Eating disorders are a prevalent condition in the elderly, especially those suffering from Alzheimer’s or other forms of dementia. Difficulties with eating and nutrition can stem from the loss of memory and problems with judgement that people with dementia experience. Many people with dementia lose some ability to feed themselves, creating a significant challenge for family caregivers, as well as feelings of anxiety. People with dementia often experience unintentional weight loss and therefore can be at risk of malnutrition.  They may experience a lack of appetite, difficulties cooking, problems with communicating or recognising hunger. Dementia may also cause some people to overeat or even develop an insatiable appetite. 

The truth is, a big change in appetite is often a natural part of the disease. Once we are able to understand why a dementia patient may struggle with eating, we may feel more at ease or become better equipped to help them.

Why do people with Dementia have a change in appetite?

There are multiple reasons for a dementia patient to eat too little or too much. Some people may have difficulty noticing their hunger or may have a problem with communicating their hunger due to their condition, especially if they are not being monitored by someone. There are also some medications that can cause a patient to not be able to taste their food, this, in turn, can result in the patient losing interest in eating. Dementia patients may even forget the purpose of food or how to chew or swallow food. 

Eating and drinking is a process that involves the control center of the brain and muscles such as the neck and throat. The progression of dementia affects these areas; ultimately leading to coughing or choking, struggling to swallow, exaggerated movements of the tongue and mouth, or outright spitting out food.

Overeating and dementia

If your loved one is overeating, it could be as a result of them forgetting that they’ve eaten recently or be concerned about when the next meal is coming. They might also experience changes in dietary preference and become obsessed with specific meals. People with frontotemporal dementia are more likely to overeat and experience dietary changes. 

How to help a person with dementia manage overeating

  • Giving the person healthy snack options when they want to eat can help. Snacks like fruits and nuts can satisfy their hunger in between main meal times. 
  • In general, try to buy and cook healthy foods. Too much of anything is bad for you, but you’d probably rather have them eat too many carrots rather than too much lasagne. 
  • Make sure most of their plate is salad or vegetables. 
  • Ensure that they’re drinking enough water. Sometimes they may have mistaken thirst for hunger. Make sure they’re hydrated and give them a glass of water with their meal. 
  • Another reason they could overeat is if they feel bored or lonely. Try to keep them occupied. Here are some memory care activities that you can do at home.

Undereating and dementia

Another scenario is when a person with dementia loses interest in or continuously turns down food. Your loved one may become angry or agitated during meal times. They may refuse to eat or even spit out their food. Undereating runs the risk of malnutrition and can lead to weight loss and less muscle strength. This can make them feel tired, weak, frailer and compromise their immune system if they’re not getting the nutrients they need.

How to help a person with dementia manage undereating

  • Rule out medications or infections that can be causing a lack of appetite. Just because a person with dementia is eating more or less doesn’t necessarily mean it’s as a result of the condition – it could also be due to mouth sores or a toothache. 
  • Offer them their favourite foods. Choose flavourful food that they’ve always loved and food associated with good memories. However, keep in mind that a person’s food preferences may change as dementia progresses. 
  • While you want to keep them eating healthy so that they get the nutrients they need, they should eat something rather than nothing. They may prefer the taste of treats and dessert so sometimes a piece of cake might be your best bet. 
  • Sometimes they may just forget to eat altogether. Give them gentle reminders when it’s mealtime. 
  • Avoid hard foods, foods with stringy textures, or mixed texture foods like cereal. 
  • Try changing up the foods offered, choosing foods that are soft and easy to chew is best. It should include a variety of flavours and temperatures. 
  • Try to limit distracting elements, such as background noises from the TV, clustered table tops and table cloths, and plates with complex designs. Keep things simple. 
  • If they refuse to eat anything and you’re concerned about their condition, it’s best to seek help from a medical professional.

If you’re caring for a loved one who has dementia, it’s important to understand what causes eating problems and how you can encourage good nutrition. Nutrition has strong ties with overall health so make sure you monitor your loved ones eating patterns and make necessary adjustments.