for creating an inviting eating environment and/or other ways to encourage a person with Alzheimer’s disease to eat?

• Involve the person with meal preparation (if the person is able). Perhaps he or she could help cook a portion of the meal or set the table.
• Allow the person to be as independent as possible by selecting the meal items to eat and drink (as much as reasonable), when to eat each type of meal (for example, he or she may prefer a larger lunch and a smaller dinner), and where to sit to eat. Remember, food preferences may change and the person may like foods previously never liked or dislike previously loved foods.
• Make mealtime a fun, friendly social event. Eat together. Talk about wonderful life events from the person’s past.
• Remove clutter/distractions from the eating area.
• Turn on soft music that the person enjoys.
• Make sure the eating area is well lit.
• Make eating as easy as possible for the person by using whatever bowls or plates are easiest for the person to manage. Same with utensils. If a large spoon is the easiest to manage, cut the food so that it can be scooped up with a spoon.
• Use solid colors (instead of patterns) and different colors for tablecloths, placemats, bowls and plates. This can help make the food easier to see.
• Check the temperature of foods and drinks before serving. Make sure food is warm but not too hot. Some people with dementia cannot judge if food or drink is too hot to consume.
• Don’t put pressure on the person to eat or make them feel rushed to finish eating. Also, don’t assume the person has finished eating if they have stopped eating. He or she may simply be tired or have lost concentration. The person may also be embarrassed by his or her physical inabilities and/or doesn’t want to struggle to eat. Try smaller portions or finger foods. Rewarm the food to make more inviting. Ask the person if they would like some help to eat.
• If possible, allow the person to eat when he or she is most alert and awake (and not necessarily tied to the “regular” meal hours).

What are some basic food-specific tips for healthy eating?

• Eat a variety of foods from each food category – fruits, vegetables, protein (fish, meat, eggs, nuts, beans), dairy, grains, and oils. Many dietitians recommend following a heart-healthy diet such as the DASH diet or Mediterranean diet. (See the resource section to learn more information about these diets and other healthy eating tips.)
• Avoid fried foods with high saturated fat and cholesterol.
• Cut down on sugars.
• Limit salt intake.
• Drink eight, 8 oz glasses of water per day. It’s very important that older persons drink enough liquids. Lack of enough liquids can result in dehydration, which can lead to confusion, urinary tract infections and constipation. Make sure a beverage is always provided with all meals and snacks. Make sure the cup holding the beverage is easy to handle and not too heavy. Offer different kinds of fluids throughout the day – beverages, soups, water, tea, shakes, smoothies, fruit juice.

Be sure to ask your doctor about possible food interactions with the medications a person with Alzheimer’s disease is taking.