Mealtime concerns related to dementia

If someone is refusing food and drink or not opening their mouth for it, look out for patterns – is the refusal linked to the time of day, mood, food textures, food type or noise levels around them?

Give gentle encouragement and describe the food eg: “I’m going to give you some pudding now, your favourite”

Let the person see and smell the food so they realise what it is and get ready for eating.

Consider personal taste – would they prefer something else? For example: a sandwich rather than a hot meal, a bigger pudding instead of main course?

If they still refuse, leave them for a few minutes then come back and try again – or ask someone else to try as the person may respond differently to a new face.

If you are concerned about the impact on someone’s health if they are refusing food or drink, or if you have concerns about weight loss or nutrition please contact their GP.

Try not to comment or make a fuss directly about the behaviour.

Use napkins, an apron or clothes protector to keep clothes clean and maintain dignity.

Give verbal prompts to keep eating eg: “You’ve still got some food there, keep going”

Consider finger foods if cutlery is difficult.

Reduce background noise by switching off the TV, radio or nearby appliances.

Remove distracting items from table eg: salt and pepper pots, vases, extra plates or cutlery.

Remove patterns – use a plain tablecloth, plain plates and plain napkins, aprons and clothes protectors as patterns can be distracting.

Serve one course at a time and only put out the cutlery and plates needed for each course

Remind the person where they are and what they are eating and gently remind them to carry on eating.

Feed only when awake and alert – this will support safe swallowing and reduce the risk of choking.

Are there any underlying reasons for drowsiness, eg: urinary infection, chest infection, medication side effects, blood sugar levels?

Offer high calorie foods little and often when they are alert.

Reduce distractions and noise by switching off the TV, radio or nearby appliances and if this is not possible, let the person have their meal in a quieter place.

Let them get up and walk during the meal – when they come back, show them their meal and tell them what it is. Gently prompt them to sit down and eat

Offer finger foods for them to eat on the move eg: small sandwiches, pieces of soft fruit, small slices of cake.

Help get the person get ‘set up’ for the meal. Put cutlery in their hand ensuring that if they have a weaker side, a spoon or fork is in their good hand.

Cut food up into bite size pieces before serving to avoid embarrassment.

Offer finger foods if using cutlery is too difficult.

Give gentle encouragement to keep going.

Try not to make comments about any dropped or spilled food.

Use napkins, an apron or clothes protector to keep clothes clean and maintain dignity.

Consider using adapted equipment such as a plate guard, non-slip mat, and/or easy grip cutlery – an occupational therapist will be able to provide advice if required.

Create a routine to make the person feel more at ease.

Consider cutting food into small pieces or offering finger foods to avoid difficulties with cutlery.

Give reminders to swallow eg: “there’s food in your mouth, try to swallow”

Give small amounts at a time and do not offer more food until the mouth is clear
Make a note of problematic foods and consider avoiding these or making them easier to eat.

If the person is holding food in their mouth or pouching it in their cheeks:

Give reminders to chew and swallow eg: “You have food in your mouth, keep chewing and try and swallow it”

Switch between food and drinks throughout the meal but avoid eating and drinking at the same time.

Check that their mouth is clear between each mouthful. Do not offer more until the mouth is clear.

Give gentle encouragement and describe the food eg: “I’m going to give you some carrots now” or “I’m going to give you a sip of your juice”

Try placing an empty spoon against their lips – this can be a reminder that there is food in the mouth.

Try not to make a fuss.

Think of the person’s likes and dislikes and note if they spit out certain foods or textures eg: grainy meat, stringy vegetables? Softer, smoother foods may be easier but changing texture may not stop the behaviour completely.

Make sure you have plenty of napkins and offer these to spit unwanted food into.

Supervise so you can support with reminders and help immediately if they start to choke.

Cut food into smaller pieces before serving and remind the person to slow down.

Offer meals with a teaspoon rather than knife, fork, spoon to reduce mouthful size

Offer small portions at a time only.

Give food that is soft, moist and in thumbnail size pieces to reduce the risk of choking – and refer to the Speech and Language Therapy service if you are concerned about choking.

If the person wears dentures, make sure they wear them and that the dentures fit properly.

Give reminders to keep chewing eg: “keep chewing that biscuit”.

Make a note of problematic foods and look out for a pattern.

Offer softer options if hard, tough or dry foods are problematic

Refer to the Speech and Language Therapy service if you are concerned about choking.

Observe the person and think about whether certain food textures are problematic – if so, modify or avoid them.

Try smaller – feed using a smaller fork or spoon and give small sips of drinks.

Slow the pace of feeding down.

If you are concerned, our Speech and Language Therapy service can offer an assessment and advice.