Are you struggling to get them to eat?

This is one of the most common concerns raised about Alzheimer’s eating problems. However, many different reasons can lead to their failure to eat.

There may be a physical reason, such as difficulty chewing and swallowing their food or having dental pain. Vision changes can also affect their eating, and they may not be able to see the food on their plate.

Their coordination changes, making it challenging for them to hold utensils or a cup and maneuver to bring the cup or spoon to their mouth.

As their communication abilities decline, it becomes challenging to communicate their wants. For example, they may not like the taste or temperature of the food served but aren’t able to tell you what the problem is. So, instead, they don’t eat.

In this article, we’ll explore the most common challenges of dementia eating and practical strategies to promote healthy eating habits for individuals living with dementia. 

Complications of Alzheimer’s eating problems

Weight loss is the number one concern of not eating. However, during the early stage of the disease, weight loss is usually not an issue. Problems typically begin to show up in the middle stage.

Weight loss in people with dementia can happen for different reasons. Sometimes, they may forget to eat or not feel hungry. Other times, they might have trouble chewing or swallowing their food. This can make it hard for them to eat enough to keep their weight up. Changes in taste and smell can also make them not want to eat as much.

For some people, dementia causes them to pace for hours every day, which can burn more calories and cause weight loss. It’s essential for caregivers to understand these causes and find ways to help their loved ones eat enough to stay healthy.

In some cases, weight loss can become severe enough in individuals with dementia that it becomes a qualifying factor for hospice care. When someone with dementia loses a significant amount of weight and is unable to maintain their nutrition despite efforts to help them eat, it can indicate a decline in their overall health. Hospice care focuses on providing comfort and support for individuals with life-limiting conditions, including dementia, during their final stages of life. Weight loss may indicate that the person’s body is gradually shutting down, and hospice can help manage their symptoms and provide compassionate care during this challenging time.

Managing Weight Loss in Dementia: Risks, Interventions, and Tracking

Weight loss is a common concern in individuals with dementia and can pose significant risks to their health and well-being. As the disease progresses, various factors can contribute to weight loss, including changes in appetite, difficulty chewing or swallowing, and decreased physical activity. Caregivers must be proactive in addressing weight loss to prevent complications and maintain overall health.

Risks:

Weight loss in individuals with dementia can lead to several complications, including:

1. Malnutrition: Inadequate calorie and nutrient intake can result in malnutrition, compromising immune function, muscle strength, and overall health.
2. Increased frailty: Loss of muscle mass and strength can contribute to increased frailty and susceptibility to falls and injuries.
3. Decline in cognitive function: Malnutrition and weight loss can exacerbate cognitive decline and impair memory, attention, and problem-solving abilities.
4. Reduced quality of life: Weight loss and malnutrition can diminish quality of life, leading to fatigue, weakness, and diminished enjoyment of daily activities.

Interventions:

To address weight loss in individuals with dementia, caregivers can implement various interventions:

1. Nutrient-dense meals: Offer nutrient-rich foods that are high in calories and essential nutrients to promote weight gain and overall health.
2. Snacks and supplements: Provide between-meal snacks and nutritional supplements to increase calorie and protein intake throughout the day.
3. Mealtime assistance: Offer assistance with meal preparation, feeding, and hydration to ensure adequate intake and address challenges such as chewing and swallowing difficulties.
4. Behavioral interventions: Encourage regular meal times, minimize distractions during meals, and create a calm and pleasant dining environment to promote appetite and reduce mealtime stress.
5. Monitoring and tracking: Keep track of food intake, weight changes, and nutritional status to identify trends and adjust interventions as needed.

Tracking:

Monitoring weight loss and nutritional status is essential for evaluating the effectiveness of interventions and identifying potential concerns. Caregivers can track weight changes, dietary intake, and hydration levels using various methods, including:

1. Regular weigh-ins: Weigh the individual regularly, preferably at the same time of day and under consistent conditions, to monitor changes in weight over time.
2. Food diaries: Keep a record of the types and amounts of food and fluids consumed each day to assess dietary intake and identify patterns or preferences.
3. Hydration logs: Track fluid intake and urine output to ensure adequate hydration and identify signs of dehydration.
4. Consultation with healthcare professionals: Seek guidance from healthcare providers, dietitians, or nutritionists to assess nutritional status, address concerns, and develop personalized interventions.
5. Learn more about the Caregiver’s Notebook for meal tracking HERE.

By implementing targeted interventions and closely monitoring weight and nutritional status, caregivers can help mitigate the risks of weight loss and promote overall health and well-being in individuals with dementia.

Dehydration & Delirium

Dehydration is a serious concern in dementia care, as individuals may struggle to maintain adequate fluid intake due to cognitive and physical challenges. Understanding the risks, symptoms, and preventive measures for dehydration is essential for caregivers to ensure the well-being of their loved ones.

Causes of Dehydration: Dehydration can occur for various reasons, including decreased fluid intake, medication side effects, mobility limitations, and difficulty recognizing thirst cues. Individuals with dementia may forget to drink water or may have difficulty communicating their hydration needs, leading to an increased risk of dehydration.

Symptoms of Dehydration: Recognizing the signs of dehydration is crucial for early intervention. Symptoms may include dry mouth, dark urine, fatigue, confusion, dizziness, and sunken eyes. In severe cases, dehydration can lead to rapid heartbeat, low blood pressure, and even unconsciousness. Caregivers should monitor hydration levels closely and seek medical attention if symptoms arise.

Preventive Measures: Preventing dehydration involves proactive measures to ensure adequate fluid intake and hydration. Encourage regular fluid intake throughout the day, offering water, juice, herbal teas, and hydrating foods like fruits and vegetables. Use visual cues and reminders to prompt individuals to drink, and consider incorporating hydration into daily routines.

Additionally, make fluids easily accessible and appealing, using colorful cups or straws to encourage drinking. Monitor environmental factors such as temperature and humidity, as extreme heat can increase fluid loss through sweating. Adjust medications as needed to minimize side effects that may contribute to dehydration.

Tracking Hydration: Keeping track of fluid intake and hydration status is essential for managing dehydration risk. Maintain a hydration log to record the types and amounts of fluids consumed, as well as any signs of dehydration observed. Regularly assess skin turgor, urine color, and overall well-being to monitor hydration levels and detect changes over time. You can find information on the using the Caregivers Notebook to track fluid intake HERE

Dehydration poses significant risks for individuals with dementia, but proactive measures can help prevent its occurrence. By understanding the causes, symptoms, and preventive strategies for dehydration, caregivers can safeguard the health and well-being of their loved ones, promoting optimal hydration and overall quality of life.

 Learn more about Dehydration HERE.

Unfortunately, dehydration can lead to Delirium, which is very serious! It is a severe disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. It is often seen in hospitalized Dementia patients. The start of Delirium is usually rapid—within hours or a few days.

For someone with Dementia, it is generally seen as an extreme worsening of behaviors, non-redirectable, and often aggressive behaviors. Families are usually flabbergasted at the sudden change in their loved one.

Delirium Symptoms

A person with delirium may experience symptoms that come and go over the course of the day, including:

• Mental confusion (especially new confusion that develops over hours or days)
• Difficulty in paying attention, listening or absorbing information
• Lack of interest in one’s surroundings, seeming “out of it”
• Difficulty thinking or remembering
• Drowsiness or lethargy
• Feeling disoriented as to time and place
• Sensitivity to light and sounds
• Distortions in sensory perception: seeing or hearing things differently
• Hallucinations: seeing or hearing things that are not there. The person may pick at or brush their hands over their bedclothes to remove dirt or insects that are not present.
• Delusions: fixed ideas not based in reality. For instance, people with delirium may fear that providers or family members are trying to harm them.
• Euphoria, anxiety or agitation

If you believe your loved one may have delirium, you should seek medical help right away.

Progression of Eating Challenges and Increased Risk of Aspiration Pneumonia

As dementia progresses, individuals may become increasingly dependent on others for assistance with eating. Initially, they may require reminders or guidance to navigate meals, but as the disease advances, they may lose the ability to feed themselves entirely. Eventually, they may become completely reliant on caregivers to provide and assist with meals. When they can no longer feed themselves, they will be utterly dependent on you for all their food and liquid intake. At this point, they may have lost their ability to chew well and will probably only be able to eat soft, mushy food.

In addition to physical assistance with eating, caregivers must also be aware of the increased risk of aspiration pneumonia as dementia progresses. Aspiration pneumonia occurs when food, liquid, saliva, or vomit enters the lungs instead of the stomach. This can lead to serious respiratory infections and complications, particularly in individuals with dementia who may have difficulty swallowing or managing their oral intake. Therefore, caregivers must be vigilant in monitoring and assisting with eating to minimize the risk of aspiration and its associated health issues.

 By adapting meal options and providing appropriate assistance, caregivers can help ensure that individuals with dementia receive adequate nutrition while minimizing the risk of complications such as aspiration pneumonia.

Aspiration: the most severe Alzheimer’s Eating Problem

You may not have heard this term before, but it is one you should know. Aspiration occurs when contents such as food, drink, saliva, or vomit enter the lungs. It almost always leads to aspiration pneumonia and is the leading cause of death in Dementia patients. However, you can take precautions to help prevent aspiration.

Aspiration Prevention Tips

1. Modify Food Texture: Offer softer foods or purees that are easier to swallow.
2. Avoid Large, Hard, or Sticky Foods: Opt for smaller, bite-sized portions of food to minimize the risk of choking.
3. Encourage Proper Posture: Ensure individuals sit upright while eating and drinking to facilitate swallowing.
4. Provide Supervision: Monitor individuals during meals to ensure they are chewing and swallowing safely.
5. Offer Small, Frequent Meals: Provide smaller, more manageable portions to prevent overloading the mouth and reduce the risk of aspiration.
6. Use Thickened Liquids: If recommended by a healthcare professional, thicken liquids to reduce the risk of aspiration while drinking.
7. Address Dental Issues: Address any dental problems or oral discomfort that may contribute to swallowing difficulties.
8. Seek Professional Guidance: Consult with a speech therapist or swallowing specialist for further assessment and guidance on reducing the risk of aspiration.

Signs of aspiration

• Coughing
• Choking
• Gagging
• Throat clearing
• Vomiting
• Hoarseness
• Gurgling sounds
• Trouble breathing

If your loved one has any of these signs of aspiration, you may need to go to the emergency room for a chest x-ray. If you notice they are beginning to have some swallowing issues, you should ask your doctor for a swallow study. The study will help determine what type of food and liquids are the safest. But be aware this test may also determine your loved one is not safe for food or drinks.

If this is the case, they will talk to you about placing a feeding tube. It would be best if you discussed this decision soon after the Alzheimer’s diagnosis. Most people with Dementia do not want a feeding tube placed. You need to know what your loved one wants before it gets to that point. If you have not completed advanced directives, you should do this as soon as possible. Here is a link to the Dementia directives site.

Healthy Eating Strategies:

In this section, we’ll explore practical strategies to promote healthy eating habits for individuals living with dementia to help prevent some of the challenges associated with eating. 

Establish Meal Routines:

Encourage consistency by establishing regular meal times. Having predictable meal schedules can help individuals with dementia feel more secure and oriented throughout the day.

Consistent meal times also support digestive health by regulating hunger cues and promoting regular bowel movements. Aim for three main meals each day, with additional snacks if needed.

Balanced Meals:

Provide essential nutrients for overall health and cognitive function. Aim to include a variety of food groups in each meal, such as:

Fruits and vegetables: Rich in vitamins, minerals, and antioxidants that support brain health.

Whole grains: Provide sustained energy and essential nutrients like fiber, which aids digestion and promotes heart health.

Lean proteins: Ensure adequate protein intake for muscle strength and repair, as well as amino acids essential for neurotransmitter production.

Healthy fats: Include sources of omega-3 fatty acids, such as fatty fish, nuts, and seeds, which support brain health and reduce inflammation.

Finger Foods:

Recognize the convenience and practicality of finger foods for individuals with dementia who may struggle with utensils or have difficulty chewing and swallowing.

Finger foods are easy to pick up and eat by hand, reducing the need for fine motor skills and minimizing frustration during mealtimes.

Opt for nutritious finger foods like sliced fruits, vegetable sticks, cheese cubes, whole grain crackers, and bite-sized sandwiches. These options provide essential nutrients while promoting independence and enjoyment during meals.

By implementing these healthy eating strategies, caregivers can ensure individuals with dementia receive essential nutrients while promoting independence and decreasing their risks of dementia complications.

Conclusion:

Navigating eating problems in individuals with Alzheimer’s disease can be challenging, but with patience, understanding, and practical strategies, caregivers can make a significant difference in their loved ones’ dining experiences and overall well-being. By recognizing the underlying causes of eating difficulties, implementing appropriate interventions, and creating a supportive dining environment, caregivers can help ensure that individuals with Alzheimer’s receive the nutrition they need to maintain their health and quality of life. With a proactive approach and ongoing support, caregivers can empower individuals with Alzheimer’s to enjoy mealtime and foster a sense of comfort, dignity, and independence throughout their journey with the disease.