Good Nutrition for people with Alzheimer's

The Alzheimer's Society has produced a leaflet called "Food For Thought" offering nutrition and delivery tips for carers of people with dementia. The Society notes that some of the biggest challenges of caring for a person with dementia involve eating and drinking, and the taking of adequate nutrition. In this leaflet, carers share their experiences and offer tips and suggestions to help overcome some of these difficulties.

Many people with dementia have a poor appetite or lose interest in food, and a poor appetite can result in weight loss, a lack of energy, a reduced ability to fight infections and impaired concentration. However, there are ways to stimulate a person's appetite and interest in food. The Society notes that presentation is important; an individual with dementia may find colourful foods are more appealing. They advise that the carer should try not to overload the plate with too much food, and to offer small portions frequently to engage interest. Only one course should be given at a time to avoid confusion, and positive encouragement and gentle reminders to eat should be given.

People with dementia often lose interest in their food once it has gone cold - just like you or I would. Since an individual with dementia can often take longer to eat, especially if they have difficulty with co-ordination or swallowing, their food is more likely to go cold, this problem can be solved by using insulated plates which can safely keep food warmer for longer. Alternatively, the carer can serve smaller or half portions and keep the remainder warm until the first portion has been eaten.

Some foods are difficult to eat and should be avoided. If a person has difficulties with co-ordination or using cutlery, they might find it very frustrating trying to eat food like peas or spaghetti. Adding too much gravy or sauce to a portion of food can make it more difficult to eat. It is also important to remember that people with dementia often experience a change in taste - they may suddenly begin to reject food that they have always loved and start to enjoy dishes that they never liked before. The Alzheimer's Society note that people may enjoy unusual combinations of food or ways of eating. They may like savoury food to be mixed with sweet food, or prefer to eat dessert before the main course. Add a small amount of sugar to savoury foods such as quiche, omelettes and sauces to encourage people with a sweet tooth to eat them. People may enjoy sweeter tasting vegetables such as carrots, parsnips or swede. Be adventurous and cook dishes that the person may not have tried before, such as lasagne or curries, and remember that a person with dementia might try a dish if you give it a different name.

Participation can make a person keener on their food. Encourage the person to get involved at mealtimes. Helping to prepare food or laying the table can remind a person that it is time to eat as well as help to maintain their skills and independence. Remember that a person with dementia may be confused by vivid prints or patterns on tableware and become distracted from their food. Plain crockery, placemats and tablecloths are preferable. People who are partially sighted may find it difficult to see white food on a white plate. Coloured plates or bowls that contrast with the food will make the food easier to see and more appealing. Dark-coloured plates highlight light-coloured food well.

The the carer can encourage daily activity, such as gentle exercise to music, walking or spending time in the garden, as these will also promote a healthier appetite.

With regard to liquids intake, remember that to stay healthy, we need to drink about eight cups of fluid every day. Many carers express concern about people with dementia not drinking enough. If fluid intake is a problem, offer small but frequent drinks throughout the day. Use a cup or a small glass rather than a mug or large tumbler. Give the cup or glass to the person to prompt them to drink, rather than just leaving it on the table.It is often best to transfer drinks that are supplied in a carton to a cup, rather than expecting the person with dementia to drink them through a straw.

If a person has poor co-ordination, they are likely to spill drinks or drop food while eating. However, this is not a reason to discourage independence or prevent people feeding themselves. There are ways to make things easier and minimise mess. People can become agitated when trying to eat using cutlery that is difficult to manage - imagine the mindset of you or I having to eat banquet style at every meal, with up to twenty choices of fiddly silverware for each course, under these circumstances we would soon find our meals much less enjoyable. Adapted lightweight cutlery can solve this problem. Non-slip placemats are also available. It may help if you cut food into pieces so that the person can eat it with a spoon - this enables them to continue to eat independently. The use of finger foods can also allow a person to eat easily while maintaining their self-reliance and dignity.

The dining area and environment also have an effect on how well people eat. Serve food in a relaxed and unhurried manner. Turn the television off, so that it does not distract people. However, a radio or background music may be comforting, especially for people eating alone.

Eating out should not be discounted, as day centres or luncheon clubs can provide welcome social events and a good environment for mealtimes. People with dementia often eat better in company, as observing and copying others can act as a cue or prompt for the person with dementia to eat. Eating out in restaurants or pubs can also be a nice change from eating every meal in the same place. When eating out, explain confidentially to staff and other diners what difficulties the person with dementia has. This can help people to tolerate and understand unusual behaviour. Eating out with understanding friends and family can also be supportive.

Sometimes eating becomes an issue. There are many reasons for unusual or 'difficult' behaviour associated with eating and mealtimes. These can range from a dislike of the food to a sore mouth or teeth or difficulties using cutlery. If the reason for unusual behaviour is identified, ways of managing it can usually be found. Give people plenty of time to eat and provide alternative places to eat if they become agitated at the dinner table. Some people with dementia, just as is the case of those of us without dementia, may prefer to eat in company whilst others like to eat alone. People may reject food to start with or say they are not hungry and if this is the case do not force the issue or become agitated yourself. Offer the food again later or provide a nutritious snack instead.

If you would like more information on Food for Thought publications and events, please contact the Food for Thought Project at the Alzheimer's Society. Contact through the website address below, telephone: 01904 633640 or email the Alzheimer's Society at: