I sometimes get anxious messages from people who are caring for someone with dementia, because they feel as if they are not able to give them a healthy diet. I remember one woman who said her dad would only eat custard cream biscuits and bananas for a week. The idea of a healthy diet sometimes gets a bit mixed up.

Because so many people in our society are overweight, the idea of healthy food has come to signify food that is slimming, including salads and sugar free puddings.  Actually, your nutritional needs are very different depending on your size, and any illness that you have or might be recovering from.  It is also influenced by your age and your level of activity.  What is healthy for anyone varies.

A person with dementia sometimes has symptoms that mean they become hyperactive and move about all the time. That presents a couple of problems.  One is that the person burns up a lot of calories by moving about and the other is that they often fail to sit down long enough to eat a meal at the time when it is served. In other cases, the person with dementia may be very passive and sleep a lot of the time and if they are living somewhere where there are fixed meal times then it may be that they miss a meal, and they might not be in a position to access something to eat in between times.

People with dementia experience changes in appetite which can lead to either increased or decreased food intake. The reasons for this are varied. Some medication has loss of appetite as a side effect. The majority of people with dementia are old or very old and the sensory changes that come with age, including changes to taste, smell, and eyesight might make food less appealing than it once would have been. Apart from the changes that come with age, there are changes in the brain which occur as a result of the damage from the disease that is causing the dementia. Those brain changes may also cause sensory impairment so that the person just doesn’t see the food or appreciate that it is there, even if it is put in front of them.

In later dementia, difficulty in swallowing and cognitive decline affect the perception of hunger and thirst. When the person really needs something to eat or drink they may still refuse an offer. Dementia can impair the ability to perform tasks related to eating and drinking such as using a cup, or a knife, fork, and spoon. Dehydration is particularly serious because it can make the symptoms of dementia worse. Because eating sometimes becomes slow and laborious, it is vital to have nutritiously dense dishes so that the right amount of nutrients, vitamins and hydration are provided in a small volume.

Healthcare professionals, including dieticians and speech therapists can offer guidance and support in managing eating and drinking. The dietician can assess the person’s nutritional status and the speech therapist has a particular interest in swallowing difficulties. They can provide recommendations for modifications in the diet or interventions as needed. A dementia nurse may be able to advise on what to do when behaviour during meals leads to challenges such as refusing food, wondering during meal times, or becoming agitated or aggressive when offered food. They will recommend methods for creating a calm and supportive environment. Many of these ideas can found in the volume Dementia, the One Stop Guide or in blogs on this website. Don’t hesitate to send in a query.

There are many strategies but always remember the importance of minimisation of distractions. Don’t forget that noise is as disabling to a person with dementia as a staircase is for a person who uses a wheelchair. The setting of the meal and the foods that are offered should be made as familiar and appealing as possible. It also seems that the person will eat more, if someone else is eating with them at the same time. But I stop short of recommending that you join your dad in a diet of custard creams and bananas. It might not do him any harm, but you might need something nicer. Bon appetit!