Dementia nutrition can become more complicated as the disease progresses. Eating requires so much more than simply putting food on a plate. Our brains help us recognize hunger, plan meals, shop for groceries, prepare food, use utensils, chew, swallow, and remember that it is time to eat. When dementia begins to affect those processes, caregivers may start noticing changes at mealtimes.
In this episode of The Geriatric Dietitian Podcast, I’m joined by registered dietitian Laura MacDonald, founder of The Seniors Dietitian, to talk about dementia nutrition and practical ways caregivers can support their loved ones.
Laura has spent more than a decade working with older adults in acute care and specializes in helping caregivers navigate poor appetite, unintended weight loss, and other nutrition challenges that can occur with dementia.
Nutrition and Cognitive Health
Before we dive into nutrition after someone develops dementia, we talk about nutrition and reducing the risk of cognitive decline. There are many factors involved in brain health, and nutrition is just one piece of the puzzle.
In this episode, Laura discusses managing chronic health conditions that are associated with cognitive decline, including hypertension, diabetes, and cardiovascular disease.
We also talk about the MIND diet, which combines elements of the Mediterranean and DASH diets and focuses on foods such as leafy green vegetables, fruits, nuts, fish, poultry, and heart-healthy oils.
Nutrition can support health, but dementia is complex. There is never one single food, diet, or lifestyle choice that determines whether someone will develop dementia.
How Dementia Can Affect Eating
One of my favorite analogies Laura shares in this episode is to think of communication within the body like railroad tracks.
Information is constantly traveling between the brain and the rest of the body. As dementia progresses, some of those tracks begin to break down, making it harder for information to get where it needs to go.
Think about everything that has to happen just to eat one meal.
Someone may need to:
- Recognize that they need food
- Know what food they have available
- Plan a meal
- Shop for groceries
- Prepare and cook the food
- Remember that it is time to eat
- Recognize hunger
- Use utensils
- Bring food to their mouth
- Chew and swallow safely
- Store leftovers safely
A change anywhere along that process can affect dementia nutrition.
For caregivers, one helpful place to start is simply asking: Where is the process breaking down?
Helping With Groceries and Meals
Sometimes the biggest challenge is simply getting food into the home. Grocery delivery may be helpful for some older adults. For others, family members, friends, neighbors, or community groups may be able to help with shopping.
As dementia progresses, meal preparation may also become more difficult or unsafe. Families may be able to prepare larger portions of meals and bring some to their loved one. Friends or family members can also rotate bringing meals.
Eating together can help too. Laura shares that people sometimes eat much more during holidays and social gatherings than they typically do when eating alone. Food is social. Sitting down with someone for a meal can provide a cue that it is time to eat while also making the experience more enjoyable.
Chewing and Swallowing Concerns
Chewing and swallowing problems can also affect dementia nutrition.
Caregivers may notice that someone:
- Takes much longer to eat
- Chews meat for a long time and then spits it out
- Coughs or chokes while eating
- Has repeated episodes of aspiration pneumonia
These can be signs that additional evaluation is needed. A physician, dietitian, speech-language pathologist, or another member of the healthcare team may need to become involved depending on what is happening.
Sometimes the problem may be related more to chewing than swallowing. For example, tougher meats may become difficult to chew. Changing the cooking method may help. Stewed or shredded meats may be easier than grilled meats.
Softer protein options may also include foods such as beans, lentils, nut butters, or other foods that are easier to manage. Some people may eventually need additional texture modifications based on recommendations from their healthcare team.
Supporting Independence at Mealtimes
Some people with dementia may have difficulty using utensils or physically feeding themselves. This can happen because of weakness, changes in dexterity, other medical conditions, or cognitive changes.
Finger foods can sometimes help someone continue eating more independently.
Laura shares examples including:
- Egg bites
- Rice balls
- Energy bites
- Strips of chicken or other protein foods
- Foods served with dips
- Frozen yogurt pops
The goal isn’t to make eating look a certain way. The goal is to help the person continue getting adequate nutrition while maintaining as much independence and dignity as possible.
Reduced Appetite and Unintended Weight Loss
Reduced appetite and unintended weight loss are other common dementia nutrition concerns.
When someone isn’t eating well, Laura recommends putting on your “detective hat.” There may be many different things affecting appetite, including constipation, medications, pain, sleep patterns, illness, and dementia itself. Once you understand some of the barriers, you can begin looking for ways to work around them.
If someone is only able to eat a small amount of food, making that food more nutrient-dense can help them get more nutrition from the amount they are able to eat. Instead of focusing on getting someone to eat a large meal, sometimes the goal becomes making every bite count.
Dementia Nutrition Takes a Team
There are a lot of moving parts when it comes to dementia nutrition.
A caregiver may be helping with grocery shopping, preparing meals, watching for chewing or swallowing problems, assisting with eating, encouraging intake, and monitoring weight. And that is only the nutrition piece of caregiving.
Nutrition care for someone with dementia often requires a team approach that may include family members, physicians, dietitians, speech-language pathologists, and other healthcare professionals.
Knowing what to look for can help caregivers recognize when additional support may be needed.
Encouragement for Caregivers
One of Laura’s messages to caregivers in this episode is simply: thank you for showing up.
Caregiving involves so much. There are appointments, medications, physical changes, mobility needs, personal care, meals, and countless other responsibilities.
Food is nourishment, but it is also family, culture, connection, and love. Nutrition gives caregivers one tangible way to support someone they love.
You won’t be able to control everything that happens as dementia progresses. But supporting someone with food, nutrition, comfort, and care matters.
Dementia Nutrition: The Takeaway
Dementia can affect nearly every step involved in eating.
The challenge may be getting groceries into the home. It may be preparing food, remembering to eat, using utensils, chewing, swallowing, dealing with a reduced appetite, or preventing unintended weight loss.
Understanding where someone is struggling can help caregivers find practical ways to support them.
And remember: you don’t have to figure everything out alone. Dementia nutrition is a team effort.
Resources From Laura
Learn more from The Seniors Dietitian:
https://theseniorsdietitian.com/
Get Laura’s Dementia Mealtime Support Guide:
https://the-seniors-dietitian.kit.com/3918450b79