Just the Facts and More: Eating
Many Alzheimer patients have problems with eating. For example, a person might lose his appetite or the ability to evaluate if food is too hot or too cold. In addition, a person might forget that he has eaten and ask you for another meal. Begin by assessing the problem. Ask yourself: "Why is the person having difficulty eating?" The following questions are helpful:
- Physical Difficulties -- Is the problem physical? Sores in the mouth, poor-fitting dentures, gum disease, or dry mouth may make eating difficult. A visit to your physician might be helpful.
- Disease -- Does the person have an additional chronic disease? Intestinal or cardiac problems or diabetes might lead to loss of appetite. Constipation or depression can also decrease appetite.
- Agitation/Distraction -- Is the person agitated or distracted? If agitated, the person probably won't sit still long enough to eat an entire meal. If the person is distracted, you might want to think about how you can reduce distractions in the room.
- Eating Style -- Have you recently changed eating styles? Does the person have a preferred eating style? Some Alzheimer patients who aren't accustomed to sitting down at the table for three full meals may prefer to have several smaller meals or snacks.
- Visual Problems -- Can the person see adequately? An Alzheimer patient who had been losing weight began to eat when she started wearing her glasses at mealtimes.
- Environment -- Are there odors or harsh noises in the room that might interfere with the person's digestion?
- Food Quality -- Is the food appealing - in appearance, smell, and taste?
Once you have evaluated the sources of eating problems, you can take action.
Adapt to the person's food preferences.
Remember that you are dealing with a person who has long-standing personal preferences and tastes. Try to keep these likes and dislikes in mind when you are preparing food. On the other hand, the person may no longer remember her favorite foods.
Try to reduce mealtime confusion.
- Provide a calm environment at mealtimes. Minimize distractions, loud noises, and abrupt movements.
- Offer meals at regular times.
- Make mealtime a pleasant but simple event. For example, put only one item of food on the plate at a time.
- Give the person only one utensil at a time. You may want to omit the knife from the place setting. Avoid using plastic utensils because they may break.
- Avoid patterned plates, tablecloths and placemats that might confuse and distract the patient. In most cases, use plain white plates or bowls and a contrasting placemat.
- Deliver simple, easy-to-understand instructions. For example, "Pick up your fork. Put some food on it. Raise it to your mouth."
- Be patient. Don't criticize the person's eating habits or urge him to eat faster.
- Speak slowly and clearly. Be consistent and repeat instructions in the same words each time.
- Be realistic about going out to eat. Avoid noisy or large restaurants and choose those that are small, comfortable, and familiar. Only you can decide if the person can order directly from the menu. As an alternative, you might want to order for the person.
- Make positive use of distractions. If the person resists eating, take a break, involve her in another activity, and return to eating later.
- Use memory aids to remind the person about mealtimes. You might try a clock with large numbers, an easy-to-read appointment calendar with large letters and numbers, or a chalk or bulletin board for recording the daily schedule.
Minimize problems in chewing and swallowing.
- Avoid foods such as nuts, popcorn, and raw carrots which may get lodged in the throat. Instead grind foods or cut them into bite-size pieces. Pureed and frozen foods can be stored in plastic bags for later use.
- Gently explain that the person should chew the food, eat slowly, and swallow.
- Encourage the person to sit up straight with her head slightly forward. If the person's head tilts backward, move it to a forward position.
- Serve soft foods such as applesauce, cottage cheese and scrambled eggs.
- Serve thicker liquids such as shakes, nectars and thick juices, or serve a liquid along with the food.
- Learn the Heimlich maneuver in order to help the person if choking occurs.
Experiment with solutions to decreased appetite.
- Serve a glass of juice before the meal to stimulate the appetite.
- Prepare some of the person's favorite foods.
- Increase the person's physical activity.
- Plan for several small meals rather than three large meals.
- Give the person plenty to drink - especially in warm weather.
- Consider the use of food supplements such as instant breakfast, eggnog mixes, yogurt and milk shakes.
Assist the person to function independently.
- Serve finger foods or serve the meal in the form of a sandwich.
- Serve food in large bowls instead of plates or use plates with rims or protective edges.
- Use spoons with large handles instead of forks.
- Set bowls and plates on a nonskid surface such as a cloth or towel.
- Use cups and mugs with lids to prevent spilling and fill glasses half full; use straws that bend.
- Use plastic tablecloths, napkins, or aprons to make cleanups easier.
- Gently place the person's hand on or near an eating utensil.
- Show the person how to eat by demonstrating eating behavior or by doing hand-in-hand feeding. After you get the first bite of food to the mouth, the person will often begin to eat.
- Give the person plenty of time to eat. Keep in mind that it can take an hour or more to feed a patient.
- Give the person the opportunity to eat with other family members for as long as possible.
Work to prevent eating and nutrition problems.
- Use vitamin supplements only on the recommendation of a physician. Monitor their use.
- Don't serve steaming or extremely hot foods or liquids. Remember, the person might not be able to tell if the food or beverage is too hot to eat or drink.
- Limit or eliminate highly salted foods or sweets if the patient has a chronic health problem such as diabetes or hypertension.
- Control potential weight gains. If the person always seems hungry, serve smaller portions of food at more frequent intervals. Fill the gaps between regular meals with healthy snacks.
- After the meal is over, check to see that the person swallowed the food and nothing remains in the mouth.
- Restrict portions when appropriate. A person with Alzheimer's may have no concept of how much she has eaten.
- Keep in mind that the person may not remember when or if she ate. If the individual continues to ask about eating breakfast, you might consider serving several breakfasts - juice, followed by toast, followed by cereal.
- Help the person maintain good oral hygiene. If it's difficult to use a toothbrush, try oral swabs. Keep in mind that regular visits to the dentist are important.
One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.
The primary resource for this fact sheet was Mary Barringer, RN.C., Partner, Professional Care Management Services, Springfield, Illinois.
Special thanks to the following Chapters of the Alzheimer's Association: Atlanta, Georgia; Eastern Massachusetts; St. Louis, Missouri; Western New York; South Central Michigan, Columbus, Ohio; Cleveland, Ohio; Northern Virginia; and South Central Michigan.
Other Resources include:
- David L. Carroll. When Your Loved One Has Alzheimer's Disease: A Caregiver's Guide. New York: Harper and Row, 1989.
- Donna Cohen, Ph.D. and Carl Eisdorfer, Ph.D., MD. The Loss of Self: A Family Resource for the Care of Alzheimer's Disease and Related Disorders. New York: Norton and Co. 1986.
- Nancy L. Mace and Peter V. Rabins, MD. The 36-Hour Day. Baltimore: The Johns Hopkins University Press. 1991.
Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.
For further information about Alzheimer's Disease or related disorders, contact the Alzheimer's Association at: