How physical and sensory difficulties can affect eating

People with dementia may have difficulty picking up items such as cutlery or a glass. They may also have trouble putting food into their mouth. A person with dementia may not open their mouth as food approaches and may need reminding to do so. Some people may also have other conditions that affect their co-ordination, such as Parkinson’s disease. This could lead them to avoid mealtimes because they are embarrassed by their difficulties or want to avoid struggling.

Encouraging the person to eat – for example, by trying finger foods – may help someone who has difficulties with co-ordination. You may find these other ideas helpful:

• If the person is struggling with using a knife and fork, cut up food into smaller pieces so it can be eaten more easily, perhaps with a spoon.
• If the person seems to have difficulty using cutlery, you may need to prompt them and guide their hand to their mouth to remind them of the process involved.
• If you are able to, speak to an occupational therapist about aids and equipment that can help, such as specially adapted cutlery, lipped (high-sided) plates or non-spill cups.

A person with dementia may have difficulties with chewing food. They may forget to chew or they may get tired easily. Certain foods, such as hard vegetables or dry biscuits, may be more difficult for the person to chew or swallow. The person may leave these on the plate.

As dementia progresses, swallowing difficulties (called dysphagia) become more common, although they will vary from person to person. Difficulties may include the person chewing continuously or holding food in their mouth. Swallowing difficulties can lead to weight loss, malnutrition and dehydration. If the person is drowsy or lying down, they may struggle to swallow safely which may cause them to choke.

• Make sure the person is fully awake, comfortable and sitting upright before you offer food and drink.
• Avoid foods that the person has difficulty chewing.
• Good dental care and oral hygiene are important. If the person has painful gums or teeth, or has mouth ulcers, then chewing will be uncomfortable and difficult. If the person wears dentures, make sure they are comfortable and fitted properly.
• If the person is having difficulties chewing or swallowing, talk to the GP about referral to a speech and language therapist. They can diagnose swallowing difficulties and give advice. In the meantime, try softer choices such as scrambled egg or stewed apple first, before considering pureed food.
• If the speech and language therapist does advise pureed food, seek advice from a dietitian too to make sure it’s nutritious and has enough flavour.
• An occupational therapist can advise on aids for eating and drinking. Ask the GP for a referral.

Constipation is a common problem. It can result in the person feeling bloated or nauseous, making them less likely to want to eat.

Try to prevent constipation by:

• encouraging activity
• offering the person fibre-rich foods, and
• encouraging them to drink plenty of fluids.

If constipation becomes a problem for the person, speak to a pharmacist or the GP. For more information see Toilet problems and continence.

If the person with dementia has problems with their sight, they may not be able to see the food. It’s important not to assume that the person isn’t hungry if they don’t start eating. The following tips may help:

• Make sure the person is wearing the correct glasses.
• If they aren’t able to see the food in front of them, it may help to describe the food to the person. 
• Make sure the environment is well lit.
• Choose contrasting, plain colours for the food, plate and table (for example a green tablecloth, a red plate and mashed potato).
• If you leave a drink out for someone, describe where it is so that they are able to find it.

As people get older they often begin to lose their sense of taste and smell, which can lead to food tasting less pleasant.

People with dementia may begin to want more sugar and salt in their food, and it’s common for them to begin eating more sweet foods.

People with dementia may also enjoy unusual flavour combinations or ways of eating. Often people mix sweet and savoury food and flavours. They may start to have a less varied diet, only eating certain types of food.

See Changes in eating habits and food preference for tips on how to manage this.

The person may lose the ability to judge the temperature of food. Be careful of giving the person hot food or drinks that could burn their mouth and make eating uncomfortable.