Top tips from our expert author, Robin Dynes on how you can overcome mealtime challenges, making the most of this valuable time together...

Are your mealtimes pleasant, warm occasions? Nutritious food is essential for good health and, as well as satisfying hunger, a meal is an opportunity for social time. It is a traditional way to celebrate. When caring for someone with dementia it can be enjoyable, or alternatively, a nightmare, both for you and your loved one.

Opportunities

It is helpful to view mealtimes as an opportunity rather than a challenge. For someone with dementia, meals mark the time of day which helps them to keep track of time. It is also a chance for them to make choices, chat and reminisce about past accomplishments through statements such as ‘This reminds me of my sixteenth birthday party. You made the most enormous birthday cake for me. Do you remember?’ This ensures meals are a social activity, a time to connect with others.

You can also help the person retain their functional skills by getting them to help do the vegetables or lay the table.

Challenges

Your loved one’s interest in eating and mealtimes is likely to change. Their sense of taste or smell may decrease making food seem less appealing. Their ability to prepare meals and eat independently could decline. Difficulties chewing or digesting food may develop. Medication can also affect appetite. As dementia progresses the person may struggle to use a knife and fork, no longer recognise the food or forget to open their mouth as food approaches. A decrease in appetite is also a part of normal ageing.

All this means that there are dangers of dehydration and lack of nourishment which increase the risk of infections, reduced capacity for healing, low blood pressure and other problems. This makes it very important to encourage eating, identify any related problems and find solutions.

Stimulating appetite

  • Encourage the person to get involved at mealtimes. As already suggested, they may be able to help prepare the food and lay the table.
  • Keep in mind their meal time rituals and preferences and modify them as necessary to fit into the current situation. They may have always eaten at a specific time, have cultural or religious food habits such as saying a prayer before meals, or particular likes and dislikes.
  • If home care professionals are being provided, make sure they are aware of eating rituals, routines and food preferences. This should include whether the person being cared for prefers to eat alone, or have someone sit down to eat and chat with them.
  • Identify and resolve issues which interfere with the desire to eat. These could include depression, ill-fitting dentures, forgetting to wear glasses or hearing aids and use of medications which suppress appetite.
  • Discuss and make sure the person has a choice about what is being prepared.
  • Stimulate the senses with the sounds of food preparation and smells of cooking.

Tips for the earlier stages of dementia

  • Try to make meal times as relaxed as possible. Avoid background noise or distractions such as television or the radio, although sometimes soft music can add to the feeling of relaxation and be helpful.
  •  If the person lives alone, you might phone and remind the person to eat. Or, if you have called in earlier, leave necessary items out in clear view with full step-by-step instructions.  Also, arranging to eat with the person can remind them it is mealtime.
  • Frozen or pre-prepared meals may be an option you could try if the person lives on their own and has difficulty preparing meals. Suppliers are available in most areas and from supermarkets. Hidden or uneaten meals are a sign the person needs additional support.
  • Assist and prompt rather than doing everything for them. The aim is to keep them independent and avoid diminishing their sense of personal control. Be creative and look for ways to involve them in finding solutions rather than taking over.
  • Talk about the food, prompt and draw attention to things they have not eaten. ‘Is the gravy too thick?’, ‘Are the roast potatoes just how you like them?’, ‘You haven’t eaten your cabbage. I thought it was your favourite vegetable’, or ‘Your tea is getting cold.’ This helps to focus their attention on the food.
  • Keep to the person’s normal meals and eating routine as far as you can. This makes it predictable and helps the person feel relaxed and more in control.

Tips as dementia progresses

  • Avoid offering too many food choices or having too many items on the table. Flowers and other decorative items may look nice, but can be confusing for the person with dementia:
  • Put out only what is needed.
  • Ensure good colour contrast between the plates and food. For example, the person might find it difficult to see cauliflower or white fish on a white plate or strawberries against a dish depicting flowers or fruit.
  • Highly patterned plates can also cause confusion.
  • Water is difficult to see in a clear glass.
  • Make sure the room in which the person eats is well lit, without too many shadows anywhere. Also, avoid bright glare. This helps with poor sight.
  • If visual perception is troubled by hallucinations or the person does not recognise food for what it is, talking to them about it may help. For example, a mushroom could be mistaken for a slug! Make allowances as needed.
  • Before the meal, make sure the person does not need the toilet.
  • Posture is important in the swallowing process. The optimum posture is in an upright chair, ensuring a straight back and level chin, facing forward. Although this is not always possible you may be able to put recliner chairs into an upright position. Avoid the head being tilted back or the neck being extended forward as this can affect the ability to swallow.