Meal time

How dementia can impact meal time habits and routines

Healthy eating is important for all of us. Sharing meal times with family and friends can provide structure to the day and increase the enjoyment of food.

When caring for someone living with dementia, however, meal times can become stressful and frustrating. The caregiver has a lot to consider making sure that the person living with dementia eats a well-balanced diet and is properly hydrated, but also ensuring that meal times are an experience associated with pleasure and enjoyment.

Our eating habits and routines develop over a lifetime. Understanding the eating habits of someone with dementia can help you understand changes in preferences and behaviour.

A person living with dementia may need help with eating and drinking because of:

• Forgetting how to prepare a meal, eat or drink or that they have already eaten 
• Not knowing what to do with food that is placed in front of them 
• Having challenges with how to use utensils 
• Putting too much food in their mouth at once 
• Eating too quickly 
• Trying to swallow without chewing or have difficulties swallowing 
• Trying to eat inedible items 
• Losing interest in eating and drinking  
• Having poor appetite, craving certain foods more than usual or overeating 

The good news is that people can continue to enjoy food and take pleasure in spending time with others over a meal. Keeping them involved in meal times is important for their well-being. By caring, prompting and adapting meal times, a person living with dementia can be encouraged to eat independently.

Nutrition 

There is no special diet required for people living with dementia, but eating a variety of healthy foods each day is as important to brain health as it is to the rest of your body. Diabetes, hypertension, high cholesterol and obesity are all risk factors for dementia.

Many healthy food choices will improve your brain health. Eat a varied diet rich in dark-coloured fruits and vegetables, including foods rich in anti-oxidants such as blueberries and spinach, and omega 3 oils found in fish and canola oils.

Discuss your diet with a registered dietitian or your doctor. See Canada’s Food Guide for more information on healthy eating and recipes, at food-guide.canada.ca

Tips and strategies for people living with dementia and caregivers  

Memory

A person with dementia may skip meals, forget how to eat or forget that they have eaten. They may not recognize utensils on a table or food items on a plate. They may also use utensils incorrectly (drinking from a plate rather than a cup.) 

If you support someone living with dementia: 

• Call the person to remind them to eat or let them know when it is time to take a pre-cooked meal out of the fridge and warm it up.  
• Use simple, step-by-step instructions and show the person with words or actions (put food on a utensil and bring it to your mouth.)  
• If you live alone with dementia: 
• Try posting reminders for meal time or setting an alarm.

If you live alone with dementia:

•  Try posting reminders for meal time or setting an alarm.

Decreased judgment

A person living with dementia may leave the stove or other kitchen appliances on. 

If you support someone living with dementia: 

• Remind the person to set the timer when using the stove or oven. 

If you live alone with dementia:  

• Create reminders to turn off the stove.  
• If you set a timer for something, use a sticky note to remind yourself what the timer is for.  
• Buy appliances with automatic shut-off switches (such as electric kettles).  
• Have an occupational therapist come in to assess your kitchen for safety concerns.  
• Consider ordering meals and fresh fruit and vegetables from local community support services.  

Concentration

Eating involves carrying out a series of complex skills, such as cutting up food, moving a utensil or hand towards the mouth, chewing and swallowing. This requires a level of concentration someone living with dementia may not be able to maintain.  

If you support someone living with dementia: 

• Limit distractions. Serve meals in a quiet place so the person can focus on eating. Turn off the television, radio, telephone ringer and mobile notifications.  
• Provide adequate lighting and try to keep the environment as calm and relaxing as possible. 
• Remove flowers, centrepieces and condiments. Use only the utensils needed for the meal.  
• Serve the meal one course at a time.  
• If the person does not want to be with other people while eating, don’t force them to eat with others.  
• If they want to stay in a different room where they are comfortable, allow this as it may be difficult for them to change routines.  
• Use a tray as needed to help with clean up. 

Visual and motor abilities 

A person’s vision and their ability to understand where objects are in relation to each other can change as their dementia progresses. This may make it difficult to distinguish items on a plate, table or place setting. It can also affect movement and co-ordination. 

If you support someone living with dementia:  

• Avoid patterned dishes, tablecloths and placemats because they might confuse or distract.  Avoid using Styrofoam cups and paper napkins, which might be eaten by mistake.  
• Choose utensils and dishes that are easy to hold. Serve food in large bowls instead of plates, or use plates with rims or protective edges that are easy to hold onto.  
• Offer the person only one utensil. Spoons with large handles, texture or colour are easier to identify and use.  
• Cups and mugs with larger handles may be easier to use; ones with lids can prevent spilling.  
• Ensure dishes are stable; use mats or even a wet cloth underneath to prevent slipping.  
• Use a clothing protector or consider using a large napkin so that any mess can be taken away without too much distress for the person.  
• Cut food carefully into bite-size pieces (about the size of a quarter). Remove all bones, garnishes and non-edible items.  
• Provide finger foods that are easy to pick up (cheese cubes, small sandwiches, small pieces of chicken, sliced fruits and vegetables, potato wedges, chicken strips and fish sticks.)
• When possible encourage and support the person living with dementia to feed themselves. Ask if they would like assistance. 

Changes in behaviour  

Many positive or negative physical, social, spiritual, environmental or situational factors may cause a person’s behaviour to change. For example, during meal time, a person not wanting to eat may be caused by: 
 

• Type and progression of dementia  
• The environment  
• Changing abilities (reduction in sense of smell and taste)  
• Memory changes  
• Needing help to eat  
• Disliking the taste, texture or smell of the food
• Food that is too hot or cold 
• Not knowing that it’s time to eat 
• Inability to sit through an entire meal  
• Side effects of medications  
• Depression, delusions, hallucinations or delirium  
• Pain or other conditions (challenges with swallowing) 
• Changes in ability to communicate  
• Inability to recognize a caregiver 
• Being rushed  
• An unsupportive or new routine/care approach 

If you support someone living with dementia: 

• Check the temperature of the food  
• Offer the person’s favourite foods. 
• Don’t rush. If the person doesn’t want to eat, take a break and return to eating later.  
• Avoid introducing unfamiliar routines, such as serving breakfast to a person who prefers not to eat breakfast. 
• Consider having nutritious foods on hand that the person can eat “on the go,” such as yogurt cups, fruits, cereal bars, etc. 
• If the person doesn’t know what to do with food after it is chewed, remind them to swallow.  
• Maintain regular medication reviews and dental, vision, hearing and physical check-ups. 

Dehydration

The person living with dementia may forget to drink or may not get enough fluids because don’t realize they are thirsty. 

If you support someone living with dementia:  

• Be sure to offer regular drinks of water, juice or other fluids to avoid dehydration.
• During the day, liquids should not be limited. 

Constipation

Constipation is a common complication of some neurological disorders that affect the nerves involved in digestion. Constipation is also caused by not drinking enough fluids or by low fibre intake. A person might choose not to drink because they have difficulty getting to the washroom in time or because of incontinence issues. Constipation can also be a side effect of medication. 

If you support someone living with dementia:  

• Remind the person to drink liquids throughout the day to avoid dehydration and constipation.  
• If the person tends to be restless and less likely to sit down and eat, offer juice boxes, water bottles and portable snacks such as a fruits so they can stay hydrated and nourished.  
• Try to position the person’s bed so that they can clearly see the toilet. Put signs in the home to direct them or place a picture of a toilet on the bathroom door.  
• Consider a bedside urinal, bedpan or a commode and place it near the bed. 

Decreased appetite/weight loss 

Medications or other conditions (such as heart conditions, diabetes, constipation or depression) may lead to loss of appetite. Oral health issues such as sores, cavities or gum diseases (gingivitis) can cause pain and affect a person’s appetite. This can lead to unintentional weight loss or changes in a person’s behaviour. Dentures not fitting properly, or dry mouth can also contribute to decreased appetite. A person may also be restless and walk around more than usual. If they are walking regularly, they will need more calories to maintain their weight 

If you support someone living with dementia:  

• Involve the person in preparing favourite meals and eat together.  
• Consider talking to your doctor about using vitamin and meal supplements and/or being referred to a dietician.  
• While extra carbohydrates and fats are not necessarily healthy, they do help maintain a person’s weight.  
• Small, frequent meals or nutritious snacks may be more tempting and easier to eat than three main meals a day, particularly if a person’s appetite is small.  
• Daily oral health habits and regular dental appointments are important to keep the mouth and teeth healthy. Make sure the dentist has experience working with people living with dementia.  
• Consider using social activities to encourage eating (e.g. having tea with friends, eating snacks with a movie, religious or spiritual observances involving food, baking.) 

Overeating  

A person with dementia may overeat if they forget they have already eaten, have a craving for certain foods or be hoarding food to eat later. Frontotemporal dementia, which affects the areas of the brain associated with personality, behaviour and emotions, may cause people to compulsively put things in their mouth, even inedible items. 

If you support someone living with dementia: 

• When possible, eat with the person to watch for overeating.  
• Overeating could be due to boredom or depression. Make sure the person is occupied with meaningful activities throughout the day.  
• Overeating may be due to a preference for specific foods. If the person is diabetic, do blood sugar checks prior to meals.  
• Make healthy snacks easily available, such as fruit, vegetables, yogurt and applesauce. 
•  Stagger food items so that only one is visible to be eaten at a time (i.e. present one food item, take that away, present another food item, take that away).  
• Limit food intake to avoid the person becoming overweight, and if you can’t, provide as much healthy food as possible (fruits, yogurt). 

Tips for dining out

• Eat in places where the menu and staff are familiar and where servers understand your needs.  
• Go out during non-peak times so you won't feel rushed.  
• Dine at a restaurant with family washrooms if you use a walker or wheelchair.  
• Request a table in a quiet corner to avoid noise and distractions.  
• Show (using a card) or tell service staff that you are living with dementia or caring for someone living with dementia and need extra support.  
• Review the menu ahead of time. Ask the server for a written copy of the specials instead of having them listed verbally. 
• Some people living with dementia experience changes in their inhibitions and judgment and may act differently while eating a meal. Try to identify if a health condition, environmental factor or social situation might be causing changes in the person’s behaviour. 

More information and resources

Brain health food guide: An evidence-based approach to healthy eating for the aging brain. Baycrest. This downloadable food guide provides more evidence-based tips for healthy eating, and was written in collaboration with nutritionists involved with the Canadian Consortium on Neurodegeneration in Aging (CCNA).

Comfort Care for Eating and Drinking: Resources for Long-Term Care (Hub). Ontario Centres for Learning, Research and Innovation in Long-Term Care. This hub provides resources about a comfort care approach to eating and drinking for residents in long-term care and at the end-of-life stage. A comfort care approach focuses on enhancing the resident’s quality of life and easing the physical and emotional factors associated with eating challenges. There are resources for family members and residents, as well as for care providers/team members.

Canada's food guide. Government of Canada. Canada's food guide lists recommendations for healthy food choices, eating habits, recipes, tips and other resources.

Canadian Association of Occupational Therapists. Find an occupational therapist.

Cooking with Dementia. National Council of Dementia Minds. In this guide, people living with dementia share their advice on kitchen safety and preparing meals. There is also a cookbook created by and for people living with dementia and care partners. The cookbook includes a wide variety of healthy, easy-to-follow recipes, and is free to download.

DREAM Healthy Eating. DREAM project partners. Key information and resources on the benefits of healthy eating, and ways to be included and supported during mealtime activities. 

Nutrition in Disguise. Research Institute for Aging. Provides recipes with healthy ingredients to common foods.

References

References

Cassolato, C. A., Keller, H. H., Dupuis, S. L., Schindel Martin, L., Edward, H. G. & Genoe, R. M. (2010). Meaning and experience of “eating out” for families living with dementia. Leisure/Loisir, (34)2, 107-125. doi: 10.1080/14927713.2010.481107

Edwoba, A-K., Keller, H. H., Daly, K. (2011). The food-related role shift experiences of spousal male care partners and their wives with dementia. Journal of Aging Studies, 25(3), 305-315. https://doi.org/10.1016/j.jaging.2010.11.002

Genoe, R. M., Keller, H. H., Schindel Martin, L. & Dupuis, S. L. (2012). Adjusting to mealtime change within the context of dementia. Canadian Journal on Aging, 31(2) 173-194. doi: 10.1353/cja.2012.0023

Genoe, R., Dupuis, S. L., Keller, H. H., Schindel Martin, L., Cassolato, C. & Edward, G. 2010. Honouring identity through mealtimes in families living with dementia. Journal of Aging Studies, 24(3), 181–193. doi:10.1016/j.jaging.2010.02.001

Keller, H. H., Smith, D., Kasdorf, C., Dupuis, S., Schindel Martin, L., Edward, G., Cook, C. & Genoe, R. (2008). Nutrition education needs and resources for dementia care in the community. American Journal of Alzheimer’s Disease & Other Dementias, 23(1), 13-22. doi: 10.1177/1533317507312805

Keller, H. H., Schindel Martin, L., Dupuis, S. L., Genoe, R., Edward, H. G. & Cassolato, C. (2010). Mealtimes and being connected in the community based dementia context. Dementia, 9(2), 191–213. doi: 10.1177/1471301210364451

Keller, H. H., Schindel Martin, L., Dupuis, S. L., Reimer, H., & Genoe, R. (2015). Strategies to support engagement and continuity of activity during mealtimes for families living with dementia: a qualitative study. BMC Geriatrics, 15, 119. doi: 10.1186/s12877-015-0120-2

Acknowledgement

This information is informed by research and the experiences of people living with dementia and their caregivers. We would like to thank Edwoba Atta-Konadu, Carly Cassolato, Carly Cook, Dr. Kerry Daly, Dr. Sherry Dupuis, H. Gayle Edward, Dr. Rebecca Genoe, Cara Kasdorf, Dr. Heather Keller, Dr. Holly Reimer, Dr. Lori Schindel Martin, and Dr. Dana Smith for their assistance in developing this information.