Dietary information for carers of patients with dementia

Good nutrition and a well-balanced diet are important for the health of people with dementia. As dementia progresses, a person’s eating habits and ability to eat may change. Appetite changes, taste changes and the ability to swallow all may affect the way a person eats.

This information sheet looks at some of these issues and suggests ways to support a person with dementia with their eating and drinking.

What is good nutrition and why is it important in dementia?

Good nutrition is when someone has the appropriate amount of energy (calories), fats, protein, carbohydrates, vitamins, minerals and fibre that they need every day to stay healthy.

Many studies have shown that eating poorly is related to ill health which can lead to malnutrition. Eating well can improve the quality of life for people with dementia.

To make sure that we eat well, it is important to have a variety of different foods every day to meet our needs. Although this is usually straight-forward for most people it can become a challenge for people with dementia.

Why might someone with dementia have a poor appetite?

Preference and taste changes

What can happen?

• Some people begin to enjoy tastes they never liked before or dislike foods they always liked.
• They may have problems with their sense of smell, or remembering smells.
• Their sense of taste may be dulled, or they may develop a preference for sweeter foods.

What can you do?

• Try new foods the person has not eaten before but remember their personal preferences and practices.
• If the person asks for meat but isn’t a meat eater you could try meat substitutes.
• Add extra herbs and spices to enhance flavours.

If someone prefers sweet foods:

• Fruit or naturally sweet vegetables (e.g. carrots or sweet potato)
• Add small amounts of honey or chutney to savoury food.
• Do not discourage dessert if a main meal is not eaten.

Unable to recognise foods

What can happen?

• Some people may have problems with their sense of smell, or remembering smells and tastes.

What can you do?

• Offer traditional foods that the person enjoyed when they were younger.
• Eat meals with other people
• Offer encouragement and reassurance at mealtimes
• Some studies have suggested that umami flavours may help to improve appetite (naturally found in mushrooms, soya sauce, tomatoes, and meat dishes).
• Offer brightly-coloured foods (e.g. variety of fruits and vegetables) and serve on colourful plates to increase attractiveness of meal.

Oral hygiene

What can happen?

• Sore gums or mouth, or poor-fitting dentures.

What can you do?

• Offer softer foods (e.g. mashed potato, crustless bread).
• Try adding extra sauces to savoury foods and cream/custard to desserts.
• Ensure regular mouth checks and good oral hygiene. A dentist can help with denture checks.
• Ensure dentures are being worn for meal times and that they fit well with fixant, as needed.
• Ensure food isn’t too hot when serving.

Environment

What can happen?

• A loud and/or unfamiliar environment may cause disruption at meal times.

What can you do?

• Ensure calm, quiet environment with minimal distractions.
• Try playing soft, relaxing music.
• Ensure the television is switched off at meal times to reduce distractions.
• Encourage involvement during mealtimes if able (E.g. setting table). If able, allow them to serve their own portions that they feel is acceptable.
• Eating with other people.

Medications

What can happen?

• Some medications may affect appetite

What can you do?

• If you are concerned, consult your GP or pharmacist to discuss this.

Requiring assistance

What can happen?

• Finding food and drinks may become a problem.
• Some people may struggle with co-ordination or be unable to remember how to use cutlery correctly.

What can you do?

• Provide assistance with meals, for example, cutting up food.
• Provide plenty of time to finish meal, but ensure the food does not go cold.
• Offering a spoon instead of a fork may be easier to use.
• Avoid over-tiredness.
• If they need feeding then try hand-over-hand feeding first as this can be a prompt to chew and swallow.
• Use coloured plates and cups so food can be seen easily.

Lack of activity

What can happen?

• Lack of activity may result in constipation – this can cause nausea or bloating.

What can you do?

• Encourage gentle walks or bed-exercises.
• Encourage regular drinks of fluids.
• Gradually increase fibre in diet, by having plenty of fruit and vegetables, and wholemeal grains.
• Some people with dementia may increase their activity – offering finger foods they can snack on as they walk can be helpful.

Finger food ideas

Snacks

• Buttered toast or bread fingers with jam or marmalade
• Buttered crumpets or muffins
• Dried fruit e.g. dates, apricots
• Mini sausages
• Toast fingers with toppings
• Small cookies or biscuits
• Pancake rolled with filling e.g. peanut butter or chocolate spread
• Banana- whole, chunks or slices
• Melon chunks
• Orange segments
• Apple slices
• Strawberries, raspberries
• Ready to eat dried apricots, pears, apple rings

Meals

• Chicken breast, cut into pieces
• Chicken nuggets
• Fish fingers/fish cakes/crab sticks
• Mini hamburgers/beefburgers
• Meatballs/slices of meat loaf
• Mini sausages/pigs in blankets (sausage wrapped in bacon)
• Mini quiche
• Pizza slices
• Pork pie slices
• Hard boiled egg
• Scotch egg
• Cheese cubes/cheese straws/savoury biscuits with cream cheese
• Samosa and bhaji
• Chips/potato wedges/potato waffles/mini new potatoes
• Sandwiches
• Cherry tomatoes
• Steamed or raw vegetable fingers or spears eg carrots, cauliflower florets
• Cucumber slices or sticks
• Button mushrooms

Puddings

• Mini fruit pie, egg custard, tarts
• Small cake
• Sponge pudding cut into chunks
• Bread and butter pudding squares
• Malt loaf/fruit loaf
• Tea cakes
• Scones/crumpets
• Small cakes or buns
• Cereal bars

Weight loss

Healthy eating is encouraged for people with dementia. However, if somebody is losing weight unintentionally, this can lead to malnutrition and a dip in their overall wellbeing. In this case, a high-energy diet is more appropriate.

Useful tips for weight loss:

• Avoid ‘low fat’ or ‘diet’ foods and drinks.
• Eat small amounts every 2-3 hours
• Try to have drinks between meals or after meals rather than just before to avoid filling up on fluid.
• Offer nourishing drinks between meals (e.g. milk, hot chocolate or malted drink).
• Use full fat butter or spread: add generously to potatoes, vegetables and on bread.
• Add full-fat cheese to scrambled egg, vegetables, mashed potato and sauces
• Use full cream milk for cereal, milky coffee, malted drinks, and smoothies.
• Sugar can be added to cereals, drinks, desserts and yoghurts. Artificial sweetener can be used to make food sweeter for those with diabetes with a sweet tooth.

Note: oral hygiene is very important for those with their own teeth to prevent tooth decay caused by frequent sugar intake.

• Add cream to soups, potatoes, sauces, porridge, desserts, and tinned fruit.
• If necessary, oral nutritional supplements can be recommended by the dietitian.

The ‘High-energy, High-Protein’ diet sheet produced by Cambridge University Hospitals can provide extra ideas if weight loss is a problem.

Anaemia

Anaemia is not uncommon in people with dementia. This can be caused by a restricted diet.

The following foods are good sources of iron and folate and should be encouraged to improve iron levels.

Folate- fortified breakfast cereals, green vegetable- broccoli, Brussel sprouts, kale, spinach and peas.

Iron- fortified breakfast cereals, oily fish, meat, eggs, beans and lentils.

Hydration

It is important to monitor how much fluid is being drunk.

Offer fluids in a bright mug or cup to stimulate the person to take drinks themselves.

Drinking too little fluid can increase confusion and contribute to urinary infections and constipation. Taking small cups of water, milk, tea, and coffee throughout the day can be helpful. Foods with high water content, such as fruit, soups, milkshakes and smoothies also count towards fluid intake.

If constipation is an issue, figs, prune and apricots can be of help. These can be eaten fresh, dried or as juice.

Over-eating

Some people overeat and may gain too much weight. It can be difficult to control weight when a person forgets that they have already eaten. It can be distressing for the individual to be told that they have already eaten if they do not remember, and this can be a challenge for those who care for them.

In this case, encourage a healthy weight with small, regular meals and plenty of low calorie drinks/snacks between meals.

Swallowing

With age swallowing can become more effortful. If there are any signs of fatiguing with swallowing then stop with the meal or drink and offer some more after a brief rest. Sit people upright and ensure they are alert. Ensure the food has all been swallowed before offering the next mouthful. Encourage self-feeding or hand over hand feeding as this movement of hand to mouth helps to prepare the mouth for swallowing and stimulates saliva production.

It is very important that any problems with swallowing need to be investigated. If a person is seen coughing on several occasions with fluids or food then consider discussing with your GP or other health care professional for a swallow assessment.

Ask a Doctor about a referral to a Speech and Language Therapist (SLT). The SLT may recommend a texture modified diet and/or thickened fluids. A dietitian can help to suggest ways to make texture-modified diets taste and look better, and make sure that it is well-balanced nutritionally.

Further information

• CUH ‘High energy and protein diet’ sheet
• CUH ‘Eating Well on a Pureed Diet’ sheet
• CUH ‘Soft Diet’ sheet
• Caroline Walker Trust Guidelines
• Dementia UK
• Alzheimer’s Society

References

• Old-Dementia-Practical-Resource (opens in a new tab)
• Alzheimers (opens in a new tab)
• Dementia UK (opens in a new tab)