Alzheimer’s and dementia cause significant changes in the brain, which can turn the seemingly simple everyday task of eating into a daunting challenge for both seniors and their caregivers.
“Seniors with dementia most often lose track of time and will forget to eat, or will overeat not knowing they already ate,” says Judy Berry, founder of Dementia Specialist Consulting and founder and past owner of Lakeview Ranch Inc., a residential care center for people with dementia.
Experts say seniors can sometimes benefit from small dietary changes — thoughtful shifts in everything from how food looks and tastes to how it’s presented. But these tweaks shouldn’t stop at the food.
Berry teaches that seniors with dementia need their emotional and spiritual needs met in addition to their physical needs. “People still need to remember the person is still in there,” Berry says. “Just because the dementia affects their ability to communicate, it doesn’t affect their feelings, emotions and who they are inside.” This means rather than treating eating as a purely physical need, it helps to look at it as something that nurtures the person in deeper ways.
Here are some easy changes to institute at mealtime that might make a big difference for an elderly loved one.
1. Make the food easy to see
People with Alzheimer’s and dementia might have trouble with meals if there’s little visual contrast on the table, says Ruth Drew, director of information and support services at the Alzheimer’s Association. For example, she explains, if you serve white chicken and potatoes on a white plate, it might be hard for them to see it visually and spatially.
While the senior might love their long-time serveware, it might be time to switch to one that makes food more visible and appealing. “Consider using placemats and plates with solid, contrasting colors to make things easier to see,” she says. Avoid using patterned dishes, place mats, tablecloths and decorations that may be distracting.
2. Add color to the meals
Lauren Kelly with Alliance Homecare says the appearance of the food itself can make a big impact. “Add color and plate the food in a way that’s presentable and exciting,” she says. “This alone can often be enough to entice someone to eat.”
Kelly suggests that bypassing “beige” food for more colorful options is a game-changer. Substitute mashed sweet potato for white potatoes, add a side of greens, or even layer pureed berries or creamy peanut butter in Greek yogurt for dessert.
“Colorful pureed soups can also be a great option in serving a more enticing dish,” she added. “Butternut squash is a great example, and avocado can be added for creaminess and extra-healthy fats and calories, without really changing the flavor at all.”
3. Pump up the flavor
It’s not uncommon for smell and taste experiences to diminish as we age, and it can take some extra effort to get someone with Alzheimer’s or dementia interested in food.
“If a pureed diet isn’t necessary, just adding more flavor to food with different herbs and spices can really improve the palatability and excitement around the dish,” Kelly says. “For instance, instead of chicken simply sautéed with garlic and onion, bake the chicken with rosemary and paprika to boost the flavor profile.”
Berry says homemade meals that smell great can help boost appetite. While caregivers might be tempted to serve easy pre-made food, it’s often bland without much taste, she says. Preparing homemade meals that the person likes can really help, especially if they’re full of flavor and have delicious smells. “When you’re cooking a roast turkey or chicken in the oven and they smell it, or making a batch of cookies, hopefully they smell it and get hungry,” Berry says.
4. Make eating a social event
Eating isn’t just about putting calories in your mouth. “Eating and drinking is an emotional activity that requires seeing others eating, drinking, communicating and encouraging,” Berry explains.
Seniors with dementia or Alzheimer’s might have a fear of embarrassment, harassment or not being able to remember what to do, she says. But if mealtime is a social activity that involves interaction and encouragement from a trusted person, the senior is much more likely to eat, Berry explains. In other words, don’t give them a plate of food and walk away — eat together.
“Make mealtime a social activity,” says Megan York, direct care manager for Right at Home of Eastern Worcester County in Westborough, Massachusetts, and a certified dementia practitioner. “People who have difficulty eating might be more encouraged if dining with others.”
5. Add special touches
When eating becomes stressful, anyone is likely to lose their appetite — and that’s especially true of a senior with challenges surrounding mealtime.
In addition to making mealtime social, try to also make each meal feel like a special part of the day. If there’s anything to celebrate, Berry says, make the mealtime special even if the person doesn’t remember it. This could mean playing music, serving festive food, displaying minimally distracting decorations or anything else that can make meals feel like a special event rather than a mundane task. “There’s a part of them that will remember having a good time at the dinner table,” Berry says. So recreating the feeling of a family meal, where they’re encouraged to talk and enjoy themselves, can help a lot.
6. Try smoothies
If you’re having a hard time getting a senior to eat, smoothies provide an easy way to get fruits and vegetables into a diet; plus they’re portable and taste great.
“Smoothies can be so vibrant, exciting, and nutritious,” Kelly says. “This can be especially appropriate for seniors who either have a hard time getting in a variety of nutrients or are on a pureed-style diet. I love to make smoothies that include a healthy fat, fiber, a serving of fruit, and protein, so they are well-balanced. An example would be one cup frozen berries, a handful of spinach, a quarter of an avocado, one tablespoon ground flaxseed, one cup of unsweetened almond milk, and hemp or whey protein powder.”
Berry adds that if you still need to get a loved one to consume more calories, you can supplement with drinks such as Ensure or Boost in between meals.
7. Make the food bite-sized
While not all seniors need a pureed diet, other issues may make mealtime problematic, such as limited attention spans or wandering often associated with dementia. At the Bistro at Integrace Copper Ridge, which serves breakfast and lunch to individuals with dementia, options are given to seniors who may feel overwhelmed by a complete meal.
“Some meals are served in nutritious, bite-sized portions that can be eaten without utensils, or carried by diners who find it difficult to remain seated while eating,” Bill Rodgers, Integrace Dining Manager, says.
8. Skip the utensils
As Alzheimer’s or dementia progresses, people may have difficulty remembering how to use utensils, Drew says. “When that happens, switching to sandwiches and other finger food can help people retain their ability to feed themselves longer.”
Another problem some seniors face is the inability to hold a fork or knife, and smoothies can be hard to grip.
“Individuals with arthritis or neuropathy who have diminished fine motor skills can benefit from using built-up utensils with rubber or plastic grips,” York says. “These grips can help people more effectively and easily hold their utensils. Weighted utensils, which help prevent food from falling off the utensil, can be used for older adults who present with hand tremors.”
9. Keep track of fluid intake
It’s important to make sure your elderly loved one is drinking fluids in addition to eating enough calories. “Most seniors with dementia become seriously dehydrated, which will exaggerate symptoms of dementia and confusion,” Berry says. Because of this, she explains, it’s critical to identify creative ways to encourage fluids, and it helps to find out what they really like and provide it often. It could be smoothies, tea, milk, juice, ice cream or sherbet, she says.
10. Reduce distractions
Mealtime can be overwhelming for someone with Alzheimers or dementia, and any additional distractions can make it more challenging, says Drew.
If your senior seems too distracted to eat, “try to serve meals in quiet, calm surroundings, away from the television or other distractions,” Drew says. “Keep your table settings simple as well.”
Drew notes that if having too many foods served at once becomes distracting, consider serving each part of the meal separately. For instance, serve sweet potatoes first, then meat, she says.
It’s key to be flexible if you’re caregiving for someone with Alzheimer’s or dementia, Drew says, especially since they might reject foods they liked previously or develop new preferences.
“The person may not remember what they ate that day, so if they are asking for breakfast at lunch time, consider serving breakfast foods,” she says. “They also may require more time to finish their meal — perhaps an hour or longer. Patience is key.”
12. Put exercise on the menu
Getting an elderly person walking may help to fire up their appetite; even something as small as going on a walk or doing some gardening or household chores can help them get hungry.
“It makes a big difference in seniors’ appetites, [if] they live a very sedentary lifestyle, when they get out and exercise,” said Stephen Zimmerman, COO of AEC Living, a California-based group of independently operated senior living communities and a Medicare-approved rehabilitation agency.
13. Rule out medical issues
If the person with dementia or Alzheimer’s has a sudden change in their ability or interest in eating, or if they have a sudden weight loss, it’s important to first rule out any medical explanations, Drew says. “They may have dental problems, pain, indigestion, constipation or some other medical explanation that they are unable to articulate,” she explains. “People with dementia often have trouble communicating pain, which means that it can be under-recognized and treated.”
While getting a senior with dementia or Alzheimer’s to eat enough can be a huge challenge, these expert tips can make the process much easier for caregivers.
With additional reporting by Emily Starbuck Gerson.