Common Challenges in Eating and Appetite and How to Address Them
We asked our NAN Expert and Clinical Nutritionist, Pat DeAngelis, RN, to share her favorite tips caregivers can use to manage the common challenges in this area. Please consult your loved one's personal healthcare providers before you make significant changes in their diet.
Caregivers Challenge: My loved one no longer enjoys their favorite food.
Explanation: Any form and stage of Dementia can result in a decreased ability to smell and taste food normally. Favorite foods may no longer have their appeal, and appetite overall can be reduced.
Caregiving Tip to boost flavor:
If your loved one likes sweet foods, then feeding them fruit and naturally sweet vegetables such as yams, sweet potatoes, and carrots may be a healthier option, though you need to make sure you also manage weight control of your loved one. Adding small amount of honey, cinnamon, or sugar to savory foods such as oatmeal can also help.
If your loved one has a favorite spice or herb, add that to a dish to enhance the flavor. Also, relish, chutney, and other condiments can make a meal more interesting to your loved one’s palate.
Caregivers Challenge: My loved one is eating less.
Explanation: People with Alzheimer’s often begin to eat less than they used to because the disease changes the brain’s sense of smell and taste. In addition, most people with Alzheimer’s experience reduced physical activity, and begin to have difficulty managing complicated situations such as shopping and cooking. In the later stages of the disease, the decline of a person’s ability to manage the act of eating, and the physical processes of swallowing, can also reduce overall food intake.
Caregiving Tips to increase food intake:
Avoid mixtures of foods, such as casseroles and dishes with sauces, which may be too complicated for your loved one to comprehend and manage.
Try serving uncomplicated foods, with one to two food choices at a time, and start with small portions on small plates. A large plate with multiple types of food can be more complicated for your loved one to manage.
Use non-breakable eating and drinking pieces in bright contrasting colors, without busy patterns on placemats or table covers.
Avoid distractions such as TV and pets. Background music, however, can be calming.
Your loved one may need prompting from you, and assistance such as helping to cut the food into small pieces, in order to start eating independently.
If using utensils becomes confusing and possibly unsafe, use finger foods to prolong independence. For example, cut sandwiches into four pieces, prepare fresh fruits and vegetables as ready-to-eat, and roll thin meat cuts for easy pick-up. Cheese sticks and fruit juice popsicles are also easy-to-eat additions.
Caregiver's Challenge: My loved one only wants "sweets" and lacks self-control to limit quantities.
Explanation: Carbohydrate foods, particularly processed "sweets," can lead to physical cravings for more of the same type of food. For our loved ones with Alzheimer’s, the part of the brain that provides behavior control, judgment, and decision-making may not be fully intact which can lead to accidental overindulgence of certain food types.
Caregiving Tips to limit the consumption of sweets:
Decrease the availability of sweets by replacing them with healthier foods such as nuts.
Add a protein to a small serving of a carbohydrate, such as putting peanut butter on a graham cracker, pairing a cheese stick with fresh fruit, adding a small portion of ice cream or nondairy frozen dessert with fresh fruit, or serving a dab of fruit or yogurt with cookies.
Caregiver's Challenge: My Loved one will eat a small breakfast in the late morning and then will only eat in evening.
Explanation: Eating only twice a day, especially with one meal that is a "small size," often means an individual consumes little more than 1,000 calories daily. Considering that to maintain their weight, the average woman needs 1600-2400 calories per day and the average man needs 2000 to 3000 per day, eating only 1000 calories per day or less will result in weight loss. If this eating pattern continues consistently for several weeks, your loved one is at risk for severe nutritional deficit as well as a decreased immune system, adding the risk of bacterial or viral infection or other frailty.
Caregiving Tips:
Try implementing the Six Smart Meals plan and add two to three prepared nutritional drinks per day (drinks that are high in protein content are recommended).
In between meals, offer four ounces of fluid, water, tea, coffee, or lemonade every two hours in an unbreakable container with a straw, if not contra-indicated by swallowing difficulty.
Obtain and record weight at least weekly. If there is a consistent undesired weight loss of two pounds or more a week, seek a medical or nutritional consultation.
Caregiver's Challenge: My loved one will not drink water!
Explanation: As we get older, our bodies naturally send fewer biochemical signals encouraging us to drink water. That is why older people are more prone to dehydration. Our loved ones with Alzheimer’s are especially at risk if their cognitive abilities don't allow them to realize they need to drink water even if they don't feel thirsty.
Caregiving Tips:
In between meals, offer four ounces of fluid, water, tea, coffee, or lemonade every two hours in an unbreakable container with a straw, if not contra-indicated by swallowing difficulty.
Consider serving foods that will allow your loved one to "eat the water they need." Watermelon, other melons and berries, cucumbers, tomatoes, and soups are good ways to add water to the diet.
Consider making a few of your “beverage breaks” an activity you can enjoy together. You can even connect a favorite beverage to another favorite activity. Maybe start a ritual of enjoying a cup of coffee or tea while you read a book together.
Caregivers Challenge: My loved one is resistant to being weighed at home, or it is not safe to weigh my loved one at home.
Explanation: For most people, maintaining a stable weight means they are getting adequate nutrition to balance the amount of activity they do each day. As we get older, weight stability is important. If you cannot safely weigh your loved one, or if it upsets them to do so, instead pay attention to the fit of their usual clothing. If their clothes still fit as usual, frequent at-home weighing may not be necessary.
Caregiving Tips:
If weighing is recommended between physician office visits, visits, work with your loved one to see if they will agree to one monthly weigh-in based on "doctor's orders. "
Either use a scale at home or utilize the same commercial scale each time, for example, at the local grocery store or pharmacy; try weighing at approximately the same time of day.
Caregiver's Challenge: My loved one has difficulty reading a menu and making a meal choice at a restaurant.
Explanation: Decision-making and language difficulties are present during the early stages of dementia-related disorders and often progress to increased difficulty.
Caregiving Tips: Pre-planning is helpful in restaurant dining. Choose the restaurant carefully and, if possible, go during off-peak hours. Less noise and a non-rushed meal will be less stressful for your loved one. Seeking out a table in a quiet area near the restroom is another benefit.
Anything you can do to avoid embarrassment for your loved one will lead to an enjoyable event.
If your loved one has difficulty at a restaurant, consider carrying small cards that explain why your loved one may have trouble understanding or need special consideration. Here's a link to Please be Patient cards, which can be printed and distributed to others at the restaurant, if necessary.
Before arriving, talk to your loved one about their favorite food at the restaurant and decide together if you are to order a favorite food, such as “that great grilled chicken sandwich", for them.
