February 10th, 2021

​Eating and Drinking Problems related to Dementia
 
A number of eating and drinking issues may occur for those with dementia including under or over eating and swallowing problems. Swallowing difficulties (dysphagia) related to dementia and Alzheimer’s have increased with longer life expectancy.  The prevalence among those individuals with intellectual disability is also increasing, however at a younger age as they prematurely age.
 
 
Swallowing difficulties:
 
How do you know someone has an eating and drinking difficulty?

They will have some or all of the following signs while or after eating and drinking:

• coughing and choking
• food or fluid spilling from the mouth. 
• food/fluid being gulped down too quickly.
• food/fluid coming out of the nose.
• refusal to eat
• long time taken to eat and drink or refusal of favourite foods
• wet or gurgly voice 
• food staying in the mouth after the swallow
• dribbling
• recurrent chest infections
• weight loss, dehydration or weight gain

---

Under-eating

As we age our appetite decreases.  For those with dementia this decrease in appetite can be more pronounced. In the early stages under-eating can be prompted by depression and later on due to forgetting to eat or even how to eat. Medications can affect appetite too.

---

Suggested support
 

• visit a dentist and make sure teeth and/or gums aren’t sore and dentures fit
• review medications
• prepare appetising food high in colour and smell
• offer finger foods, they may be more easily managed

• offer food little and often throughout the day may be more beneficial than three big meals
• exercise - this can help make people feel hungrier so therefore they will eat more

 Over-eating:
 
For some people with dementia an increase in weight can be an issue for a number of reasons.  They:

• forget they have eaten.

• eat too much - as they are not aware of feeling full
• have cravings for lollies or chocolate
• are bored
• have reduced their exercise
• are on medications that affect appetite and weight gain

Suggested support:

• limit access to sweets or disguise unhealthy snacks behind plain wrappers.
• substitute healthy alternatives.
• nutritious snacks or finger food throughout the day with smaller main meals
• plan activities to decrease boredom.
• review medications.

General suggestions:

• keep it simple 
• limit choices to reduce confusion or frustration. (1-2 foods at a time is optimum)
• focus on fluids - make sure they drink regularly to maintain hydration
• prepare appetising foods full of scents, colours and flavours.
• finger food may be a good option.
• prompt to eat and drink if required
• have someone sitting with them
• monitor medications - these can affect appetite, and cause a dry mouth (in these cases increased fluid or oral lubrication products may be beneficial) 
• make mealtimes pleasing  
  • the individual needs to feel comfortable with who is feeding them
  • avoid giving them food that is too hot or too cold
  • try to offer foods they enjoy and serve on coloured tableware dishes that contrast highly with the food colours
• reduce distractions around meal times.
• get a speech language therapist to do an assessment who may recommend modification of food and fluid textures

---

Equipment:

• choose plates, bowls and utensils that can be easily handled.
• may benefit from larger handled spoons and forks.
• trial cups that have lids and/or straws.

Use visual and other strategies:

• diaries
• use of post-it notes
• visual symbols
• timers - visual or auditory.
• visual schedules 

---

Safety:

• cooking for themselves - watching for burnt pots, under or uncooked food
• meals on wheels or other options may be a safer option

 
The role of the team and when to refer:

• GP – review of medications
• Dentist – ensure teeth and gums are healthy/dentures fit
• Speech-Language Therapist – assessing for swallowing problems, modified diet and fluid and textures prescription
• Dietitian – supplement and dietary advice
• Occupational Therapist – eating and drinking utensils
• Physiotherapist - exercise

If you need help with someone with a swallowing problem, just contact us at Therapy Professionals Ltd, our friendly Speech Language Therapist can help.
 
                                    Phone:                       03 377 5280
                                    Email:                         admin@tpl.nz
                                    Website:                    therapyprofessionals.co.nz