Let’s Talk about Dementia

I have been asked to share some of the common questions I get asked as a dietitian about eating and drinking in relation to dementia.  I hope you find this information useful but please feel free to get in touch at [email protected] if you have any questions of your own. 

Question: My Mum/Dad/Partner/Friend has developed a sweet tooth.  I am worried this is unhealthy and they are not getting the nutrients they need.  What can I get them to eat healthily?

Answer: Healthy eating messages are something we are all familiar with. So when eating habits do not match them it is understandable that we may become worried. When someone has a Dementia the food still has the same flavours but the brain can struggle to make sense of these the way it did before. We know that stronger flavours such as sweet and sour can be detected more easily and this can be why someone may opt for these foods instead.

However, there is no need to panic. Sweet tasting foods can still offer a good balance of nutrients; it just looks a little different to what you may expect to see from a ‘healthy diet’.  With a few adaptations food can still be enjoyable and provide the nutrition we need.  Milk based desserts such as rice pudding, custard, ice cream, semolina and tapioca are all high in energy, protein, calcium and vitamin D.  Adding some tinned, fresh or stewed fruit helps to add fibre as well as a range of other vitamins and minerals to the mix.  Cakes or biscuits also provide energy, those with nuts or dried fruit also add fibre, protein, vitamin E and iron.  Savoury foods can also be altered to make them more appealing.  Try adding naturally sweet vegetables such as carrots, squash, red or yellow peppers, sweetcorn, parsnip or sweet potatoes.  Roasted or mashed vegetables can also be sweetened further with a little maple syrup or honey.  You could also add sauces such as sweet chilli, apple or cranberry sauce. 

Question: What if someone starts to say that their food tastes bland but it is something they have always enjoyed?

Answer: Foods with subtler flavours such as potatoes, pasta, meats, rice and fish may taste bland. Again this is because they may not be as easily detected by the brain. 

Be creative and try new foods!  If they have always enjoyed more traditional food such as mince and tatties or fish and chips consider offering dishes such as lasagne, curry or chilli.  Keep experimenting!  You may find a food is enjoyed one week but not the next.  This can be frustrating but retry foods at a later date.

If food tastes bland use herbs and spices to enhance flavours.  Mustard and honey or ready-made marinades or spice rubs can be used to coat meats or vegetables before roasting or grilling.  Garlic or herbs such as rosemary or oregano can be added to roast or mashed potatoes.  Worchester sauce can be added to pasta sauces or casseroles.  French or citrus dressing can be added to salad vegetables.  The only word of caution is to avoid adding extra salt. Especially if there is a diagnosis of vascular dementia or there are issues with high blood pressure as adding more salt can be harmful.

Having a flexible approach can ensure meals and snacks can still offer a range of nutrition and be enjoyed.   

My relative tells me they will eat when they are hungry but they never seem to be hungry!  I am worried they are going for long spells without eating and drinking, how can I help?

This is a very common question we receive as Dietitians.  There are all times when we all don’t feel like eating. This can be true whether you have dementia or not.  The concern is when this happens regularly. In dementia the body is still sending signals telling us we need to eat and drink but they aren’t being read properly by the brain.  Examples of these signals is your stomach rumbling near lunchtime or you becoming aware that your mouth is dry.  Additional prompts are a good way of helping recognise these needs.  Using a smart speaker, reminder on a phone or even written signs can help.  Visual cues such as leaving out a jug or sports bottle with juice or water nearby or a grazing plate with foods may also help.  A drinks fridge with a clear front can make prepared foods more visible. 

If someone is receiving support with their meals speak to the care provider and agree a list of foods with the person that they enjoy for meals or snacks which can be offered at visits.  It is better to give an either/or choice from agreed options rather than ask if someone what they would like. A question like this can be difficult to answer and can be why people say they will have something later.  If there are concerns, good communication about what someone has eaten or drank is important. This could include a food diary or sharing what meals are not being well received.  Sharing information is especially important when there may be a range of family, friends or carers providing support.  

Question: We have just had our meal and our friend is telling me they haven’t eaten. I am worried that giving them more food will harm their health.  What should I do?

Answer: In Dementia’s such as Frontal Temporal Dementia it can be likely for a person to forget they have just eaten.  Imagine if you believe you have not had a meal but someone else is telling you that you have.  You would feel confused, distressed and maybe that you are being deprived of food making you annoyed.  For the person offering the food this can also be distressing. Often it is easier to provide more food but this is not always helpful if their weight is increasing to an unhealthy level or they have a condition such as diabetes.

A good tip is to make the same sized portion meal but offer half at a time.  When the first portion is complete and a further meal is requested the second half can be given.  Alternatively give only a small amount of meat, fish, chicken or textured vegetable protein and starchy foods such as potatoes, rice, pasta or bread and fill the majority of the plate with vegetables.  A low calorie drink such as tea, coffee, sugar free flavoured waters or diluted drinks can be offered instead of extra food.  Or try lower calorie snacks such as ice lollies, jelly, fruit, pretzels, carrot sticks with reduced fat hummus or salsa or flavoured popcorn.   

Question: I have noticed my relative is not eating well lately and they are losing weight.  What should I do?

Answer: Although dementia can alter what someone eats and drinks it is important to remember that there can be other causes for this too.  Do they have a condition that causes them pain?  If so does their pain medication cover when they are trying to eat.  What about their mouth?  Do they have problems with their gums, teeth or dentures that are making it hard to eat?  Are they experiencing constipation?  This can be sore and uncomfortable making you less likely to eat.  Has there been a change in their mood? 

If someone has lost weight suddenly or has not eaten well for 5 days or more then speak to their health care team for advice.  You can also check out the malnutrition screening tool at https://www.malnutritionselfscreening.org/ which includes good first line advice and may help you when you speak to the care team.

Contributor: Gillian RD

Other useful resources:

Dietitian postcard sharing who they are and how they CAN help can be found here

Eating Well at Home information sheet can be found here

Hints and tips to establishing mealtime routines and ways of making dining into a meaningful activity can be found here

A balanced healthy diet is key to good brain and body health and to preventing problems that can arise from a lack of nutrients. This theme explores diet and nutrition and resource can be found here